How SnapshotNIR can help with amputation prevention and care in Veterans Affairs (VA)

Written By Kent Imaging

In the United States, the Department of Veteran Affairs (VA) provides health care to approximately 9 million veterans annually through the Veterans Health Administration (VHA). VHA provides care at 1,321 health care facilities including 172 VA medical centers and 1,138 outpatient sites of care.

As one of the largest and most complex agencies in the US government, the VA faces many pain points and challenges. Veterans deal with increased healthcare expenses and physical impact of military service that requires high-quality long-term care. In the United States, almost a quarter of all veterans (4.4 million) return from active military careers to reside in rural communities. They can experience rural healthcare challenges that are complicated by combat-related injuries and illness and their increased risk for amputation.

Rates of amputation in the veteran population are higher than the national average likely due to the increase in the prevalence of diabetes and arterial vascular disease too. Many veterans tend to deal with multiple chronic diseases. Approximately 150,000 patients in the United States undergo lower limb amputations annually; of that, 10 percent of the amputations are performed in the VA. The rates of lower extremity amputation due to chronic limb-threatening ischemia (CLTI) in the VHA is substantially higher than in the US population.

Veterans living with limb loss require lifelong care that can range from acute hospitalization after an amputation to long-term follow-up and outpatient care. Integration of surgical services and amputation prevention strategies is critical. Management of this care for veterans requires a comprehensive coordinated transdisciplinary program of services through the continuum of care.

In 1993, the Preservation-Amputation Care and Treatment Program (PACT) was established to prevent or delay amputation through proactive early identification of veterans at risk of limb loss. In 2008, the US Department of Veteran Affairs established a form Amputation System of Care (ASoC) to enhance the quality and consistency of amputation rehabilitation care for veterans with limb loss. A new program was eventually formed, a progression of PACT, called PAVE (Prevention of Amputation in Veterans Everywhere) which follows a veteran from entry into the VA health-care system through all levels of care back into the community.

In 2019, the VA provided care to 96,519 veterans with amputation and half had at least one major limb amputation. The majority of these veterans have limb loss resulting from a disease process such as diabetes mellitus (DM) and peripheral arterial disease (PAD). The most common cause of limb loss is vascular disease which can result in poor blood flow to limbs, causing pain, tissue damage, and wounds that don’t heal correctly.

The standard of care with screening for PAD is taking segmental blood pressure measurements and calculating an ankle-brachial index (ABI) or toe-brachial index (TBI). However, ABI is not reliable in patients with vascular stiffness (often found in diabetics), and it can’t detect early arteriosclerotic development. And while guidelines recommend TBI as an alternate screening method for PAD if there is elevated ABI, there is also not enough high-level evidence that supports TBI as a standalone diagnostic test either.

Because wounds can be deceptive, leveraging near-infrared spectroscopy (NIRS) to assess tissue can help healthcare providers measure critical microvascular levels. We’ve all heard the adage ‘time is tissue’ so reducing the amount of time it takes physicians to start imaging improves the workflow and expedites effective treatment options.

“Snapshot images can be a very important part of vascular screening in the wound care clinic,” says Dr. Charles Andersen, Chief of Vascular/Endovascular/Limb Preservation services (Emeritus) Chief of Wound Care Service, Madigan Army Medical Center, Tacoma, WA. 

“Through the regular use of near-infrared spectroscopy (NIRS) imaging in the Wound Care Clinic at the Madigan Army Medical Center, we have concluded that the oxygenation images captured with Snapshot are very valuable in providing additional data and insight to evaluate the treatment plan,” he says. “This data may be used to change the treatment plan or confirm the continuation of the current course of action. This data also supports the tracking and documentation of the wound healing progress.”

SnapshotNIR is a mobile device that can be used at the bedside for instant screening of PAD in the veteran population because it uses near-infrared spectroscopy to measure the value of oxygen saturation, oxyhemoglobin, and deoxyhemoglobin levels in superficial tissue. It is also a cost-effective, easy-to-use device that can assess how effective a certain treatment is helping with preventing deteriorating patients with PAD. It can impact treatment options and healthcare costs because it allows the health team for any given veteran to compare pre-and post-intervention data.

SnapshotNIR technology also allows for easy integration of images into the patient’s electronic medical record and access to that data enhances communication with other specialty groups caring for that veteran patient. Armed with the rapid results from Kent Imaging’s SnapshotNIR device, physicians and healthcare teams can help improve patient outcomes and care and reduce limb loss rates for the veteran population.

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Kent Imaging
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