Limb Evaluation and Preservation Program (LEAPP)

Overview: A Multidisciplinary Approach to Peripheral Artery Disease and Limb Salvage

Over 8 million people in the United States are impacted by peripheral artery disease (PAD), a circulatory condition in which arteries are narrowed by a buildup of plaque (atherosclerosis), reducing blood flow to the limbs, particularly to the legs and arms. This can be painful and, if not optimally managed, may result in amputation.

Through the Peripheral Artery Disease Center, the Massachusetts General Hospital Limb Evaluation and Preservation Program (LEAPP) specializes in the multidisciplinary care of patients with PAD. LEAPP is committed to reducing amputation rates and providing world-class, evidence based, comprehensive care for our patients.

Mass General clinicians are leaders in the field and well-versed in the most cutting-edge limb salvage endovascular and open operative techniques. LEAPP is one of the only dedicated programs in the country with clinicians that specialize in every area of vascular disease. We design individualized treatment plans that enable patients to lead active lifestyles and minimize the risk of cardiovascular complications and amputation.

What to Expect as a LEAPP Patient

PAD is a complex disease and requires a multidisciplinary team to treat it. To help patients navigate the process and ensure all are cared for in a timely fashion, LEAPP is composed of providers from the following specialties:

• Vascular and Endovascular Surgery
• Vascular Medicine
• Interventional Cardiology
• Interventional Radiology
• Supervised Exercise Therapy
• Podiatry
• Comprehensive Wound Care
• Vascular Laboratory Imaging
• MGH-LEAPP Liaison Nurse
• Infectious Disease
• Prosthetics

The following services are also provided through LEAPP:

• Physical Therapy
• Physical Medicine and Rehabilitation
• Endocrinology
• Nutrition

The LEAPP liaison nurse will work directly with each patient and provider to ensure that appointments and referrals are made in a timely and seamless way.

Diagnosis of PAD

Upon referral to LEAPP, patients will undergo evaluation and imaging by a team of diagnostic imaging experts who are specially trained to detect abnormalities in the vascular system and whose practice focuses specifically on vascular disease. These specialists are board certified in vascular medicine, surgery, radiology and imaging with fellowship training in vascular procedures.

To diagnose PAD accurately, our specialists rely on noninvasive tests that use inflatable cuffs similar to those used to measure blood pressure. These tests can be performed during a regular office visit and include:

• Ankle-brachial index (ABI), a test that measures blood pressure at the ankle and in the arm to determine the severity of PAD
• Pulse volume recording (PVR), a noninvasive technique developed and introduced by clinicians at Mass General to measure the blood flow in the upper and lower extremities
• Duplex ultrasound, which uses sound waves to evaluate blood flow
• Computed tomography angiography (CTA), where dye is injected into the vein to get detailed images of blood vessels and tissue
• Magnetic resonance angiography (MRA), a type of MRI that provides images of blood vessels

All of our diagnostic tests can also be performed at our convenient Waltham location.

Treatment Options

PAD symptoms often depend on the severity of the disease. The most common symptoms include minor leg discomfort while walking, severe leg pain with little to no movement and sores or ulcers on the skin.

To treat PAD, our clinicians consider several therapeutic options, including:

• Medical therapy: Medications are used to reduce the cardiovascular risk and/or symptoms associated with PAD. These important therapies control blood pressure, cholesterol and diabetes, and block platelet activity (blood clotting). Novel therapies under investigation at Mass General may be considered where appropriate

• Smoking cessation: Preventive care is central to the treatment process. Our vascular specialists guide patients through smoking cessation and other lifestyle changes to treat associated conditions
• Exercise therapy: This approach helps patients to exercise without pain. Exercise sessions involve walking on a treadmill and performing other lower body training exercises
• Advanced endovascular therapies: These minimally invasive treatments offer an alternative to conventional surgery, do not require an incision in the skin and typically offer a shorter recovery time. By inserting narrow plastic tubes, or catheters, into the blood vessels, our specialists are able to access and open sites with cholesterol plaque blockage through a variety of techniques:
  • Angioplasty: A balloon-tipped catheter is placed into the artery and directed to the obstructed area. The balloon is inflated to expand the blockage, and then deflated and retrieved, widening the narrowed artery
  • Stenting: Often performed during angioplasty, this technique inserts a mesh-like device at the point of the cholesterol blockage and is expanded permanently into the vessel wall, propping open the blockage
  • Atherectomy: A specialized catheter with directable cutting blades, a laser tip or a polishing drill is pushed through the cholesterol plaque repeatedly, removing plaque debris from the vessel wall to restore blood flow in the channel

Surgical techniques will also be considered, such as:

• Endarterectomy: Through a surgical incision, the blocked artery is exposed and opened. The plaque is then removed, resulting in a widening of the blocked artery

• Surgical bypass: Blood flow is rerouted around the blocked blood vessel by attaching a tube (either a vein harvested from the body or a prosthetic tube) above and below the point of obstruction

The Mass General Difference

Committed to Increasing Awareness of PAD

LEAPP has a long tradition of excellence in clinical care, with clinicians who are considered national and international leaders in the diagnosis and treatment of PAD. Our physicians are dedicated to pioneering research and serve on many national and international professional boards and societies, including the:

• Society for Vascular Surgery
• Society of Interventional Radiology
• American College of Cardiology
• American Heart Association
• Society for Vascular Medicine
• Society for Cardiovascular Angiography and Interventions
• American Board of Vascular Medicine
• Intersocietal Commission for the Accreditation of Vascular Laboratories

Our clinicians also are committed to educating patients regarding PAD and its risks. Mass General was the first hospital in the United States to partner with the Peripheral Arterial Disease Coalition, a national campaign funded by the National Heart, Lung and Blood Institute and designed to increase public awareness of PAD.

Evaluating New Technologies Through Research and Clinical Trials

The Fireman Vascular Center, which houses the LEAPP Peripheral Artery Disease Center, participates in major clinical studies that evaluate new technologies and devices to treat PAD. This allows us to bring our patients promising new treatments as quickly as possible, such as:

• New and cutting edge endvascular devices: Since 1997, the Fireman Vascular Center’s vascular ultrasound core laboratory (VasCore) has been a leader in the design, development and implementation of clinical trials on new endovascular devices
• Drug-eluting stents and drug-coated balloons: Our clinicians are national and international leaders in investigations to determine if the use of drug-eluting stents (stents that slowly release medication to prevent a recurring blockage) and drug-coated balloons can keep arteries open longer after minimally invasive PAD treatments
• Advanced, up-to-date surgical and endovascular treatment options: Our physicians are leading national investigative efforts to determine the roles of surgery and endovascular treatments—such as pedal access procedures and deep venous arterialization for “no-option” extremities for advanced limb salvage—in patients with the most advanced forms of PAD

Tracking Outcomes to Improve Care

LEAPP is committed to ensuring that our interventions reduce amputation rates and maintain limb functionality for patients. To that end, the outcomes of our patients are followed carefully. We pledge to deliver quality care every step of the way.

Patients and family members can feel confident that our team is always striving to provide the best possible outcome.

One Point of Care

We can be contacted Monday through Friday from 8:30 am to 5:00 pm to request an appointment and answer questions. Call 877-644-8346 to reach our nurse coordinator or request an appointment online.

We strive to see patients as soon as possible and assign every patient to one clinician as a way to streamline care between members of our multidisciplinary team. From diagnosis to treatment to follow-up, this physician guides patients through every step of care.

Rona Cavallaro, NP
Lead Administrator and Coordinator, Mass General PAD Center

Lindsey Ferraro, RVT
Technical Director, Mass General Vascular Lab

Maureen McCarthy, NP
Lead Wound Care Specialist

Edgar Rodriguez, MSPO, CPO
Hanger Prosthetics Clinic (Mass General)

Kathleen Traynor, RN
Supervised Exercise Therapy (SET)