March 30, 2017 | Andrew Prouse, MD
Education

It’s currently estimated that 6.5 million individuals age > 40 have peripheral artery disease (PAD) in the U.S., equating to 5.5 percent of that population. We also know that PAD is often under-recognized in the primary care setting, which is concerning since PAD is associated with major adverse cardiovascular events including stroke and myocardial infarction. A particularly concerning issue as a professional training in cardiovascular disease is the common response by medical housestaff when presented with peripheral vascular disease or the “cold leg” in the middle of the night, which is to refer to consult services other than cardiovascular medicine.

For decades, surgical intervention for acute and chronic peripheral arterial occlusive disease was the only viable option. However, with the growth of the field of vascular medicine, which includes experts from internal medicine, general cardiology, interventional cardiology, interventional radiology and vascular surgery, treatment options have expanded to include percutaneous and hybrid interventions. Given this rapidly expanding field, the need to educate medical professionals on the concept of vascular medicine has become increasingly critical.

The first step in this education is to change the nomenclature we use when teaching trainees and other members of the health care team. As cardiovascular medicine specialists, we must increase awareness of colleagues and trainees regarding the idea of vascular medicine as a primary referral service for vascular disease. We must nurture the concept of vascular medicine as a collaborative team that offers therapeutic options that extend beyond the operating room. Most importantly we can show these rising practitioners that cardiovascular medicine plays an integral role in the treatment of PAD.

Education about the growing menu of therapeutic interventions for PAD is crucial. Drug-eluting stents, drug-coated balloons, and scoring balloon angioplasty, atherectomy, lithoplasty and thrombectomy are becoming widely available in catheterization laboratories around the country. Interventional vascular medicine provides alternative, endovascular, options to surgical intervention in the periphery, aorta and carotids.

Advances in medical therapy also must be emphasized since optimizing clinical outcomes requires prevention of disease recurrence and associated cardiovascular complications not just arterial revascularization.

Finally, when involved with teaching services or acting as consultants, we must establish vascular medicine as the unifying discipline in PAD. Vascular medicine has played an  integral role in the formation of both PAD guidelines and low extremity intervention treatment formation.

It is each of our responsibility as cardiovascular providers to embrace vascular medicine and make it the centerpiece of PAD care. The next time you are faced with a non-healing wound or a cold leg, make vascular medicine the universal answer to the classic question “Who you gonna call?” 

This article was authored by Andrew Prouse, MD, a Fellow in Training (FIT) at the University of Colorado.