SOCIOLOGY OF CARE IN PATIENTS WITH SEVERE PERIPHERAL VASCULAR-DISEASE

Peripheral vascular disease (PVD) remains a leading cause of limb ampu tation, resulting in a significant morbidity and disability. This stud y was undertaken to evaluate whether earlier referral of the patients with severe limb-threatening PVD to a vascular surgeon could result in a higher limb-salvage rate. Seventy-one consecutive patients, 48 men and 23 women, with mean ages of 67.1 and 70.4 years, respectively, wer e studied; there were 64 blacks (42 men, 22 women). Risk factors inclu ded smoking (39 men, 20 women) and diabetes mellitus (31 men, 11 women ). The delay in seeking medical attention in patients with rest pain w as 9 to 24 weeks (mean, 14.2), and with nonhealing ulcers the delay wa s 4 to 20 weeks (mean, 6.7). An additional delay of 11.7 weeks was not ed if the patient was seen by a primary-care physician, and only 4 wee ks if the patient was seen in the Emergency Department. Ten primary am putations were performed; 61 patients underwent limb-salvaging revascu larization procedures, with a success rate of 87 per cent; 8 patients had below-the-knee amputation as a result of failed bypass. Delay in r eferral of patients with severe PVD can cause an increase in limb loss .