More than a decade earlier, a separate University of Minnesota Medical School study also showed that primary care physicians had limited awareness of the potential for peripheral artery disease, "PAD may be under diagnosed in primary care practice."
While there have been many studies addressing the need for more awareness and scrutiny of vascular disease, there has been less so about preventable amputations, Mustapha says. "My sense is that the majority of physicians do not refer appropriately to an amputation prevention specialist."
One of the concerns is that podiatrists and wound care specialists treat the symptoms (wounds and foot pain) without referring for an evaluation for "potential ischemic causality, " Mustapha says, referring to the restriction of blood supply to patients' tissues.
In addition, some physicians still make the decision to recommend amputation based on "patient symptoms without obtaining a selective angiogram," a specific X-ray to determine blood flow.
But Mustapha says he holds a glimmer of hope that research and attitudes are changing, especially among primary care physicians.
"The tides are changing due to an increase in awareness, advocacy, and available data," Mustapha says. Physicians who are referring cases to specialists like him are spreading the word that amputations can be prevented.