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Saving Lives and Limbs


August 2004

by Natalie Gutierrez

Paula Shireman, M.D., assistant professor of surgery at the Health Science Center, sees firsthand the debilitating effects of diabetes every day. As a vascular surgeon, Dr. Shireman performs nontraumatic lower-limb amputations on diabetic patients at the Audie L. Murphy Division of the South Texas Veterans Health Care System. During a three-year period (1998-2000), surgeons performed 113 amputations at the VA hospital. Of those, 75 percent resulted from diabetes.

"Patients with diabetes often have such severe disease that leg amputation is their only option. If a diabetic patient has one leg amputated, he has a 50 percent chance of having his other leg amputated within four years," Dr. Shireman said. "It is frustrating for me as a surgeon to tell patients and their families that I cannot save their legs. Clearly, new treatments are needed to reduce amputation rates."
More than 60 percent of nontraumatic lower-limb amputations occur among people with diabetes.
FACT: More than 60 percent of nontraumatic lower-limb amputations occur among people with diabetes.

FACT: In 2000 and 2001, about 82,000 nontraumatic lower-limb amputations were performed annually among people with diabetes.

–National Diabetes Fact Sheet 2003, U.S. Centers for Disease Control and Prevention

Dr. Shireman is on a mission to decrease the number of limbs lost to diabetes. She is the principal investigator on several research studies in the department of surgery that focus on atherosclerosis-induced ischemia, the hardening of the arteries that is one of the complications of diabetes and the leading culprit in lower-limb amputations. The National Heart, Lung and Blood Institute of the National Institutes of Health (NIH), the U.S. Department of Veterans Affairs and the Texas affiliate of the American Heart Association have funded these projects for a collective total of $2.5 million over five years.

Dr. Shireman’s research works to understand the relationship among white blood cells, artery formation and skeletal muscle regeneration.

Patients with atherosclerosis develop ischemia, an insufficient supply of blood to an organ or limb resulting from a blocked artery. As a result, cells, tissues and nerves in the lower limbs die. Patients with ischemia are often able to naturally grow collateral arteries (new blood vessels) around the blocked artery to assist in transporting blood throughout the body to regenerate damaged tissues. But in diabetic patients, collateral artery growth is slower than in patients without diabetes. Through research, Dr. Shireman and her team hope to find a method to enhance collateral artery growth in patients. Their research could lead to medications that do just that and encourage the regeneration of already damaged tissue in the lower limbs, thus potentially reducing or even eliminating the need for lower-limb amputations in the future.

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