Satish Gadi, MD and patient Joyce Dodds
On November 4, 2019, Joyce Dodds, 78, noticed that the big toe on her left foot looked infected. She had been previously diagnosed with a condition called scleroderma, in which wounds do not heal easily, or at all. She saw a podiatrist for this infection for a few months, but her foot was not healing.
Dodds sought out a second opinion from an orthopedist, and then a wound care specialist, who determined that her lack of blood flow was attributed to the scleroderma, a hardening or tightening of the skin and connective tissues which can affect the blood vessels, organs and digestive tract. She was informed that if her foot didn’t heal, it would have to be amputated. “It was very scary,” she recalled. She continued with wound care and home health visits twice a week to dress the wound. The bone in her foot became infected as well, and she endured several procedures over many weeks to no avail. “It was very frustrating, and I lost hope that my foot would heal,” she said.
That’s when Dodds was referred to Dr. Satish Gadi, interventional cardiologist at Cardiovascular Institute of the South. Based on his initial assessment, Dr. Gadi quickly realized that her arteries were small and she had artery blockage in her foot, which is why it wouldn’t heal. She was in danger of losing her left toe, and ultimately losing her lower left leg to a below-the-knee amputation. He performed a procedure to open the artery in her left leg and open blood flow. However, after two attempts, the area re-occluded, and the blockage returned.
At that point, Dr. Gadi knew another option was needed. He obtained approval from Our Lady of the Lake to proceed with a complex procedure called a deep venous arterialization (DVA) in a last resort attempt to save her leg. During a DVA, a fistula (or tunnel) is created between an artery and a vein to push blood from the artery to a deep vein. A deep venous arterialization can last five or more hours and involves a highly-skilled team of physicians and care providers working together to ensure the patient’s safety.
Dr. Gadi and vascular surgeon Dr. Vince Weaver collaborated on this case which was the first of its kind performed in Baton Rouge. Dr. Gadi explained, “We all have good veins to our legs and feet. Veins do not develop blockages, but they may develop clots or leaky valves. But if you can make the vein into an artery, you can flood the foot with fresh arterial flow.”
“Vascular surgeons and interventional cardiologists are now able to offer patients who have been told amputation is their only option—like Ms. Dodds—another option to re-establish blood flow to their legs and feet,” said Dr. Weaver. “Patients in Baton Rouge greatly benefit from this collaboration between cardiology and vascular surgery.”
The procedure worked for Dodds, and her wound began to heal. Complete healing of her foot will take several months, but she is grateful to have had this option. “Thank you to Dr. Gadi and Dr. Weaver for not giving up on me and saving my foot. I will be eternally grateful to them.”