Plan

Unusual title, cancer was not mentioned in this article.

Peripheral arterial disease can initially cause pain in major muscle groups on exertion known as claudication, this limits walking distance, the worse the disease, the shorter the claudication distance so covering any distance can be a painful, stop/start affair.

This can have significant impact on quality of life if patient was otherwise active, fit and relatively well.

Outline the contribution that the various tests and interventions made to the medical decisions related to the patient's journey.

Simple ABPI measurement in clinic revealed low values indicating PAD, no mention of contra-lateral ABPI made in article. Duplex ultrasound was requested and this pinpointed SFA stenosis as likely to be the cause of the problem, the image is the article shows an OCCLUDED SFA rather than a stenosis.

Duplex ultrasound is a cheap and extremely accurate way of assessing arterial problems and with experienced staff, it can be used in isolation before proceeding to angioplasty.

I beleive MRA is now the imaging modality of choice as recommended by NICE but this is not easily available in some trusts.

Catherer angio and CT angio are also considered for diagnostic tests but calcification of vessels sometomes confounds CT, plain catherter angio also has risks of intervention and contrast load.

Reflect on the role of MDTs in your area of clinical practice and the contribution that radiology makes.

We have weekly MDTs for vascular surgery/interventional radiology where all NICE guidelines for specific case discussion are followed. Radiology, although interventional, offers less invasive treatment of PAD in those not requiring/not fit to have major leg bypass operations.

We review AAA treatment, carotid stenoses for endarterectomy and angioplasty for PAD stenoses and short occlusions.

Meeting also includes registrars in surgery and radiology, junior doctors, vascular ultrasonographers and vascular nurse specialists.

Meeting is also attended by anaesthetists for the major cases.

Outline the procedures in place for highlighting comorbidities in those attending the radiology department for treatment.

patient admitted to day case unit and no doubt had baseline observations as well as bloods to check renal function, Hb and clotting were taken.

Discuss the implications each comorbidity has within the procedure pathway.

Patient build, diabetes, high BP, inactivity and smoking history are all significant.

Build obviously causes difficulties for access to vessels for ultrasound, access to vessels for caheterisation in angiograph. Diabetes causes calcification of vessel walls making puncture difficult/risky, this also makes imaging less accurate, CT and ultrasound are confounded by calcification. Smoking causes platelet sedimentation within arteries, this builds and solidifies to cause plaque, this may rupture and migrate to occlude smaller vessels more distally, this could happen on intervention. High BP is a common contributor to stroke and allied to PAD this is much more significant.

Reflect on the role of operator during an interventional procedure – how is the ALARP principle applied within your area of clinical practice?

My area of practice is principally ultrasound, whilst there is little evidence that ultrasound is biologically damaging in vivo, studies have noted cell damage whist using colour/pulsed high power doppler so we use the least amount of time of skin contact possible consistent with producing an accurate diagnostic test.

Use the prompts within CPD Now or another reflective model.

Upload your answers to the questions as evidence.

I am an extremely experienced vascular ultrasonographer, I have not learned anything new or anything that changes my prcatice.

the article was read and responded to because it involved my rather narrow area of expertise.

A nice well laid out article, the only issue is that the ultrasound image does not represent a stenosis.

I will contact editorial team.

Put a note in your calendar to review this plan and your action plan progress in 12 months.

Add to the reflection at this time.

I will check for e mail reply to my comments.