TREATMENTS WE PERFORM
Below-the-Knee & Pedal Revascularization — Where Limb Salvage Is Won
Most vascular programs stop at the knee. The disease often doesn’t. The blockages that truly threaten a limb are frequently in the small arteries of the calf, ankle, and foot — and reopening them is the difference between healing and amputation. This is the center of our work.
Why below the knee is the part that matters
In advanced peripheral artery disease and chronic limb-threatening ischemia, the tibial arteries below the knee and the small arteries of the foot are often the most diseased. When blood can’t reach the foot, wounds won’t heal and tissue is lost. Restoring flow all the way down to the foot is what gives a wound the chance to heal and a limb the chance to be saved. These are technically demanding vessels — many centers don’t attempt them, which is why patients are so often told amputation is the only option. We treat exactly these cases.
Experience that defines the program
Our physicians are fellowship-trained interventional cardiologists whose practice is centered on below-the-knee and below-the-ankle (BTK/BTA) revascularization. This is a dedicated limb-salvage focus — not a general practice that occasionally goes below the knee — led by Matthew Comstock, DO, FACC, FSCAI alongside John Evans, DO.
How we reach and reopen these vessels
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Pedal and retrograde access — when a blockage can’t be crossed from above, we work upward from a small artery in the foot or ankle to reopen it from below; this two-way approach treats blockages single-direction techniques can’t.
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Angioplasty — reopening narrowed or blocked segments with a balloon to restore flow.
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Vessel preparation — used when a vessel is too calcified to respond to a balloon alone.
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Intravascular ultrasound guidance — imaging the artery from inside to size treatment to the vessel’s true dimensions. How we treat PAD →
Healing takes flow and wound care together
Reopening the artery is one half; closing the wound is the other. We pair revascularization with in-house wound care and medical therapy so blood flow and healing advance together. Technical success is not the same as limb salvage — we set expectations honestly and follow you through healing.
What’s normal afterward — reperfusion
After we reopen a long-blocked tibial artery (a chronic total occlusion, or CTO), it is normal to have pain and swelling in the foot and lower leg for a few days to a few weeks as blood floods back into tissue that was starved — this is called reperfusion, and on its own it is not a cause for alarm. Elevate the leg, use pain medication as directed, and give it time. If you need to be seen sooner, just call — we will get you in. What is not routine, and needs urgent attention, is pain that is severe, unrelenting, or rapidly worsening, or a foot that turns cold, blue, or numb.
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 — Refer complex below-the-knee and pedal disease — including “no-option” limbs and cases declined elsewhere. We assess whether flow can be restored before amputation is considered. Refer: (918) 943-5303 · fax (855) 312-3594.
Refer urgently: a non-healing wound, rest pain, or a cold, painful foot · Routinely: known tibial/pedal disease or a limb told it has no options, for a second look. Full referral guide →