Diabetes Peripheral Artery Disease

Diabetic Coordination of Care

It is estimated worldwide that every 30 seconds a leg is amputated and 85% of those are due to a diabetic foot ulcer.1 Treatment of diabetic patients that come to Modern Vascular cannot happen without coordination of care between our interventional radiologist and the endocrinologists and podiatrists who regularly treat diabetic patients.

Coordination of Care for Diabetes Patients with PAD Reduces Amputations

One example of such collaboration that occurs regularly is among San Antonio-area physicians Dr. Firas Akhrass, an Endocrinologist, Dr. Russell Stanley, a Podiatrist, and an Interventional Radiologist that used to manage Modern Vascular’s original San Antonio clinic. How do these doctors work together to reduce diabetic-related amputations?

How do an Endocrinologist, a Podiatrist, and an Interventional Radiologist work together?

All three participated in our Webinar, but here’s a preview of their talk:

Interventional Radiologist

From an Interventional Radiologist’s point of view, patients do not magically realize they need an interventional radiology procedure of their own accord. They need education on PAD, its symptoms, and its treatments, and that often comes with the help of the other physicians treating them for diabetes and related complications. “These doctors are able to identify symptoms of PAD, and know when to escalate treatment to prevent amputation. This coordination of care is important in saving limbs and restoring lives.” Recommendation by your physician is the most common way to find out you may be at risk for PAD, but another tool available to anyone is this easy self-assessment quiz to check for significant risk factors.


Dr. Stanley, a Podiatrist, notes common indicators that his patients should be evaluated for PAD are discoloration in the skin, bruising, mottling of small blood vessels distally, foot ulcers (holes in the skin), skin temperature, and sometimes ischemia. Patients often don’t feel pain from PAD symptoms, due to diabetic neuropathy. The most important thing to note is that left untreated, any of these symptoms can lead to worsening problems and future amputation. Patient awareness is paramount, he says: “Having patients be able to identify that there is a problem, they need help, and it’s not going to get better and self-resolve, is of utmost importance.” When referring patients to Modern Vascular, Dr. Stanley is always pleased to receive reports of progress, including from patients who received an interventional radiology procedure, as they often report a return to normal neurological sensation, decrease in swelling, and nocturnal cramping. “This is the result of a team approach for patient care,” he adds.


Dr. Akhrass, an Endocrinologist, treats many patients with type 2 diabetes who have a wide range of symptoms. While lifestyle changes – such as a healthy diet and regular exercise – and medication help many people keep their diabetes under control, he notes that he also looks for symptoms such as leg pain, color change, and pain while walking. Patients with these symptoms get a PVD (Peripheral Vascular Disease) screening in his office. That said, Dr. Akhrass adds that caution is recommended: “it is better to screen for PVD before symptoms are present than after.” If a PVD screening indicates the patient may have PVD, Dr. Akhrass refers patients to treatment at Modern Vascular. Specialists do not evaluate and treat patients in a vacuum; when endocrinologists and podiatrists coordinate care to include interventional radiologists like those at Modern Vascular in the management of type 2 diabetes, it can result in life-altering – and limb-saving – interventions.


  1. Diabetic amputations may be rising in the United States / AJMC
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