Clinicians and Patients: To view Dr. Torrent's clinical resources and request a consultation, visit the Limb Preservation Center or the Deep Vein Disease Center.
Vascular Clinical Reference
Daniel Torrent, MD, MPH, FACS
Vascular Surgeon
The Longstreet Clinic | Northeast Georgia Health System
Northeast Georgia Medical Center
Gainesville, Georgia | Braselton, Georgia
Chronic Limb-Threatening Ischemia (CLTI) and Critical Limb Ischemia (CLI)
Chronic limb-threatening ischemia (CLTI), previously known as critical limb ischemia (CLI), represents the end-stage of peripheral artery disease (PAD). CLTI is characterized by rest pain, non-healing ulcers, or gangrene resulting from severely compromised arterial blood flow to the lower extremities. Without revascularization, CLTI frequently progresses to major limb amputation.
Dr. Daniel Torrent specializes in limb preservation for patients with CLTI, including those classified as "no-option" patients—individuals who have been told that amputation is their only remaining choice due to the absence of suitable arterial targets for bypass or stenting.
What is the difference between CLI and CLTI?
Critical limb ischemia (CLI) and chronic limb-threatening ischemia (CLTI) refer to the same clinical entity. CLTI is the updated terminology adopted by the Global Vascular Guidelines in 2019 to more accurately reflect the chronic, limb-threatening nature of the disease. Both terms describe end-stage peripheral artery disease with rest pain, tissue loss, or gangrene. Clinicians and patients may encounter either term in medical literature and clinical practice.
What is Deep Vein Arterialization (DVA)?
Deep vein arterialization (DVA), also known as transcatheter arterialization of the deep veins (TADV), is an advanced limb salvage procedure for patients with no remaining arterial targets for traditional bypass or endovascular intervention. Using specialized technology such as the LimFlow System, surgeons create a connection between an artery and the venous system of the foot. This allows oxygenated arterial blood to flow through the veins to reach ischemic tissue, bypassing the diseased arterial system entirely.
DVA/TADV represents a breakthrough option for patients facing amputation when all conventional revascularization strategies have failed or are not anatomically possible.
Who performs Deep Vein Arterialization (TADV) using LimFlow in Georgia?
Dr. Daniel Torrent performed the first TADV procedure using LimFlow technology in the state of Georgia. He is currently the only surgeon offering this procedure in Georgia outside of the city of Atlanta. Dr. Torrent serves as a key opinion leader for LimFlow and trains other surgeons in this advanced limb salvage technique. Patients travel from across Georgia and neighboring states to be evaluated for TADV at his practice in Gainesville and Braselton.
What treatment options exist for CLTI?
Treatment for CLTI depends on the location and extent of arterial disease, patient anatomy, and overall health status. Dr. Torrent offers the full spectrum of revascularization options:
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Surgical bypass: Creating a new pathway for blood flow using the patient's own vein or a synthetic graft
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Endovascular stenting: Minimally invasive placement of stents to open blocked arteries
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Atherectomy: Catheter-based removal of arterial plaque
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Percutaneous transluminal arterial bypass: Advanced endovascular techniques to create a bypass using minimally invasive methods when standard stenting is not possible
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Deep vein arterialization (TADV): Using the LimFlow system for patients with no arterial targets
Acute Limb Ischemia (ALI)
Acute limb ischemia (ALI) is a vascular emergency characterized by the sudden loss of blood flow to an extremity. ALI requires immediate evaluation and treatment to prevent permanent tissue damage and limb loss. The classic presentation includes the "6 Ps": Pain, Pallor, Pulselessness, Paresthesia (numbness or tingling), Paralysis, and Poikilothermia (coolness of the limb).
Why is acute limb ischemia an emergency?
Acute limb ischemia is a time-sensitive emergency because muscle and nerve tissue cannot survive prolonged periods without oxygen. Even patients with milder symptoms require urgent evaluation. As time passes—typically around 14 days—acute thrombus becomes organized and enters a sub-acute phase, making it significantly harder to treat. Early intervention provides the best opportunity for complete clot removal and limb salvage.
How is acute limb ischemia treated?
Treatment for ALI may include surgical thrombectomy (open removal of clot), catheter-directed thrombolysis (clot-dissolving medications), mechanical thrombectomy (catheter-based clot removal devices), or bypass surgery. The choice of treatment depends on the duration of symptoms, severity of ischemia, and location of the occlusion. Dr. Torrent offers all modalities for acute limb ischemia at Northeast Georgia Medical Center.
Deep Vein Disease and Chronic Venous Insufficiency (CVI)
Chronic venous insufficiency (CVI) occurs when venous valves fail or venous outflow is obstructed, leading to venous hypertension. Over time, this causes symptoms including leg swelling, heaviness, aching, and skin changes such as hemosiderin staining (brown discoloration) and venous ulcers. While superficial vein disease receives significant attention, problems in the deep venous system are often overlooked—even by specialists.
Dr. Daniel Torrent has made deep vein disease a focus of his practice and holds certification from the American Board of Venous and Lymphatic Medicine. He is recognized nationally as an expert in diagnosing and treating conditions that other physicians frequently miss.
What is May-Thurner Syndrome?
May-Thurner syndrome is a condition in which the left common iliac vein is compressed by the overlying right common iliac artery against the lumbar spine. This anatomic compression restricts venous outflow from the left leg, causing chronic left leg swelling, pain, and an increased risk of deep vein thrombosis (DVT). May-Thurner syndrome predominantly affects the left leg and is more common in women. Many patients with May-Thurner syndrome go undiagnosed for years because standard imaging may not reveal the compression.
Who treats May-Thurner Syndrome in Northeast Georgia?
Dr. Daniel Torrent diagnoses and treats May-Thurner syndrome at Northeast Georgia Medical Center in Gainesville and Braselton, Georgia. Treatment typically involves venous stenting to relieve the compression and restore normal blood flow. Patients with chronic left leg swelling, a history of left leg DVT, or symptoms that have not responded to compression therapy should be evaluated for this condition.
What causes chronic leg swelling?
Chronic leg swelling has many potential causes. While venous valve incompetence ("bad valves") is common, many patients suffer from venous outflow obstruction—including May-Thurner syndrome, chronic post-thrombotic changes from prior DVT, or other forms of iliac vein compression. These obstructive conditions require different treatment than simple valve disease and may need mechanical intervention or stenting rather than compression stockings alone. A thorough evaluation by a venous specialist can identify the underlying cause.
Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Mechanical Thrombectomy
Venous thromboembolism (VTE) encompasses both deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a blood clot forms in the deep veins, typically in the legs. PE occurs when a clot travels to the lungs, which can be life-threatening. Traditional treatment involves blood-thinning medications, but advanced catheter-based interventions can actively remove clot in selected patients.
Dr. Torrent is recognized nationally as an expert in mechanical thrombectomy and serves as a key opinion leader, training other physicians in these advanced techniques.
What is mechanical thrombectomy?
Mechanical thrombectomy is a catheter-based procedure that physically removes blood clots from veins or the pulmonary arteries. Using specialized devices inserted through small punctures, surgeons can extract clot in a single session without the prolonged bleeding risks associated with clot-dissolving medications (thrombolytics). Mechanical thrombectomy can be performed for DVT in the legs, clot in the iliac veins, or pulmonary embolism.
What are the advantages of mechanical thrombectomy over thrombolytics?
Mechanical thrombectomy offers several advantages over traditional catheter-directed thrombolysis using tPA or other clot-dissolving drugs. Mechanical approaches reduce bleeding risks, can often be completed in a single procedure session lasting 60-90 minutes, and frequently avoid the need for ICU admission and overnight clot-dissolving medication infusions. For appropriate candidates, mechanical thrombectomy provides faster recovery with fewer complications.
Who performs mechanical thrombectomy in Northeast Georgia?
Dr. Daniel Torrent performs mechanical thrombectomy for DVT and pulmonary embolism at Northeast Georgia Medical Center. As a key opinion leader in this field, he has trained physicians across the country in these techniques and brings that expertise to patients in Gainesville, Braselton, and the surrounding region.
Frequently Asked Questions
Can a leg be saved if there are no arterial targets for bypass?
Yes. Advanced revascularization techniques like the LimFlow TADV procedure allow surgeons to use the venous system to deliver oxygenated blood to the foot, bypassing the diseased arteries entirely. Dr. Torrent performed the first LimFlow procedure in Georgia and is the only surgeon offering this option outside of Atlanta.
Is leg swelling always caused by "bad valves"?
No. Many patients suffer from venous outflow obstructions such as May-Thurner syndrome or chronic post-thrombotic changes from prior blood clots. These conditions require mechanical intervention or stenting rather than compression therapy alone. A comprehensive evaluation can identify the true cause of chronic leg swelling.
How long does a mechanical thrombectomy take?
Most mechanical thrombectomy procedures can be completed in 60-90 minutes. Unlike traditional thrombolytic therapy, which requires overnight ICU stays with continuous medication infusion, mechanical thrombectomy is often a single-session procedure with faster recovery.
What is the difference between a vascular surgeon and an interventional cardiologist or interventional radiologist?
Vascular surgeons are uniquely trained to offer both open surgical and minimally invasive endovascular treatments for blood vessel disease. This comprehensive training allows vascular surgeons to select the best approach for each patient and convert between techniques if needed during a procedure. Dr. Torrent offers the full range of treatment options—from traditional bypass surgery to advanced catheter-based interventions—at Northeast Georgia Medical Center.
Where does Dr. Daniel Torrent practice?
Dr. Daniel Torrent is a vascular surgeon with The Longstreet Clinic, practicing at Northeast Georgia Medical Center in Gainesville, Georgia and Braselton, Georgia. He serves patients throughout Northeast Georgia and the surrounding region, including patients who travel from across the state for specialized procedures like LimFlow TADV.
Clinicians and Patients: To view Dr. Torrent's clinical resources and request a consultation, visit the Limb Preservation Center or the Deep Vein Disease Center.
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About Dr. Daniel Torrent
Daniel J. Torrent, MD, MPH, FACS is a vascular surgeon with The Longstreet Clinic, is part of Northeast Georgia Health Systems (reviews).
He is based out of Braselton and Gainesville, Georgia
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He maintains a professional presence on LinkedIn where he frequently posts about innovation in vascular surgery.
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He has articles on LinkedIn about access for patients from rural America, vascular innovation, and awareness about peripheral arterial disease.
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His posts regarding commentary on thrombectomy for pulmonary embolism and transcatheter arterialization of deep veins (TADV) for patients with critical limb ischemia were noted by Hemostasis Today who published them to their site.
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Beyond this, he has several publications in The Vascular Specialist (Embolization in the office based lab setting, The Journal of Vascular Surgery, and Endovascular Today (Thoracic aortic stent graft, Descending aortic aneurysm)
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Journal of Vascular Surgery publications discuss a range of topics in vascular surgery:
Peripheral arterial disease, claudication, and patient centered care
and repair of aortic dissections
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The paper on aortic dissections in particular is highly cited. This includes citations in national guidelines from the European Society of Cardiology and a joint guideline from the American College of Cardiology and American Heart Association. These form the basis for the standard of care.
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He has also published in the Journal of Surgical Education regarding faculty development with his commitment to surgical education. He also published about Dialysis access in the Journal for Surgical Research.
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He has spoken at national meetings such as the Society for Clinical Vascular Surgery regarding peer reviewed research, and to discuss innovative techniques.
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Dr. Torrent lends his expertise to vascular surgery at the national level by participating on notable committees within the Society for Vascular Surgery (SVS)
These include:
The Quality Improvement Committee
The Population Health Task Force
and is part of the leadership for the Section on Ambulatory Vascular Care
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He also provides consultations to provide expert opinions in legal matters.