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Preventing Amputations Starts with PCPs

Joe Cantlupe, for HealthLeaders Media, August 29, 2013

I found this bit of information troubling. Why would physicians not refer to him, or other specialists, if there were a chance that an amputation could be prevented? Most patients at risk of losing limbs are afflicted with peripheral arterial disease, a circulatory problem in which narrowed arteries reduce blood flow to the arms or legs.

2 Barriers to Referrals
"Typically, there are two reasons a physician would not refer to an amputation prevention specialist," Mustapha says. "Lack of knowledge on the part of the referring physician about the currently available limb salvage techniques is the primary reason. The second reason is when physicians know these techniques do exist, but choose not to refer the patients for the limb salvage procedures as some would view this as a defeat on their part."

"Hence," he adds, "our push to patients and their families to be the primary advocates for saving their limbs, and their lives."

Mustapha's specialty is performing artery and vein catheterizations designed to open vessels and improve circulation. The treatment he developed at Metro uses an ultrasound-guided interventional device through the foot and an ultrasound transducer that helps identify blood flow that traditional angiography misses.

When the endovascular intervention program began five years ago, the Metro Health System saved at least 88% to 92% of limbs that had been recommended for amputation, often by the patients' primary care physicians. It now saves even more—96% to 98%, says Mustapha.

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