Before joining Corazon’s team of experts, I was fortunate to spend my last clinical assignment in a peripheral-vascular lab. Our services covered PAD (peripheral artery disease), but we also cared for a huge population of renal fistula/catheter patients. Due to the reoccurrence of problems involved with renal access sites, our renal patients returned on a continual basis. So, I had the pleasure to get to know many of them on a friendlier level.
One such patient was Freddie.
Freddie had a history of diabetes and was on dialysis. Roughly every 4-6 months his fistula would develop problems and he would come to see us. Freddie was a father, grandfather, and professional musician who would regale us with his stories about his family and his experiences as a local musician. Mostly though, he loved to talk about the food he cooked for his large family get-togethers and would share his culinary secrets for the best Sunday barbeque. He had a big heart and was passionate about life. Too passionate, in fact. Because sadly, his lifestyle was not conducive to his health issues, and he continued to deteriorate. Eventually he developed PAD and was visiting our clinic much more frequently in the hopes of salvaging his ulcerated leg. Our best clinical efforts eventually failed, and Freddie suffered through two amputations and died a short time later.
Diabetes is the highest risk factor for foot ulcer due to PAD and leads to minor amputation (below the ankle) and major amputation (above the ankle). Once the progression of PAD leads to minor amputation, the patient’s risks for re-amputation and consequent death is significantly increased. In “Lower Extremity Amputations and Long-Term Outcomes in Diabetic Foot Ulcers: A Systematic Review,” which appeared in a 2020 edition of the World Journal of Diabetes, the authors reviewed 22 publications involving a total of 2,334 patients and found that the weighted mean of re-amputation was 20.14%, 29.63%, and 45.72% at one, three, and five years, respectively. Additionally, the weighted mean mortality at one, three, and five years were 13.62%, 30.25%, and 50.55%, respectively. These statistics are shockingly high.
Meanwhile, the incidence of global diabetes is expected to rise to 10.2% by 2030. With this growing sector, there is absolutely a need to raise the bar in the level of peripheral vascular care delivered to patients. And while these programs are often seen as a side offering to the more dominant sub-specialties within the cardiovascular service line, hospitals must give due attention to PV programs, especially if the community served has a high incidence rate of PV issues and accompanying or contributing conditions.
First, we need to focus on the screening process with the first-line providers. Ideally, PAD should be identified and addressed prior to the incidence of unresolvable ulceration through ABI testing. It is imperative that this occurs with the first line provider such as a PCP or Podiatrist. It cannot be assumable that there is adequate ongoing and current education at this level, nor can we assume that the patients are understanding the information that they receive. The PVI program must actively pursue clinical relationships, support, and education with first line providers through sales and marketing.
Second, we need to increase the number of peripheral interventional vascular programs, elevate the quality of care that they provide, and improve upon the accessibility of care they provide. There simply aren’t enough programs to serve the growing PAD patient population and clearly, there is only going to be more demand for these services as the baby boomers age.
And finally, we need to ensure quality at all levels of a program. A solid quality-assurance program should be in place to ensure the best possible outcomes for these patients whose quality of life oftentimes depends on the care they receive for these significant circulatory issues.
The team at Corazon can help you implement and accredit your peripheral vascular program so you not only stand out as a leader in healthcare, but also to make sure that more people like Freddie can play their own music and host family barbeques on sunny Sunday afternoons.
Ayeshmanthe Rathnayake, Apoorva Saboo, Usman H Malabu, et al., Lower extremity amputations and long-term outcomes in diabetic foot ulcers: A systematic review, World Journal of Diabetes, 2020 September 15; 11(9): 391-399, DOI: 10.4239/wjd.v11.i9.391 ISSN 1948