In this episode, guest host and vascular technologist Jill Sommerset interviews Dr. Mary Costantino (interventional radiologist) and Dr. Miguel Montero-Baker (vascular surgeon) about their perspectives on an ultrasound-first approach to diagnosing and planning treatment for critical limb-threatening ischemia (CLTI).

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SHOW NOTES

To begin, each doctor shares how ultrasound fits into their practice philosophy. Dr. Costantino is the sole practitioner in her outpatient-based catheterization lab, and she finds that ultrasound provides an opportunity for her to connect with patients and communicate their diagnoses and options in a straightforward manner. She also recognizes the value of investing in advanced ultrasound training for her vascular technologists and for herself, so the practice can function cohesively and focus on providing patient-centered care. On the other hand, Dr. Montero-Baker speaks about the utility of ultrasound in practices across the globe, particularly in resource-limited settings. Additionally, he describes the need for the longitudinal follow up needed to fight this chronic disease process, as well as the need to manage holistic aspects of CTLI such as proper nutrition, wound care, and orthotics. He is currently building a clinical center that will provide these aspects.

We take a moment to reflect on the power of social media as a unifying force for a like-minded “global tribe” of vascular specialists. All three guests can recall numerous instances in which they were inspired by another practitioner, or they were contacted and asked for advice by others. Dr. Costantino adds that social media has helped her realize that there is a strong need for collaboration between interventional radiologists and vascular surgeons, in order to generate treatment options and provide quality patient care. She speaks about the importance of learning from and trusting other specialties.

To wrap up the episode, we examine how innovation in ultrasound technology has largely stagnated with the advent of other imaging modalities and opportunities to better incorporate ultrasound into CLTI care. Dr. Costantino encourages vascular specialists to seek out ultrasound training and let patient symptoms and quality of life guide treatment decisions. Dr. Montero-Baker believes that change is required on the systemic level and he advocates for a move towards value-based care.

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RESOURCES

Ep. 90- Pedal Acceleration Time for Limb Salvage:
https://www.backtable.com/shows/vi/podcasts/90/pedal-acceleration-time-for-limb-salvage

Ep. 229- Ultrasound Series: First Line Imaging for CLTI:
https://www.backtable.com/shows/vi/podcasts/229/ultrasound-series-first-line-imaging-for-clti

Ep. 241- Emerging Techniques of Advanced Ultrasound in No Option CLTI Patients:
https://www.backtable.com/shows/vi/podcasts/241/emerging-techniques-of-advanced-ultrasound-in-no-options-clti-patients

Ep. 155- The Butterfly Story:
https://www.backtable.com/shows/vi/podcasts/155/the-butterfly-story

Advanced Vascular Centers:
https://advancedvascularcenters.com/

Jill Sommerset Twitter:
https://twitter.com/JillSommerset

Mary Costantino Twitter:
https://twitter.com/drcostantino1

Miguel Montero-Baker Twitter:
https://twitter.com/monteromiguel

Society for Vascular Ultrasound (SVU):
https://www.svu.org/

American Vein and Lymphatic Society (ALVS):
https://www.myavls.org/