Peripheral arterial disease
Management consultation
If PAD is complex and severe, allow vascular specialists—whether interventional cardiologists, interventional radiologists or vascular surgeons—to direct care, especially for management of young patients or patients who need an endovascular or surgical intervention.
Refer complex patients to high-volume hospitals, and high volume interventionalists which are associated with better outcomes than low volume hospitals for peripheral arterial surgeries.
Delayed vascular consultation has been associated with worsened living status and lower limb salvage rates.
Consult a vascular surgeon for patients with:
- severe PAD (ABI <0.25)
- moderate to severe PAD with lifestyle-limiting claudication in whom medical therapy has failed
- moderate to severe PAD plus diabetes with nonhealing ulceration and nonpalpable pulses
- acute limb ischemia
Vascular medicine specialists can help manage patients with comorbid hypertension and dyslipidemia to aggressively reduce risk factors.
Consult a plastic surgeon for assistance with complex wounds and for reconstructive tissue flaps.
Ask physiatrists for aid with postamputation care.
Contact ACP Internist
Send comments to ACP Internist staff at acpinternist@acponline.org.