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The number of amputations performed annually in the U.S. is estimated to be 160,000 to 180,000 and more than 50% of these patients never undergo an arterial evaluation prior to amputation. The objective here is to show that a multi-disciplinary team of wound care and endovascular specialists can decrease/prevent amputations.
A retrospective, observational, single center (TriStar Southern Hills Advanced Wound Care Center, Nashville, TN), analysis of CLI patients with arterial wounds was completed from May, 2012 to November, 2015 to determine the impact of a team based approach on arterial wound healing and amputation rates.
The addition of a vascular surgeon (with endovascular skills and knowledge of orbital atherectomy) to a wound care team resulted in a decrease in amputations while the number of arterial wounds under care increased (Figure 1). In addition, the percent of arterial wounds healed at 16 weeks improved from 46% to 91% during 2012-2015. In 2012, the heal rates for arterial ulcers was 54% and the time to heal in these patients was 51 days. In 2015, 91% of these patients healed within 25 days and the palliative patient population decreased by 40%.
Creating a multi-disciplinary team dedicated to peripheral arterial disease (PAD) awareness and a limb preservation program leads to improved arterial wound heal rates and lower amputation rates. These results support the idea that the standard of care for CLI patients should mandate an immediate referral to a CLI program with an evaluation by a vascular specialist upon detection of a new wound. Therefore, vascular surgeons and endovascular specialists can play an important role in the formal wound care setting.