Taking a Multidisciplinary Approach to Peripheral Arterial Disease

[Michael Barraza]
I've actually learned a ton of tips and techniques from the two of you and others, just through Twitter. It's been a great resource for that. It's part of how we decided to reach out to the two of you.

But one of the things I noted, maybe about a month ago, was that you had posted something about your partnership with the podiatrists at Rush. Is that something that you guys use as part of your practice?

[Kumar Madassery]
Yeah, I think the collaboration with podiatry is something that over the last few years has been growing leaps and bounds. Dr Arslan, our director, he's a big aortic and PAD guy, he actually brought the president of the APMA, the American Podiatry Association, to SIR a couple of years ago as a first ever joint session where we kind of talked about how important it is for IR and podiatry to work together, because we both have ultimately the same exact goal which is saving that limb.

I mean, podiatrists are daily battling the non healing wounds, and we are the ones who can help them with kind of the best expertise and capabilities to get them the best help possible, so it's kind of a natural relationship that gives the patient the best options. So, we do a lot of work with podiatrists, a couple of us cover the wound care clinic with them, and then help them on all patients and kind of co-manage them.

It's a beautiful relationship, and I think we try to educate and tell others to work on as well. Actually I give a talk with one of our podiatrist at our medical school because they also have one of the best podiatry schools in the country. So giving those students an understanding early on, the importance of this relationship, I think it's something we need to all extrapolate.

[Michael Barraza]
Yeah. Sabeen, what about you?

[Sabeen Dhand]
Yeah. I mean the relationship with podiatry I think is very important. It was something that was already established when I came to my group. There's a wound care center that's run by five or six podiatrists and the relationship with interventional radiology was established in endovascular care. They just get so many patients with terrible wounds and they're automatically, in addition to all their medical therapy, they automatically refer to us.

It's been a great resource. Most of our legs come from them. They're great people and we have a great relationship. And I think if anyone's starting to start a PAD practice, just reaching out to the community of podiatrists and showing that you're available would help you a ton. There's so much out there and so many podiatrists that don't have an endovascular specialists that can help them. It's just an unused resource.

[Michael Barraza]
And for me, here in Nashville, it's primarily vascular surgery and so it's been a bit more of a challenge to go out and get these. And what it appears to me is that the best place for me to start, is to start below the knee, which in my experience tends to be more of the challenging cases.

[Sabeen Dhand]
Yeah, definitely. I see it a lot when I talk to other people about turf wars with vascular surgery, and even cardiology. And I think below the knee is definitely a place where interventional radiology can shine because I've also seen vascular surgeons just not really go below the knee. Our cardiologists just are not comfortable with it.

My situation at PIH is kind of unique where we have two vascular surgeons who are a bit older and they're not interested in endovascular interventional stuff. And our cardiologists don't touch legs either. All the care goes to us. Which is unique and I hope it stays like that forever. I know that can change. But it's a good situation for me. I was going to say that below the knee is where I think most interventionalists can really shine. And they are the tougher cases. If you have a good mentorship or something, someone just to teach you how to do it, you can do a lot of good care.