Key Insights On Working With Vascular Specialists To Manage PAD

Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

When treating patients with peripheral arterial disease (PAD), it is vital to ensure proper referrals to trusted vascular specialists. These expert panelists discuss what information to include in referrals and how to manage wounds until patients can see vascular specialists.

Q:

Once you diagnose PAD, what is your referral method to other medical doctors and vascular specialists?

A:

Early recognition of PAD and prompt referral to a vascular specialist are essential, according to Nicholas Bevilacqua, DPM. As he notes, a comprehensive, multidisciplinary approach improves the quality of care. Dr. Bevilacqua says the collaboration between the vascular surgeon and the podiatrist is a natural partnership that complements the skills of each specialist. He has daily interaction with vascular surgeons and will call them directly while the patient is in the office in order to arrange follow-up consultation. Dr. Bevilacqua does not rely on patients to schedule their own appointments, emphasizing that any delay in care can compromise the outcome.

   For Kazu Suzuki, DPM, CWS, the referral method depends on the degree of PAD and the treatment plan for the particular patient. If the degree of ischemia is mild, he may check with the patient’s doctor (internist, diabetologist and/or cardiologist) to make sure the blood pressure, cholesterol and blood glucose are optimized as per the American College of Cardiology/American Heart Association PAD management guideline.1 Dr. Suzuki may suggest a consultation with a nutritionist and encourage daily walking exercise.

   On the other hand, if Dr. Suzuki suspects moderate or severe PAD in the form of critical limb ischemia (CLI), he would notify the patient’s medical doctor right away. He would also make an immediate referral to a vascular specialist (vascular surgeon, interventional radiologist, interventional cardiologist) in his hospital.

   Desmond Bell, DPM, notes his practice is unique as he only treats patients with chronic, non-healing wounds. He says many already have been diagnosed with PAD. His practice can make a difference when he discovers a suspected underlying occlusion or overall worsening of the PAD that exacerbates the condition of the wound.

    “We have developed strong relationships with several cardiovascular interventionalists in the Jacksonville region. We make immediate referrals to them, whether they are cardiologists or vascular surgeons,” notes Dr. Bell. “We often keep the vascular interventionalists informed of their patient’s condition between their follow-up appointments.”

Q:

As you make your referral, what kind of information do you relate to the vascular specialist?

A:

Dr. Suzuki gives as much information as he can to the vascular specialist. He will send the skin perfusion pressure/pulse volume recording (SPP/ PVR) test results, size of the wounds, digital photos and when he expects that the specialist should see the patient. Likewise, Dr. Bevilacqua says one should include the results of non-invasive vascular studies, noting that these studies provide valuable information and may help determine the need for further workup or intervention.

   At the time of referral, Dr. Bell discusses with the specialist his recent findings or suspicions of worsening of the patient’s PAD that may be leading to CLI. He notes this often revolves around several factors, including increasing pain and clinical deterioration of any wounds, cursory Doppler results and a comparison to available baseline findings.

    “The overall clinical picture with these specifics is usually enough to warrant a recommendation for an expedited or stat appointment for the patient with the cardiovascular interventionalist,” says Dr. Bell.

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