Dr. Bryan Fisher Photo by TriStar Centennial Medical Center

By Ashley Benkarski

NASHVILLE, TN — Heart Month is here, and TriStar Centennial’s Dr. Bryan Fisher is spreading the love by educating patients, peers and politicians on the connection between race or ethnicity, vascular disease and amputation rates.

Fisher, Centennial’s chief of vascular surgery, is passionate about limb preservation of patients. He’s supported a national study on the disparities of care African-American patients with complex lower extremity disease receive, engages in patient advocacy within the healthcare community and has moderated a Capitol Hill discussion calling for legislation to require patients receive a vascular workup before undergoing amputation. “I noticed that there was a difference in the level of care and the vigor with which we were going about trying to save people’s legs,” he said. “What I was seeing was actually quite the norm. We have disparities all around the country when it comes to the delivery of cardiovascular care.”

These disparities exist mainly due to a lack of healthcare accessibility and education in the African-American community, with regional variances being the biggest contributor to disparities in amputation rates. “You can go to three out of the six hospitals here in Nashville, and in three of them you’re going to get offered an amputation,” Fisher said. “And then the other three, you probably will not. Someone will probably take the effort to go through and see if they can restore the blood flow.”

To stave off amputation rates Fisher recommends a standardized protocol of treating patients with vascular disease, including checking the patient’s feet for ulcers, drying and discoloration— all signs of a possible blockage. Fisher noted that about 30 percent of patients don’t receive any formal workup before the decision to amputate is made. That’s why he urges patients to seek a second opinion “If that person can’t do anything to make [blood flow] better.”

Providing options for endovascular treatment, such as the use of ultrasound imaging, is also key to mitigating amputations. It allows doctors “to access vessels that otherwise we wouldn’t be able to … and then treat it without having to make an incision,” Fisher said.

Making amputation a bad outcome is another way to reduce rates of amputation, which Fisher says will likely cause doctors to perform a workup of the patient before suggesting major surgery. For many that can mean the difference between life and death, especially when the patient isn’t walking. “These people do poorly,” Fisher said. “50 percent are dead in two years, and many are dead within five.” 

Patients also need to have a regular doctor and seek care when symptoms arise rather than waiting until symptoms become unbearable and going to the emergency room. A primary care physician can catch signs of vascular disease before severity worsens, increasing amputation risk. Co-occurring issues like diabetes, hypertension and obesity further increase risk of amputation, more complex diseases and mortality. 

People experiencing fatigue and cramping pain in the calves and upper legs while walking regular distances may have a blockage. Due to nerve impairment patients with diabetes may not experience pain, making the proper diagnosis more challenging. But Dr. Fisher emphasized that because someone is experiencing these symptoms doesn’t mean surgery is imminent—managing weight, exercise and smoking cessation help to stop the disease progression, and could assist disease regression.

“[TriStar has] the best limb preservation program in this area” and the only hospital with an integrated program of limb preservation and comprehensive wound care, Fisher said. Though he gets a lot of the recognition for leading Centennial’s successful vascular care practice, Fisher quickly credited his team. “One of the things I enjoy about being at Centennial is that the folks in the room with me, they truly care about that patient.”

Fisher plans to continue his advocacy by working with others in finding creative ways to educate such as encouraging pharmacists to identify at-risk patients by their medications and engaging them in conversations about their vascular healthcare risk. He’s also partnered with device companies that share his vision to reduce unnecessary amputations, a move that could bridge the gap of care between hospitals.

For more information on vascular disease and wound care, visit https://www.tristarcentennial.com.