Nattawut Puangpunngam
Current Position
Assistant Professor
Faculty of Medicine Siriraj Hospital, Mahidol University
Peripheral Artery Session

Topic: Multidisciplinary team management in CLTI patients


Chronic limb-threatening ischemia (CLTI) represents the advanced-stage peripheral artery disease (PAD). Interdisciplinary collaboration is particularly important for management of this condition spanning from diagnosis to rehabilitation postoperatively. Siriraj Hospital has established the CLTI multidisciplinary team since 2015 that later evolved to Siriraj Vascular Center (SiVasc) in 2020. The evidence-based protocol has been implemented to organize the patient-oriented care process. All CLTI patients will undergo vascular non-invasive test by vascular technician to confirm the state of critical limb perfusion. Then, proper imaging studies are arranged for treatment planning. Pre-operative evaluation and preparation are completed by anesthesiologist and related specialties, mostly cardiologist given that the leading cause of PAD is atherosclerosis and cardiovascular co-morbidities are common among this population. Gathering all the relevant information, the decision of revascularization options and treatment plans are discussed and made among the forementioned multidisciplinary team and the vascular surgeon. In case that the tissue loss is extensive, plastic surgeon, podiatrist and rehabilitation physician are then primarily involved to plan foot reconstruction and its related functional issues. Finally, specialized vascular nurses take an important role in screening, counselling, and conducting the health literacy process for the patients throughout the continuum of care from registration to the CLTI clinic to the scheduled postoperative surveillances. As a result of implementation of this care pathway and its many revisits later on, we have achieved the improvement in our patient outcomes in terms of limb salvage rate, morbidity, mortality, and importantly the quality of life compared with the eras before the protocol.