Mandeville Regional performs first below-ankle bypass to save patient's leg

Doctors at Mandeville Regional Hospital recently carried out a complex vascular bypass that prevented an older man from losing his remaining leg. Consultant general surgeon Dr. Varunesh Chand, who led the operation, said it was the first time the hospital had performed an infra-malleolar bypass, meaning blood flow had to be restored to an artery below the ankle.

Chand said limb-saving bypass surgery is not new to the hospital and that similar procedures have been done there since 2017 at an average of about four each year. This case was more difficult because the target vessel was smaller and the graft had to extend much farther into the foot. He said the patient had lost his left lower limb four years earlier after a diabetic foot infection and later arrived with peripheral arterial disease and gangrene in a toe on the other leg. In that situation, he said, removing the toe alone would have left a wound without enough blood supply to heal, allowing infection to spread and putting the leg at immediate risk.

According to Chand, Jamaica ranks among the countries with the highest amputation rates in the world, alongside Barbados depending on how the data is measured, and he estimated there are about 15 amputations a week across the island. He said diabetic foot infections, peripheral arterial disease and trauma, including motor vehicle crashes, are common causes. Atherosclerosis, or narrowing of the arteries, can affect the heart, brain and lower limbs. Chand said the process comes with age but worsens faster when diabetes, hypertension and cholesterol are poorly controlled, and when people smoke; he also warned that cannabis is no safer than tobacco.

He said the hospital's general surgery service includes three consultants, with medical officers and other staff helping to assess patients and complete investigations. Before surgery, the team had to determine whether the patient was mobile, cognitively intact and fit enough for a major procedure, then use a CT scan focused on the blood vessels to map the blockage. The operation lasted about six hours. Chand said the arteries were blocked from the thigh into the leg, so surgeons harvested the saphenous vein, reversed it and connected it from higher in the thigh down to the plantar artery in the foot because synthetic grafts tend to fail or become infected more easily in such low bypasses.

Chand said the man's earlier rehabilitation also mattered: after his first amputation he worked with a physiotherapist, received a prosthetic limb and remained fully independent. Preserving that function was critical, he said, because losing both limbs carries a very high risk of death, which he put at as much as 30 per cent per year. Even in high-volume centres overseas, Chand said, the success rate for this type of bypass is only about 40 per cent, making the outcome especially significant for the Mandeville team.