CHAPTER 1: The Problem
• Patient Story #1 (African American who got amputated and life is now a struggle)
• Diabetes & PAD Hotspots
• Access to good nutrition and to good healthcare
• CLI is deadlier than many cancers
• Too many amputations performed as a first-line treatment
• Amputation Hotspots
• Many patients don’t receive proper PAD Screening before amputation
• Many providers aren’t aware of the latest treatments
• Not enough qualified specialists
• Amputations come at great cost to patient, family, health systems, & society
• Amputations & CLI effect socioeconomically disadvantaged at a higher rate
CHAPTER 2: History & Disease
• Patient Story #2 (follow Native American patient diagnosis through treatment)
• First amputations
• What is PAD vs CLI and how does diabetes play a role
• How has it been treated historically
• Latest & Greatest Treatments
CHAPTER 3: The Roadblocks
• The hotbeds of this pandemic
• The socioeconomically disadvantaged
• Patient Story #3 (socioeconomic patient story)
• Who are Interventional Radiologists, Interventional Cardiologists, & Vascular Surgeons
• Patient Story #4 (patient caught up in turf war)
• History of Turf Wars (DeBakey vs Cooley Story & Early days of balloons/stents)
• Today’s Landscape
- New Frontier of CLI
- Who’s going to treat these patients and how?
- OBLs vs Hospitals
- Surgeons vs Endovascular Specialists
- Insurance coverage (barriers to care)
- Costs of amputation vs therapies
- Should CLI be its own specialty?
CHAPTER 4: When is the Right Time to Amputate?
• Why do most Patients die within 5 years of Amputation?
• Is a small amputation better than a large amputation?
• Patient Story #5 (Patient who died within 5 years)
• Patient Story #6 (Patient who continues to thrive after 5 years)
• Do new technologies work or are we just delaying the inevitable?
• Should we intervene to save legs endlessly until there is no alternative?
• Advancements in prosthetics
• Should we amputate before patients are too sick to handle prosthetics?
• CLI Amputees are different than other amputees... they're sick and don't recover
• Unhealthy legs are usually attached to unhealthy bodies
• Psychological Effects of loss vs the promise of hope
• Is there no hope for amputated CLI patients?
• CLI is not curable. How do you define success?
• Amputation prevention vs wound healing vs vessel patency
• The importance of a multi-disciplinary team to include primary care, podiatry, wound care, endovascular specialists and surgical specialists
• They do if for cancer patients, why not CLI?
CHAPTER 5: Where Do We Go from Here?
• Patient Story #7 (Model Patient who has gained years of quality life with legs)
• Work together among all specialties (even podiatrist)
• Patient Lifestyle changes
• Early Detection
• Training more CLI Specialists
• Educating insurers and policy makers
• New Diagnostic Tests of the future
• New limb saving technologies of the future
• Patient and Referring Physician Education is key
• What should a patient do when faced with CLI and amputation?
• Amputation should not be a frontline therapy without proper screening, education, and treatment options explored
• The right time for an amputation is when an educated patient makes an educated decision with the help of an educated physician
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