In 2016, I traveled to Italy to watch Dr. Mariano Palena, Dr. Marco Manzi, and others who are advanced skilled vascular specialists, unblock arteries in legs. I watched case after case with some of the toughest, calcified lesions, including a no stump SFA, in which a retrograde approach led to a seamless revascularization. In each one, the physician would always check runoff clear into the toes with a full leg bolus chase. Any turbulent flow would be met with the smallest balloon possible to gently “kiss” the tibial and pedal loop vessels using low barometric pressure and slow inflation.
Prior to that first visit to Italy, I had watched dozens of cases in the States by multiple vascular specialists and had never seen a vascular specialist do what Dr. Palena and Dr. Manzi called, “completing a case.“ What good is fixing the sink, if the plumbing below can’t support it, especially if the pipes are eroding? Some doctors would stop at the knee after revascularizing a lesion in the SFA and when the patient would follow up a month later with continued foot cramps, the doctor would say nothing could be done about that, to tough it out, and walk, walk, walk because treating below the knee and into the foot would lead to a revolving door of treatment thereby increasing the risk of amputation. But doctors in Italy have proven different using their advanced tools and techniques. They have some of the lowest readmission rates for these patients in the European Union.
I’ve been back to watch some of the pioneers of the most advanced techniques of limb salvage in Italy at least half a dozen times now, including one trip where I visited nine hospitals across the country in 11 days. Every single physician I watched, completed the case. Now, I’ve also been in hundreds of endovascular suites in the States and other parts of the world and know there are advanced skilled doctors such as those in Italy as well. What’s disconcerting is that so many are not. I don’t understand how doctors can be aware of others who are saving legs, and yet only offer their patients amputation as their best and only option, thereby cutting their lifespan and sentencing them, even if it is their final months or years, to a life without a limb, immobile and with mental and physical anguish. It’s unconscionable.
The opportunities to learn new advanced limb salvage techniques are available. Even during COVID lockdowns, physicians provided teaching opportunities online. There’s no excuse not to learn advanced limb salvage techniques, especially now that COVID restrictions have lifted. I've already attended an incredible conference this month called NCVH in New Orleans and have been invited to AMP in Chicago later this summer to continue to learn what's new and next in the treatment of P.A.D. I am also jumping on the first opportunity to go back overseas to Italy to learn from Dr. Palena, Dr. Manzi at CLI-C Global Face-to-Face 20202 in Padova, Italy. It's reconvening in person for the first time in years June 23 and 24. They have grants available for physicians in order to democratize access to advanced learnings that have life and limb saving potential around the world.
CLI-C Global Face-to-Face 2022 is worth attending to learn from advanced skilled vascular specialists in Italy. While their training and standard protocols don’t differ from other countries, Dr. Palena, Dr. Manzi, and other advanced skilled vascular specialists in Italy share a powerful common guidance for P.A.D. treatment that runs deep in mainly two ways:
First, Italy has been at the forefront of CLI treatment with some of the earliest revascularization operations being performed there. And with that clinical history as pioneers, they strive to maintain centers of excellence around the treatment for P.A.D. and CLI treatment, continuing to pinpoint gaps in care, adopting new tools, and adapting their skills accordingly to improve all outcomes.
Secondly, their efforts in limb salvage stem from a deeply engrained personal social conscience. They break beyond the barriers of limited, cherry-picked, studies that make blanket statements of what should and shouldn’t be done in general to treat P.A.D. They rely more on a commitment to take each patient as an individual and do what is necessary to improve the life of that patient, which inherently, one by one, has an impact on the entire health system and natural national welfare. This mentality helps them to think logically about their approach, in the moment when a patient is on the table, and use lower trauma techniques that allow them to perform revascularization clear into the toes without a revolving door of treatment every few months. They tell me that a revascularization may take more time than an amputation, and may reimburse less than an amputation, but an amputation has a longer, more costly impact on not only the patient, but also on the entire healthcare system, and even more, overall society. They feel it’s their commitment to the patient, the entire healthcare system, and national welfare, to exhaust all efforts using the most advanced lower traumatizing techniques to keep a patient on their feet and contributing positively to society.
Join us and ask how they are so successful in treating below-the-knee and into the foot without a revolving door of treatments? Let them show you. At CLI-C Global Face-to-Face 2022, they’ve created an intimate experience with multiple live cases that allows, not only for the onstage panel, but the entire audience to get involved in a candid conversation about how to complete the most complex cases successfully to improve both short-term and long-term outcomes of patients.
I will be at CLI-C Global Face-to-Face 2022 learning more!
I hope you will join me!
I will be taking everything I learn back to the more than 11,000 patients I support around the world to empower them with the knowledge of what’s possible, which will help them make more informed decisions about their health, making limb salvage their top priority.
You as a physician don’t want to be left behind!
It’s easy to go to conferences and get your Continuing Medical Education (CME) credits in sessions that only affirm your current techniques and tools as being what contributes to your definition of good patient outcomes based on your skillset. It’s easy to find studies that affirm your beliefs as well and look past ones that suggest a different approach. But it takes courage and commitment to improve patient outcomes that truly separates a vascular specialist from a CLI fighter, who goes above and beyond the promise of “do no harm,” and continues to practice medicine in a way that takes life and limb salvage to an entirely new level of consciousness that helps patients to live a better quality of life.
Amputation is harm when there are options available to save that limb, even if it does take maintenance each year to keep that patient on their feet. From my experience with patients in our network having amputations, that too, is a revolving door. Not one of our patients has had just one amputation. So let’s not hide behind this idea of a “revolving door" when it comes to revascularization, as a deterrent for exhausting all efforts to save life & limb. It's no longer an adequate reason for failing to learn new advanced limb salvage techniques that can work if performed correctly on medically appropriate patients. I’ll make you this commitment, that if you learn these new limb salvage techniques, I’ll take it from there and help improve compliance of your patients to critical lifestyle modifications through The Way To My Heart’s walking, diet, and smoking cessation programs, which help improve the long-term patency of your work.
Let’s save life and limb together.
I’ll see you at CLI-C Global Face-to-Face 2022.
Check out the prelim agenda below.