When a patient is referred to me with peripheral arterial disease from their primary physician, I start with a very, very careful vascular history and physical. How far can they walk, what are their symptoms, are there any wounds, what testing has been done? Depending on what’s been done, I then tailor my therapy and more specifically my diagnostic testing based on what’s been going on with the patient. It could be as simple as a duplex ultrasound or a more formal segmental pressure of the legs. It could be CTN geography. It could be a diagnostic invasive angiogram. But I usually wait until I have a cetiteriagram and enough symptoms to justify doing a procedure. Once we’ve defined that the patient need intervention, then I plan based on the CAT scan or an angiogram, the best treatment. The treatment may actually be peripheral bypass surgery, in which case I can refer that patient to a vascular surgeon. It could be medical therapy, continued walking program, or it could be an intervention which could include simple angioplasty of a narrowed artery. It could be an atherectomy or a scrape away the plaque. Put stents in or if I have to use an Ocelot catheter to get across a blocked artery, I have the ability to do that. Which will allow me to do the other treatments and open the leg vessels. Thereafter, once that patients been treated, I like to follow that patient as well, because once an artery’s been treated, there’s a chance it could re-narrow. And therefore, follow up testing is necessary and I take that on so the primary doctor does not necessarily have to. But I also insist the patient goes back to the family doctor for treatment of their other risk factors including their diabetes, cholesterol and high blood pressure.
