Written by Kymberlie McNicholas, Founder of The Way to My Heart
“If a vascular doctor is able to open up the Pedal Loop when it is blocked, it has the potential to heal a wound and prevent a major amputation in some instances,” explains Interventional Vascular Specialist Dr. Srini Tummala.
As part of our ongoing Vascular Innovation Series in conjunction with The Way to My Heart, Emmy Award-winning Journalist Kym McNicholas interviews Dr. Srini Tummala.
When Melody was diagnosed with stenosis below the ankle, her vascular specialist recommended a technique to carefully thread a wire and catheter into the arch of the foot, known as the Pedal Loop. Melody now walks 2 miles per day, 3 months later, and is optimistic she will be able to continue to prevent the loss of her toes, feet, and limbs with proper management of her condition.
Melody’s experience, however, is unique. Only 10% of vascular specialists in the U.S. are trained in below-the-ankle (BTA) revascularization. Why? A question of whether the benefits outweigh the cost. The risks include dissection, spasm, rupture, and thrombosis according to Dr. Srini Tummala, an Interventional Vascular Specialist in Miami, Florida. He believes that if a patient is facing amputation, this procedure could make the difference in keeping or losing a limb. New tools and advanced techniques shared online, in webinars, and at major conferences around the world are increasing awareness and adoption of these below-the-ankle interventions, especially in Europe and slowly gaining traction in the U.S. Dr. Tummala is discussing his BTA techniques with care providers around the world, including via a YouTube Channel designed to educate U.S. vascular specialists not yet trained in Pedal Loop arterial intervention.
What is the story behind this Pedal Loop arterial intervention technique? Where did it originate?
Pedal loop intervention has been around for decades. It has been shown to be safe, feasible, and needed in certain clinical scenarios when performed by a skilled operator.
What need does it address?
It can help to save a leg from amputation as it is the last outflow of blood from the leg.
What is the potential for patient impact?
If a vascular doctor is able to open up the Pedal Loop when it is blocked, it has the potential to heal a wound and prevent a major amputation in some instances.
Are more specialists considering using this as a limb-salvage strategy? What are the barriers to adoption?
There is a lot of interest now and it is growing daily. Many are not willing to perform pedal loop intervention due to lack of training, experience, or concern related to the risks involved with this type of intervention. Here is my review of the available evidence for below-the-ankle interventions in the treatment of critical limb-threatening ischemia (CLTI), where I propose that pedal artery intervention “should be an integral part of the armamentarium” when physicians are faced with patients with both below-the-knee and below-the-ankle disease: Pedal artery revascularisation: Is it ready for prime time? (interventionalnews.com).
How can patients or advocates get involved in advancing this technique?
More education, studies, and “how-to” courses are needed to advance this further. I have a YouTube Channel designed to help further education around advanced techniques to restore flow in patients with Critical Limb Threatening Ischemia
Anything else we should know?
There are experts out there who can achieve success more often than not. It takes asking the question, “Do you revascularize the Pedal Loop?”
For more reading on the Pedal Loop procedure:
- The Way To My Heart. Limb Saving Pedal Loop Intervention Technique | Dr. Srini Tummala.; 2021. Accessed February 5, 2021. https://www.youtube.com/watch?v=geltw9CVWcA&feature=youtu.be
- Manzi M. Pedal-Plantar Loop Technique. Endovascular Today. Published online 2009:62-65.
- Manzi M, Palena LM. Treating Calf and Pedal Vessel Disease: The Extremes of Intervention. Semin Intervent Radiol. 2014;31(4):313-319. doi:10.1055/s-0034-1393967
- Graziani L. Crossing the Rubicon: A Closer Look at the Pedal Loop Technique. Annals of Vascular Surgery. 2017;45:315-323. doi:10.1016/j.avsg.2017.06.135