leads to unnecessary limb amputations. A 2019 study in Diabetes Care showed that after a 2-decade decline, rates of nontraumatic lower extremity amputations in individuals with diabetes was surging. Between 2009 and 2015, such amputations increased by 50% among these patients and were most pronounced among those ages 18 to 64.


“Patients are getting amputations and don’t even get an angiogram or a procedure done to assess for peripheral arterial disease first,” Dr. Misra said. “So, one of the things that this plan is pushing for is lowering amputation rates; public reporting of amputations, especially by hospitals; and really advocating for appropriate workup of patients before they get an amputation.” Healthcare professionals need to make sure they have “exhausted all interventional medical surgical techniques before a patient loses a limb,” he said.


If a patient is diagnosed early, cholesterol- and blood pressure-lowering medications and lifestyle changes, such as tobacco cessation, exercise and a healthy diet, may halt or reverse PAD. Beyond that, IRs can play a critical role in treating and managing patients, striving to prevent patients from reaching the CLI stage and limb amputation.


Raising awareness about IR treatments that restore blood flow in limbs— including angioplasty, stents, stent- grafts and thrombolytic therapy—could reduce the rate of limb amputations.


In addition, IRs can become a valued part of a healthcare team, helping to manage patients long after their treatment. Dr. Bryce considers her PAD patients to be patients for life, as an interventional treatment does not cure PAD but rather manages it. In her vascular lab, she has developed a regimented system of follow-up care.


“After I do the procedure, I see them, depending on a wound or not a wound, in 2 weeks vs. 4 weeks, and I follow them. If the wound is healed, I still follow them every 6 months to make sure they’re doing well, and I image them and make sure I catch a problem early—rather than say ‘OK, I fixed you; go on with your life,’” she said. “They are my patients forever— for as long as they’re alive.”


Dr. Bryce recommends that IRs who treat PAD patients consider longitudinal follow-up, dedicated clinic space and how to work with a multidisciplinary team to manage a patient’s risk factors.


Getting involved in research is also important. “The USPSTF has said that there’s insufficient data to screen for PAD. Therefore, we need research in this area to show that screening for PAD in a high-risk population is worthwhile,” she said.


She also pointed out the historical mistrust of doctors and research projects among some in the Black community because of racist medical treatment and experiments such as the Tuskegee syphilis study. This makes it ever more important for nonwhite IRs to become involved in research, she said.


“Studies have shown that increased involvement of principal investigators or members of the investigating team who are minorities increases enrollment of minority patients,” she said.


While many factors are connected to the increase in PAD and limb amputations in the United States, IRs play an important role in preventing amputations and improving patients’ lives, experts say.


“I think it’s part of our duty to help all of our patients, and we shouldn’t have a disproportionate number of patients who get to a point where they need an amputation or were never offered limb- sparing treatment,” Dr. Patel said.


References


1. Six steps to reducing PAD. SIR Today, June 2022. bit.ly/3MJWp4z.


2. PAD National Action plan. American Heart Association. professional.heart.org/-/media/ PHD-Files-2/Science-News/p/PAD-National- Action-Plan.pdf.


3. Final recommendation statement: Peripheral Artery Disease and Cardiovascular Disease: Screening and Risk Assessment with the Ankle-Brachial Index. U.S. Preventative Services Taskforce. spreventiveservicestaskforce.org/uspstf/ document/RecommendationStatementFinal/ peripheral-artery-disease-in-adults-screening- with-the-ankle-brachial-index.


4. Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult U.S. population. Diabetes Care .2019;42(1):50–54. doi. org/10.2337/dc18-1380.


Inclusion: The practice or policy of providing equal access to opportunities and resources for people who might otherwise be excluded or marginalized, such as those who have physical or mental disabilities and members of other minority groups.


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