A collaborative friendship between interventional radiology, vascular surgery and ultrasound technicians is opening new doors to what is possible in the area of limb salvage.
Desarom Teso, MD, a vascular surgeon and medical director at PeaceHealth Thoracic & Vascular Surgery, and Mary Costantino, MD, FSIR, an IR and medical director at Advanced Vascular Centers, both work in the venous disease area. Venous disease is hugely prevalent among Americans aged 40 and older and, of that group, approximately 8.5 million individuals have peripheral arterial disease.1,2 As with IRs, vascular surgeons offer treatment solutions to prevent amputation, creating natural competition for these patients.
Drs. Costantino and Teso’s working relationship, however, isn’t as competitive as one might expect. Instead, they enjoy a knowledge-sharing relationship, regularly consulting each other and referring patients back and forth.
Dr. Costantino describes meeting Dr. Teso as a relief. In her outpatient setting, she often sees difficult venous disease cases, many of which may require surgical evaluation.
“Endovascular first is a good motto, but it’s not always right,” Dr. Costantino said. “I call Dr. Teso all the time to get his perspective, and I can’t imagine working without a good vascular surgeon. It makes my job easier and helps my patients when I can turn to someone who knows the other available treatments.”
The respect goes both ways, according to Dr. Teso, who says Dr. Costantino is an invaluable source to brainstorm with. “Dr. Costantino has skills I don’t have, and it’s great to have a superb IR who I can confer with to make sure the patient is being treated as a whole and can have their concerns addressed in a holistic way.”
“It’s not a turf battle,” Dr. Teso says. “It’s a joint venture to make sure the patients are taken care of before moving on to amputation or more major interventions.”
The link between Drs. Costantino and Teso is Jill S. Sommerset, RVT, the technical director of PeaceHealth Thoracic & Vascular Surgery. Ms. Sommerset has worked with both Drs. Costantino and Teso as an ultrasound technician and introduced the two physicians, believing they would find commonalities and benefit from the other’s experience.
Ms. Sommerset is the creator of the pedal acceleration time (PAT) method, a technique that measures pedal artery flow using ultrasound imaging, regardless of calcification. The method involves scanning the entire pedal arch in order to assess perfusion in the pedal vessels, which allows for real-time imaging and knowledge of the efficacy of therapies such as atherectomy and angioplasty. According to Ms. Sommerset, using PAT helps with decision making, provides trackable data and helps give physicians more confidence in the efficacy of their procedures.3,4
PAT is still a relatively new technique. Ms. Sommerset and Dr. Teso have published their data and methods in various journals, and Ms. Sommerset dedicates much of her time to teaching the method to other ultrasound technicians.
“In order for the technology to grow, we need more physicians and techs who are dedicated to limb salvage to collaborate and take advantage of each other’s skills,” says Ms. Sommerset. Drs. Costantino and Teso both use PAT on their patients, and Dr. Costantino’s lab uses PAT on all arterial patients.
According to Dr. Costantino, the biggest mistake a physician can make is to disregard the knowledge of their medical colleagues—especially ultrasound technicians. She says Ms. Sommerset has become a partner in care on her cases, and discussions with her and Dr. Teso have changed the way Dr. Costantino approaches and views some procedures.
“I look at common femoral artery calcification very differently now, and I send those to Dr. Teso,” Dr. Costantino says. “And when Jill and I work on patients together, she has great advice on the best way to access or where to cross, because we pre-plan and talk to each other.”
“We all share a mutual respect and a passion for lower limb salvage, and that naturally leads to collaboration,” says Dr. Teso. “With all our skillsets combined, we can do great things for patients.”
References
- Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation. 2019;139(10):e56–528.
- Criqui, MH, Jamosmos M, Fronek A, eta al. Chronic venous disease in an ethnically diverse population: The San Diego population study. Am J Epi. 158(5):448-456. doi:10.1093/aje/kwg166.
- Sommerset J, et al. Pedal acceleration time: A novel predictor of limb salvage. J Vasc Sur. 69(6):e234.
- Sommerset J, Teso D, Feliciano B, et al. Innovative arterial duplex examination: A guide to evaluate flow in the foot using pedal acceleration time. J Vasc Ultrasound. 2019;43(1):11-17. doi:10.1177/1544316719827328.
