Any one else's program bump heads with Vascular?

[blessed.pod]

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Does any else bump heads with Vascular Surgery at their programs? Like sometimse Vascular says a patient wound heal any Podiatric intervention(debridement or any amputation to the foot) but you know patient needs revasc but they are adamant that patient doesnt need a revasc procedure? just wondering.....hmmmmm.

 

[Feli]

You're likely just miscommunicating with them. There are limits to what they can do.
There are some wounds you just paint with betadine until the pt dies or get infected and need their proximal amp.
They'd never say a wound "will heal"... only that the pt is optimized from a vascular standpoint.
Some people are just not safe for procedures, their vessels are effed, or they're not able to get more revasc (and ethical Vasc won't try).
They don't always have time for podaitry stuff... you know, with malfunctioning fistulas and 95% carotids and AAAs and all. 🙂

At the end of day, Vasc surg is usually one of podiatry's biggest allies.
It's a stay-in-your-lane situation once they give their eval. Find a different Vasc refer if you like.

Also, realize that they can do everything you can do (for wound/skin/amp care).
Just because they don't have time to do toe amps or wound care or Rx DME, that doesn't mean it's hard.
The converse is not true. They have tons of skills we don't have (and that pts critically need).

 

[Adam Smasher]

The problem is you have all kinds of CME lecturers talking up the multidisciplinary approach, plus how it could be negligence if you don't consult vascular, and then in a real world scenario, vascular says "monophasic flow, pulses are dopplerable, no intervention indicated" and give you attitude for wasting their time. Or they say just amputate the infected/necrotic tissue, see if it heals, and revasc in the future if it doesn't, which I don't find to be contentious but other dpms might.

Basically we as a profession need to accept that every surgical case is a roll of the dice, amps don't heal some of the time, and it's NOT negligence when that happens.

 

[air bud]

Nothing heals with blood flow. They can only do so much. You are doing something wrong if vascular is not your best friend. That being said maybe you need to find a different group. If limb salvage not a passion...like they don't get jacked talking about being down cleaning up the pedal march....find someone else to bro out with.

 

[heybrother]

Move to a big enough city and you can find an interventional cardiologist to see these patients next day. 😉

 

[Retrograde_Nail]

Vascular surgeons still come in two forms. Old vascular surgeons who are terrible or not interested in endovascular interventions and can only do basic endovascular stuff or just want to do bypasses. The newer generation of vascular surgeons are more in touch with the podiatric needs. 95% of diabetic foot ulcers with vascular component are due to some form of tibial vessel disease. You need someone who is going to be willing to do the nitty gritty vessel work. Some vascular surgeons value this work and want to do it where others avoid it like the plague. Like they won't even try. They will just document "peroneal vessel run off to the foot". They never document small vessel disease either.

Personally I get along with some vascular surgeons and battle with others. The ones who are lazy or liberal with their documentation are setting you up for failure and a lawsuit. I am not surprised there not more lawsuits involving podiatrists over wounds not healing despite vascular surgery saying they have enough perfusion. That kind of miscommunication is a breeding ground for frivolous lawsuits.

Podiatry really needs to learn how to read angiograms just like we master reading foot x-rays. I constantly look at the angiogram and document small vessel disease when I am not seeing those small arteries open. If I have to further protect myself I will order numerous non invasive vascular studies to further prove my point (usually toe pressures or TCPO2 study if I have to). You must protect yourself.

The patients will believe the vascular surgeon more than you. If their vascular surgeon did not do much for them but tells them they have good perfusion to heal and you try to clarify with them that they have microvascular disease they will not believe you. Then they will blame you when their toe amputation does not heal and you are telling them they need an open TMA with wound vacuum.

I do so much wound and limb salvage volume that this is a constant issue that I see. It can create a lot animosity.

 

[Hybrocure]

My personal experience is that vascular surgeons or interventional specialists couldn’t be happier to investigate any vascular concern. Inpatient or outpatient they’re more than happy to wheel them back and see what’s going on.

I remain a firm believer in maintaining good relationships with vascular or interventional cardiologists/radiologists. They want you and you want them

 

[Robin-jay]

My personal experience is that vascular surgeons or interventional specialists couldn’t be happier to investigate any vascular concern. Inpatient or outpatient they’re more than happy to wheel them back and see what’s going on.

I remain a firm believer in maintaining good relationships with vascular or interventional cardiologists/radiologists. They want you and you want them

At my hospital, when I put in an IR consult, they will be seeing a patient ASAP and doing a surgery for patients who need it, while IM can't seem to clear a patient for podiatric surgery on time for the life of them.

 

[PTPuser]

Vascular at my shop are running on E. They're just insanely busy. But we do have good relationship with them and they do try their best to help our patient.

There's more work than the entire country can handle and produce and I am so jealous of them for that cause they can command anything.