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How to Manage Complex CLI Patients With Wounds in an Outpatient Program
El Paso Cardiology Associates, El Paso, Texas
At Wednesday’s session on CLI in 2024, Laiq Raja, MD, FACC, FSCAI, from El Paso Cardiology Associates in El Paso, Texas, presented on the effective management of complex critical limb ischemia (CLI) patients with wounds in an outpatient program. His presentation underscored the significant burden of peripheral arterial disease (PAD) in the United States, affecting 20 million people, with numbers projected to rise sharply by 2030. He highlighted the high mortality rates associated with CLI and the alarming rate of amputations, many of which are performed without prior angiographic evaluation, as well as the cost of CLI treatment.
Dr. Raja emphasized that CLI patients are often burdened with multiple comorbidities, making their management particularly complex. Successful treatment requires a multidisciplinary team approach, with constant surveillance of wound healing and perfusion. Central to this approach is having a CLI Program, which focuses on optimizing blood flow to wounds and coordinating care across various specialties, including vascular surgery, interventional cardiology, infectious disease, and wound healing.
He detailed the structure of the outpatient CLI Program at El Paso Cardiology Associates (EPCA), established in 2018. The program performs over 500 PAD procedures annually, serves a broad regional area, and offers around-the-clock support through a dedicated CLI navigator. While the outpatient setting allows for timely and autonomous care, Dr. Raja noted the challenges in managing high-risk patients who may require hospitalization and the limitations in reimbursement for newer technologies.
In conclusion, Dr. Raja highlighted the success of the EPCA CLI program in reducing amputation rates and improving patient outcomes. He stressed that with a well-organized and multidisciplinary approach, it is possible to manage CLI patients effectively in an outpatient setting, reducing the need for major amputations and improving overall patient care.
