Something about a certain road paved with good intentions. I (nor USPTF) am not aware of any evidence that screening for PAD reduces costs, anxiety, or amputations in any population. There is ample evidence that overtreating “low grade” PAD leads to CLTI and, thus, amputation. 1/ https://twitter.com/avastarmd/status/1384194134307602447">https://twitter.com/avastarmd...

Amputation reduction is a noble goal, and PAD education is a must. However, this bill (as written) does not accomplish that. There are scores of patients who present too late along the CLTI pathway, with mail perforans ulcers, with a non-salvageable neuropathic limb months 2/

after a trauma (that would not fall under ‘traumatic’), or a necrotizing infection to which angiography would only delay appropriate, life saving, and empathetic care.

The way to reduce amputations is not to incentivize expensive, invasive angiography and interventions with 3/

questionable cost-effectiveness, but basis like PAD education, DM education, podiatry care, and smoking cessation.

Are there patients with delayed recognition of PAD that contributes to limb loss? Absolutely, but without investing in the basics of care we aren’t going to 4/

move the needle for our patients. This is a harrowing experience for our patients, and we owe it to them to do it in a respectful, sensitive, and empathetic manner. This bill does none of that. /fin @VascularSVS @WashUVascular @stanfordvasc @ReidRavin @ahmedkayssi @sternvascular