ABU DHABI // A tiny balloon has allowed doctors at Al Ain Hospital to save the limbs of almost all diabetic patients admitted with gangrenous feet.
Since April last year only four of the 50 patients treated for gangrene have needed amputation. Before that almost half of them did.
For years, part of the treatment for gangrene has been to perform an angioplasty, in which a balloon is inflated inside a blocked artery to restore the blood flow.
But until recently the balloons available were quite large - about 3 millimetres in diameter - meaning the technique only worked for the large arteries towards the top of the leg.
If the artery was blocked below that, there was sometimes little to be done short of amputation.
But doctors now have much smaller balloons at their disposal, only 1mm in diameter. This allows them to get into the much narrower arteries in the lower part of the leg and save many more patients' feet.
"Before this, the first option when patients came in with gangrene was amputation," said Dr Jamal Al Koteesh, the head of the interventional radiology department. "Now the angioplasty is going down to the foot. Five years ago we did not have balloons small enough."
Gangrene is a major problem for diabetics. They suffer high blood pressure that can cause arteries to become blocked easily, meaning tissue cannot get oxygen and dies.
Normally this process would be extremely painful. But in diabetics the nerves can become inflamed, preventing the sufferer from feeling pain.
So the usual cues to do something about the blocked blood supply are missing, and the patient does not realise there is a problem until it is too late and gangrene has set in.
Simple lack of blood usually results in dry gangrene, in which the dead tissue eventually falls off the bone.
More dangerous is wet gangrene, which results from injuries to the hands and feet going untreated because the patient does not feel them.
Wet gangrene can spread very quickly, causing massive - and grotesque - damage.
And even with the smaller balloons, amputation remains all too common, said Dr Al Koteesh, so diabetics needed to stay alert.
"It is important to examine the feet every day, and to clean them," he said.
"The way they cut their nails and their shoes, which can cause ulcers, also have to be checked.
"Most people who come in at a late stage, they think the gangrene will go away.
"If they see a black spot, they go to a pharmacy and buy ointment or use a homemade paste, and only when the foot starts to smell do they come to the hospital."