This advertorial is sponsored by Tampa General Hospital.
As the prevalence of peripheral arterial disease (PAD) continues to climb across the U.S. and globally, a pioneering limb preservation program in south Florida is sharpening its resolve to provide cutting-edge treatment specifically tailored to individual patient characteristics, furthering efforts aimed at more precision care.
The Limb Preservation-Peripheral Arterial Disease Program team at Tampa General Hospital (TGH) Heart & Vascular Institute (HVI) and the University of South Florida (USF) is laser-focused on what its new director, Sashi K. Inkollu, MD, calls “functional limb preservation,” a concept that not only encompasses technical and surgical case planning but also drills deep into patient-specific risk factors such as those dictated by their anatomy, disease pathology and functional status.
The TGH HVI is part of a tertiary-level, academic institution that serves a patient population who often present with severe and complex problems. As the only academic health system in the area, volume of cases is robust. That presents an ideal opportunity to continue to trailblaze in the tradition of TGH’s chief of vascular surgery, Jean Bismuth, MD, explains Inkollu.
“We get a lot of patients who have already had prior procedures—for instance, a lot of the bypasses we perform are re-do procedures,” he says. “The difference between TGH and a lot of other hospitals is that many of the patients who we see are complex, and, as such, we have a talented group of surgeons and ancillary staff with the skillset and the tools to handle these complex situations.”
The Limb Preservation-Peripheral Arterial Disease Program, the first of its kind in the region, already provides a truly multidisciplinary, integrated and evidence-based approach to the management and care of patients with complex PAD, continues Inkollu. But as Florida’s population continues to grow—and with it the number of people living in the state with vascular disease—patient volume is following suit. “Vascular disease is rampant and growing across the country, and, of course, a lot more goes into taking care of the sorts of complex patients we tend to see,” observes the USF assistant professor of surgery and associate program director of the vascular surgery residency and fellowship. “At the same time, unfortunately not all medical facilities in the state have an organized or outcomes-based approach to take care of these patients who get interventions or surgery. This can be down to the fact that the procedures these patients received were not indicated, or because the wrong decisions were made for their care.”
That TGH-USF evidence-based approach to care includes access to the latest in devices that have the potential to push beyond the current frontiers of PAD treatment.
“We are looking at newer devices that can tackle aggressive disease patterns, such as in the setting of heavily calcified lesions, where arteries simply cannot be traversed with conventional techniques,” says Inkollu. “For example, we recently performed a procedure on a heavily calcified lesion in an elderly lady using a newer crossing catheter. This is a patient who would not otherwise have tolerated a bypass, and we were able to cross this lesion with this device, enabling us to avoid a bigger operation for someone who is an elderly patient with multiple medical conditions.
“We are enrolling in several clinical trials, such as in the use of drug-coated balloons [DCBs] in vascular beds where we currently have less data. We are also involved in comparing different techniques and approaches to the use of stents, as well as intravascular lithotripsy [IVL]. All in all, we are currently either enrolled or in the process of enrolling in trials of these different minimally invasive technologies. We aim to tackle PAD on every front, with the overarching mantra that the answer is not always the same for every patient.”
That customized approach to the patients who present marries the academic with the innovative, which follows a tradition set by TGH chief of staff and USF chair of surgery Murray Shames and furthered by vascular chief Bismuth, whose career in vascular surgery has been defined by a commitment to innovation in the field.
“I feel there is role for every tool,” says Inkollu. “At the same time, you have to really establish which device fits which pathology, and for whom it will be successful in terms of the technique deployed. The advantage of being in a place like TGH is that you have a huge clinical volume, so even though we are enrolling and using these devices—deep vein arterialization, crossing catheters, DCBs—we have enough patient volume to be able to perform a meaningful number of procedures with each of them and, thus, provide a long-term difference in patient management.”
Inkollu spent part of his vascular training working alongside Bismuth in Houston, itself a traditional breeding ground for innovation in vascular disease treatment. He was drawn to reunite with his former partner in part because of the opportunity it presented to break new ground at TGH.
“Dr. Bismuth’s vision is crystal clear and highly impressive: his CV speaks for itself about how he consistently has dedicated his life and career to innovation and making a huge difference in the care of patients and to the field of vascular surgery in general,” says Inkollu.
“I myself want to crystallize the picture of limb preservation as more one of ‘functional limb preservation,’ where we already have a plan from a technical and surgical standpoint, but also have an approach, in the pre- and postoperative setting, of individual risk factor identification and preserving limb function. This means not only medical risk factors, but also lesion or anatomic, with the aim of helping us identify disease and what device actually works for some patients more than others. There is a lot of innovation and research in the aortic field in the use of preoperative assessment and planning for complex aortic cases, as well as in, to some extent, pulmonary embolism care, where there is a role for artificial intelligence [AI] in terms of patient management. But there is very little in the management of PAD.”
Inkollu wants to drive this kind of innovation in PAD care through the TGH Limb Preservation-Peripheral Arterial Disease Program. “If we can use patient scans to identify if someone has calcific occlusions or disease, and—based on their symptom duration and risk-factor-profile—create a predictive pattern of success,” he says, “we can then choose a customized technique that will streamline the care of these patients and, at the same time, conserve resource.”
Ultimately, it’s a vision in keeping with the approach to care across the TGH vascular division, Inkollu finishes. “The biggest thing here is we are building a great program with excellent leaders in Dr. Bismuth and Dr. Shames, alongside an excellent group of ancillary staff including nurse practitioners and other advanced practice providers who are focused on providing great care for the Tampa Bay area.”
