Peripheral Artery Disease Lifetime Achievement Award For Advanced Limb Salvage

In the field of peripheral artery disease (PAD) treatment, there exists a profound divide between those who see limitations and those who see possibilities. Recently, I had the privilege of honoring Dr. Marco Manzi of Padova, Italy with our 2025 PAD Lifetime Achievement Award – recognizing a physician who has dedicated his career to exploring what is possible when others might stop trying.

Dr. Manzi has built his remarkable career on a simple yet powerful philosophy: “If a patient is already facing amputation because of PAD, because of those blocked arteries in the legs, then why not try? Why not try to open them up and restore blood flow?” This approach has led him to develop pioneering techniques in distal vessel revascularization that many once considered absolutely impossible.

What sets Dr. Manzi apart isn’t just technical innovation, but truly measurable results. His team maintains one of the lowest readmission rates for PAD patients in the region – concrete evidence that going further to save a limb benefits the entire patient, the whole patient. Some may question whether his aggressive approach to limb salvage goes too far, but Dr. Manzi’s response is pragmatic: “As long as it doesn’t cause further harm, the attempt itself has so much value.”

Dr. Manzi doesn’t just perform procedures, he transforms standards of care and challenges our collective sense of what is possible in limb preservation. His impact extends far beyond his own patients through his dedication to training others, including our own Dr. John Phillips, who shared how his visit to Dr. Manzi’s lab transformed his practice.

“When I went over there, I was about two and a half years into practice and really maybe a year into feeling comfortable doing some of this vascular work,” Dr. Phillips explained. “We were doing a case and Marco wouldn’t give up. And I was like, ‘Marco, when do you quit?’ And he’s like, ‘Failure is not an option.’” That philosophy has guided Dr. Phillips ever since, pushing him to keep trying when patients are facing amputation.

During our conversation, Dr. Manzi shared the moment that defined his pioneering approach. He recalled a young diabetic patient with severe gangrene of the forefoot and a complex vascular situation. After failing twice with this patient, the foot surgeon asked if he wanted to try one last time before proceeding with a major amputation.

“So I thought to myself, OK, I spent almost four hours with this guy and I had two failures. OK, let me try again, you know, something could happen different,” Dr. Manzi explained. “During this third attempt, I thought, well, I cannot go anti-grade. I cannot go retrograde in the normal fashion. And I thought, okay, I will try to perform a retrograde puncher of the digital arteries (pedal access — accessing arteries through the foot and tackling the blockage coming up from below).”

As he described it, “It was the first patient in the world receiving this approach.” His colleague Mariano looked at him with wide eyes as if to say, “Are you crazy? Are you joking?” But they succeeded, and that patient is still walking on his leg after 12 years, having only needed a transmetatarsal amputation; his leg remains in tact.

Dr. Manzi also shared another powerful story that captures the essence of what it means to be a true limb salvage specialist. He described working with a diabetic patient who had “a very complex multilevel lung occlusion, more or less from the groin to the foot.” After two hours of unsuccessful attempts, he was ready to give up.

“It was in the middle of the afternoon and sincerely, I was in a hurry. Because at the end of my day, I had my gym. I’m trying to maintain myself in good shape. I had to leave because my last daughter, she’s only eight,” he admitted candidly.

Dr. Manzi ended the procedure, and the patient graciously thanked him for trying. But after just ten minutes, the foot surgeon delivered devastating news: they would need to perform a major amputation high in the thigh.

“And I felt myself, you know, how stupid you are,” Dr. Manzi reflected. “I am in a hurry for my gym. And for this gym, I let this patient lose a leg.”

In that moment of clarity, Dr. Manzi made a decision that defines the true spirit of limb salvage. He stopped the patient during transport to surgery, brought him back to the cath lab, and started the procedure again from the beginning with a double approach. This time, he succeeded.

“So at the end, the lesson is that probably the first success starts how you prepare your mind,” he explained. “Sometimes in our job, patient really comes first. So we have to moderate our hurry, our desire to end the day, and be available to spend time enough to try to do our best.”

What struck me during our conversation was Dr. Manzi’s candor about balancing his medical mission with family life. With four daughters and a wife who understands his commitment (she was a nurse in his cath lab), he acknowledged the challenges of a profession that “is not a normal job” but “more similar to a mission in the romantic view of the medical profession.”

When asked about concerns regarding radiation exposure during these long procedures, Dr. Manzi explained that the retrograde approach (working from below) can present higher radiation risks than the traditional anti-grade approach. “The problem is when you have to approach a patient from the foot. In the retrograde fashion, you have your hands and your body, your head very close to the flat panel.”

However, he emphasized that this risk can be minimized through experience and training: “It’s very important to try to give your best during the formation. Because if you are skilled, if you become skilled, you reduce the time you need to be exposed. Because you are faster and you are sure to be successful.”

This commitment to training has seen his practice evolve dramatically. “In the beginning, I think probably 15 years, 20 years ago, the percentage of retrograde approach in my lab was less than 3%. Now it’s more than 45%,” he noted. The increase comes from confidence that “if you fail anti-grade, immediately you shift to a retrograde approach because you know that in very short time in a very fast way you will achieve the vessel from below.”

Dr. Manzi also described a pivotal career moment that launched his international recognition. About 20 years ago, as a young and completely unknown physician, he gave a presentation at a congress in France. In the audience was Dr. Frank Veith, who didn’t believe the case presentation was real.

“He told me, this is fake. You did with Adobe Photoshop,” Dr. Manzi recalled. “So I was terrified and I thought, oh, my God.” He invited Dr. Veith to sit with him and review hundreds of other cases on his computer. “And since that moment, I have been invited as faculty in Veith Symposium in New York, and I understood that probably I was on the right path.”

This defining interaction began a journey that has seen Dr. Manzi transform from an unknown young doctor to one of the most influential figures in PAD treatment globally. His techniques have been adopted worldwide, and through his teaching, he continues to inspire interventionalists to push beyond conventional limitations.

What Dr. Manzi embodies – and what our Lifetime Achievement Award recognizes – isn’t just technical excellence, but a mindset that transforms standards of care and challenges our collective sense of what is possible in limb preservation. His story reminds us all that in PAD treatment, the greatest breakthroughs often come from a simple yet powerful question: “Why not try?”

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If you are on deck for amputation, call the Global PAD Association's Leg Saver Hotline to check on getting a second opinion at 1-833-PAD-LEGS or go to PADhelp.org

Watch the full interview with Dr. Marco Manzi below:

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