Peripheral Vascular Diseases
Greetings to all my co-fellows. I am Mahmoud Abdelghany, MD, a peripheral vascular interventional fellow at Yale University School of Medicine and editor of ACC's Peripheral Vascular Disease Section. I am delighted to serve in this position and hope I can discuss throughout this year the purpose and importance of vascular medicine and peripheral vascular interventional training.
Let me start with a story that I experienced when I was a first-year cardiovascular fellow. After examining a patient who presented to the clinic with a remote history of myocardial infarction, my attending physician asked me if the patient had bruit on auscultation of the femoral artery.
It was an unexpected question and, at that time, I saw it as an unreasonable question. Why would I check his femoral pulsations if he did not have any recent interventions? He realized what was going on in my mind and answered "you are a cardiovascular fellow, not a cardiology fellow. Who would check him for vascular diseases if you would not?"
It was an eye-opening statement for me. Over the years, vascular medicine was part of the cardiovascular training and practice diminished.
As a cardiovascular fellow, when was the last time you checked the distal pulsations of the patient as part of the routine cardiac examination? When was the last time you asked your patient if he gets claudication when he walks? When did you realize that a 70-year-old patient who gets leg pain when he walks a block needs vascular workup? When did you order a test to screen for peripheral vascular disease (PVD)? We are all probably aware of the indications of a cardiac stress test, but how many of us are aware of the indications to screen a patient with an ankle-brachial index test?
PVD has gotten more attention recently. Although it is still under-diagnosed, recent reports estimate that more than 200 million people have PVD worldwide, with symptoms ranging from none to severe. Patients with PVD have an increased risk of cardiac and cerebrovascular morbidity and mortality.
Furthermore, patients with critical limb ischemia – an advanced stage of PVD – have a higher mortality rate than those with colon, breast and prostate cancer together. The Medicare expenditures for PVD treatment in 2001 ($4.3B) was more than the cost for treatment of patients with congestive heart failure, cerebrovascular diseases and cardiac arrhythmias.
It is clear that PVD represents a huge health problem and economic burden, and we must do more to control it. As medical providers, this starts with developing a solid, well-structured training in vascular medicine and peripheral vascular interventions.
This article was authored by Mahmoud Abdelghany, MD, peripheral vascular interventional fellow at Yale University School of Medicine in New Haven, CT.