RS33 - From Prevention to Intervention: A Quality Improvement Program for Peripheral Artery Disease at a Safety Net Hospital

Objectives: Peripheral Artery Disease (PAD) affects over 12 million Americans, disproportionately impacting underserved populations. Patients at safety-net hospitals (SNHs) frequently present with advanced diseases, including critical limb-threatening ischemia (CLTI), leading to high amputation rates (~25% annually). Despite its prevalence, PAD remains underdiagnosed at SNHs due to multiple factors. To evaluate the impact of a structured limb salvage program on outcomes for patients with PAD at an urban SNH, we hypothesize that early identification and intervention can reduce adverse limb events.

Methods: In 2019, we launched a vascular surgery program focused on limb salvage, expanding from 0 full-time vascular surgeons prior to 2019 to 2.5 by 2023. Program initiatives (Figure 1) included multidisciplinary PAD care (2022), establishment of full endovascular capabilities (2023), implementation of EMR-based PAD registry stratifying patients as “At-Risk for PAD” or “CLTI” (2024). Primary outcomes include amputation and limb-salvage procedure rates.

Results: Our registry identified 47,876 At-Risk and 1,301 CLTI patients. Annual CLTI encounters increased from 208 in 2021 to 922 in 2025. Amputation rates peaked early during program implementation (16% in 2022) and subsequently declined, stabilizing at 2.6% by 2024-2025 (Figure 2). The absolute number of limb-saving interventions increased 49 in 2021 to 111 in 2025; however, the proportional rate declined over time, reflecting rapid denominator expansion with broader capture of earlier-stage disease rather than reduced limb-salvage delivery. Using registry data, we initiated dedicated CLTI surveillance clinics, partnered with nonprofit organizations for at-risk screening, and obtained approval for 1.5 additional FTE-vascular surgeons in 2025.

Conclusions: A structured limb salvage program with increased vascular surgeon availability has improved access and outcomes for PAD patients at a SNH. Future steps include expanding EMR based PAD screening, establishing a dedicated CLTI clinic, implementing full-time vascular surgery call coverage, and collaborating with other SNHs to enhance outcome tracking and to standardize interventions.