Before any amputation, the arteries deserve one more look
Many patients facing amputation have blockages that can still be reopened — including in the small arteries below the knee and inside the foot itself, the vessels directly underneath a wound that will not heal. That is the work this practice was built for. The procedure is done through small punctures, without open surgery. Most patients go home the same day, and nothing is left implanted in the foot.
Proof you can check
More than half of the arteries we treat in our limb-salvage program are below the ankle — the arteries of the foot itself, where many of these wounds live. Our results are counted the hard way: every consecutive limb-salvage procedure, every artery we attempt graded on the day of the procedure against a published standard, and every attempt counted whether or not it succeeded. We publish the results with the definition behind every number, because your decision deserves proof, not promises. How we count, and what we found →
When to ask for a second look
Call us, or ask your doctor for a referral, if any of these is true:
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A sore or wound on the foot or leg has not started healing after two weeks.
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Foot or toe pain at night eases when the leg hangs down.
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A toe or part of the foot is turning dark.
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Your doctor cannot feel a pulse in your foot.
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You have been told you need an amputation, and no one has recently looked at the arteries below your knee.
The first step of a second look is an office visit, which is noninvasive. When a blockage is likely, your ultrasound, your procedure (an angiogram), and your follow-up visit are each scheduled before you leave.
What happens at a visit
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An office visit with your physician. When a blockage is likely, your ultrasound (including the arteries of the foot), your angiogram, and your follow-up visit are each scheduled before you leave.
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If the arteries need a closer look, an angiogram, which maps exactly where the blockages are.
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Treatment during the angiogram when it is indicated, through small punctures.
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Most patients go home the same day.
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Your wound-care team continues your care, now with the blood flow restored.
Referring clinicians: For Referring Providers →
What it is
Chronic limb-threatening ischemia is the most advanced stage of peripheral artery disease: blood flow to the leg has fallen so far that the tissue can no longer sustain itself at rest. It is defined by what it produces — rest pain, a wound that will not heal, or tissue loss — rather than by any single number on a test.
The stages are described by the Rutherford classification:
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Stage IV — ischemic rest pain / ischemic neuropathy: foot or toe pain at rest, often worse at night (detailed below).
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Stage V — minor tissue loss: ulceration or gangrene limited to the digits or forefoot.
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Stage VI — major tissue loss: extending above the forefoot — midfoot, heel, ankle, or calf.
Diabetic foot ulcers fall predominantly in Stages V–VI. Diabetic Foot Ulcers →
Why it matters
When others say "no," we take a closer look
Many patients are told amputation is their only option — usually because the disease is in the below-the-knee and pedal arteries that most programs don't treat. That's exactly our specialty: we routinely reopen these vessels, including by working upward from the foot when a blockage can't be crossed from above.
When patients are told amputation is the only option, the disease is usually in the below-the-knee and pedal arteries — the vessels we specialize in reopening. The OCC difference: Dr. Matthew Comstock and Dr. John Evans are fellowship-trained interventional cardiologists whose practice is centered on below-the-knee and below-the-ankle (BTK/BTA) revascularization, with a dedicated limb-salvage team focused on exactly these cases.
Ischemic Rest Pain — The Earliest Limb-Threatening Stage
Ischemic rest pain (sometimes called ischemic neuropathy) is foot pain that occurs at rest — not just with walking — because circulation has dropped severely. It is Rutherford category 4, the first limb-threatening stage of CLTI, and catching it here, before wounds or tissue loss, is the best opportunity to protect the limb.
What it feels like
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Burning, aching, or pins-and-needles pain in the foot or toes at rest
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Pain that worsens lying down and eases when the foot hangs over the bed
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Pain often worst at night
Because it can feel like nerve pain, it is sometimes mistaken for ordinary neuropathy — but here the cause is poor blood flow, which is treatable.
Why it matters
Rest pain means the limb is already threatened — the stage just before non-healing wounds and tissue loss.
Restoring circulation now can relieve the pain and prevent progression. We assess flow with our in-house vascular lab, including pedal (foot-level) ultrasound, then restore it with minimally invasive, same-day revascularization when needed.
Diagnostic Imaging →
Risk Factors
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Diabetes — particularly with neuropathy, which removes the pain that would otherwise warn you
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Chronic kidney disease, especially on dialysis →
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Smoking or any nicotine use — the single strongest modifiable risk →
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Advanced or long-standing PAD, prior revascularization, or prior amputation on the other side
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Age, coronary or carotid disease elsewhere, and heavy arterial calcification
Diagnostic Testing
We assess perfusion in our in-house vascular lab — including pedal ultrasound and pedal acceleration time (PAT), which can be measured beside an open wound where toe pressures cannot — then define the anatomy with angiography.
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Complete arterial duplex, pelvis to toes, including the pedal arteries →
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Pedal acceleration time (PAT) at the wound
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ABI and toe pressures — useful, and unreliable in exactly this population when arteries are calcified
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Angiography to define the target vessel before treatment Diagnostic Imaging →
Treatment Options
Medical & conservative therapy
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Coordinated wound care from our wound-care-trained team
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Risk-factor control, a statin, and antiplatelet therapy
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Infection management and offloading for ulcers
Important — but in CLTI, medical therapy alone rarely saves the limb without restoring flow.
Invasive treatment
Restoring blood flow is the key to limb salvage:
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Below-the-knee & pedal revascularization — our signature work, including no-option cases
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Pedal/retrograde access, vessel preparation, drug-coated balloons, and selective stenting
When to call us — don’t wait for your next visit
Advanced artery disease can worsen fast. Call us right away — don’t wait for your next scheduled visit — if you notice any of these:
Call our office today if you notice:
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New or worsening pain in the foot or leg — especially pain at rest or at night
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A new wound, or an existing wound getting larger or draining
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Black or darkening toes or skin
Call our office at (918) 943-5303 and tell us what’s changed — we’ll get you seen sooner, because catching these early often keeps a small problem from becoming a big one.
Go to the emergency room now, or call 911, if you have:
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A foot or leg that becomes suddenly cold, pale, numb, or painful
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An infection that is spreading quickly, or a fever with a wound
Frequently asked questions
For referring providers — We welcome complex CLTI and limb-salvage referrals, including no-option cases declined elsewhere. Refer: (918) 943-5303 · fax (855) 312-3594.
Refer urgently: rest pain, a nonhealing wound or ulcer, gangrene, tissue loss, or any limb told it needs amputation. Full referral guide →