Fundamentals of Limb Salvage and Disparities: Global Perspectives


In this special, extended roundtable episode, The PVD Channel welcomes vascular disease specialists Lorena Henderson, APRN, and Drs. Fabrizio Fanelli, Bryan Fisher, and Jason Mendivil as they share their individual perspectives on the fundamentals of limb salvage and the disparities in treatment that impact our CLI patients. Learn directly from experts across the care team as they cover the basics, building toward in-depth examinations of individual patient cases, focusing on below-the-ankle interventions in Europe and the US and the ideal tools and approaches to help our patients avoid amputation.

Learning Objectives

After completing this activity, the participant should be better able to:

  • Identify the drivers of disparities in care among CLI patients
  • Outline how to utilize a multidisciplinary approach in which the CLI patient is at the center of care
  • Describe the value of IVUS imaging in the treatment of complex peripheral vascular disease
  • Discuss how to incorporate GLASS Staging to predict technical, clinical, and hemodynamic outcomes following infrainguinal revascularization for Chronic Limb-Threatening Ischemia (CLTI)

Target Audience

The educational design of this activity addresses the needs of Interventional Radiologists, Vascular Surgeons, Vascular Specialists, Nurse Practitioners, Radiologic Technologists, and Vascular Allied Health Professionals involved in the treatment of patients with peripheral vascular disease.

Bryan T. Fisher, Sr., MD

Bryan T. Fisher, Sr., MD

Tri-Star Centennial Medical Center
The Surgical Clinic
Nashville, TN, USA

Dr. Bryan T. Fisher is both an expert in limb preservation and a nationally recognized vascular surgeon at Tri-Star Centennial Medical Center in Nashville, Tennessee. Uniquely qualified to address the challenges and solutions aimed at the delivery of high-quality patient care, Dr. Fisher is consistently recognized by his peers as a caring professional and respected colleague in the Nashville community.

Dr. Fisher graduated with honors from Tennessee State University and became a Ronald McNair and MARC Scholar. He was accepted into the UW Madison School of Medicine and Public Health, but deferred one year to teach elementary school in an underserved Virginia community. After medical school, Dr. Fisher completed a five-year general surgery residency at The Ohio State University under Dr. E. Christopher Ellison. He then culminated his surgical training at Vanderbilt University under Dr. Thomas C. Naslund.

Board-certified in Vascular Surgery, Dr. Fisher serves as the Chief of Vascular Surgery, Director of Wound Care, and co-Director of the Center for Limb Preservation HCA Healthcare's Centennial Medical Center, and is a member of The Surgical Clinic in Nashville. As Chief of Vascular Surgery at Tri-Star Centennial’s Heart and Vascular Center, Dr. Fisher provides his leadership and vision of providing cutting-edge, personalized, high quality care for patients with vascular disease.

Dr. Fisher specializes in complex open, endovascular and hybrid techniques in the treatment of aortic disease and lower extremity occlusive disease. Under Dr. Fisher's leadership, Tri-Star Centennial Medical Center has become a national leader in providing a multidisciplinary approach to vascular disease.

Lorena C. Henderson, APRN, MSN, FNP-C

Lorena C. Henderson, APRN, MSN, FNP-C

Administrator and Clinical Director
PULSE Amputation Prevention Centers
Clinical Research Coordinator
El Paso Cardiology Associates
El Paso, TX, USA

Lorena C. Henderson is a Family Nurse Practitioner and the Administrator and Clinical Director of the Amputation Prevention and Patient Care Coordination Program at PULSE, a novel multidisciplinary program focused on wound and vascular management and limb preservation.

She also serves as Clinical Research Coordinator for El Paso Cardiology Associates, under the direction of Dr. Laiq Raja, MD.

Lorena earned her Bachelors of Science in Nursing at the University of Texas at El Paso and completed her Masters of Science in Nursing as a Certified Family Nurse Practitioner at the Texas Tech University Health Sciences Center School of Nursing in Lubbock, Texas.

Credentialed at all of the Hospitals of Providence (Sierra, Memorial and Transmountain) and Las Palmas Medical Center in El Paso, Lorena practices under the specialty of cardiology. She has focused specialization in the treatment and management of critical limb ischemia and amputation prevention under the direct supervision of Dr. Laiq Raja, MD, one of the country’s foremost experts in the treatment of critical limb ischemia, who is the director of the Amputation Prevention Program at the Hospitals of Providence as well as PULSE Amputation Prevention Centers.

A published author in Cath Lab Digest and Endovascular Today, Lorena has assisted in the development and initiation of a CLI and Amputation Prevention Treatment Program in collaboration with a local healthcare system as well as being a co-founder of PULSE Amputation Prevention Centers. Early in her career she was also involved in the development of heart failure program initiatives to establish dedicated heart failure clinics. Lorena is a member of the Sigma Theta Tau International Honor Society of Nursing.

Fabrizio Fanelli, MD, EBIR

Fabrizio Fanelli, MD, EBIR

Director, Vascular and Interventional Radiology
Careggi University Hospital
University of Florence
Florence, Italy

Dr. Fabrizio Fanelli is a Professor of Radiology and the Director of the Vascular and Interventional Radiology Department at Careggi University Hospital, University of Florence. Dr. Fanelli is certified by the European Board of Interventional Radiology (EBIR).

An active researcher, Dr. Fanelli has participated in more than 20 clinical research studies and has authored or co-authored more than 100 scientific publications in peer-reviewed journals. Dr. Fanelli has also authored 4 books and co-authored 19 books on radiological-interventional sciences and has been an invited speaker at more than 400 international congresses.

Dr. Fanelli has been involved in more than 90 training courses on endovascular techniques, serving as organizer and co-organizer of several international and national courses.

Dr. Fanelli is an active member of the Italian Society of Medical and Interventional Radiology (SIRM), European Society of Radiology (ESR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE), Society of Interventional Radiology (SIR), and the Italian College of Interventional Radiology (ICIR).

He currently serves as a member of the program committee of Interdisciplinary Endovascular Aortic Symposium (IDEAS) and is responsible for the organization of CIRSE’s “PAD Day” Symposium. Dr. Fanelli is also an editor for EURORAD, a publication of the Vascular and Interventional Radiology section of ESR, and an Associate Editor of JVIR and CVIR Endovascular and Diagnostics. He also serves on the editorial board and as a reviewer for several other medical journals.

Jason M. Mendivil, DPM

Jason M. Mendivil, DPM

Foot and Ankle Physician and Surgeon
Orthopaedic Surgeons Associates
Director of Surgery and Wound Care
PULSE Amputation Prevention Centers
El Paso, TX, USA

Dr. Jason Mendivil is a native El Pasoan and graduated from Americas High School in 2002. He attended Trinity University for his undergraduate degree and went on to obtain his Doctor of Podiatric Medicine (DPM) degree from Barry University in Miami Shores, Florida in 2013.
Dr. Mendivil completed a three-year foot and ankle and reconstructive rearfoot surgery residency training at Southern Arizona Veterans Affairs Healthcare System in Tucson, where he worked closely with an amputation prevention and limb salvage team.

Dr. Mendivil has extensive training and experience in limb salvage surgery and advanced wound management, including diabetic foot wounds and reconstructive surgery. He has become well known as a limb salvage expert and continues to advance the field of podiatry through research and development of new treatments. He is a leader in his field, using advanced treatments for wound healing, such as autogenous stem cell therapy and platelet-rich plasma for advanced wound management.

Dr. Mendivil is experienced in performing the most advanced foot and ankle reconstructive surgical procedures available for limb preservation and amputation prevention. He serves on the Editorial Board for Ostomy Wound Management (OWM) and is a member of the American College of Foot and Ankle Surgeons, American Podiatric Medical Association, and the American Academy of Podiatric Sports Medicine. He is also one of the founders of PULSE Amputation Prevention Centers, currently serving as the Director of Surgery and Wound Care.

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Educational Awareness Solutions. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credits commensurate with the extent of their participation in the activity.

ABIM MOC Recognition Statement

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.5 medical knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Nurse Practitioner Continuing Education

This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Educational Awareness Solutions. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 1.5 contact hour(s) (which includes 0.0 hour(s) of pharmacology).

American Society of Radiologic Technologists

This activity has been reviewed and approved for 1.5 Category A CE credits by the ASRT.

European Board for Accreditation in Cardiology

This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC) for 1.0 hour(s) of external CE credit(s). Each participant should claim only those hours of credit that have actually been spent in the educational activity.

Term of Offering

This activity was released on February 15, 2022 and is valid for one year. Requests for credit must be made no later than March 1, 2023.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or

Instructions to Receive Credit

In order to receive credit for this activity, the participant must complete the pre-activity questions, view the program in its entirety, and complete the post-activity questions, evaluation form, and credit request.

Fee Information and Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) adheres to the policies and guidelines, including the Standards for Integrity and Independence in Accredited CE, set forth to providers by the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All persons in a position to control the content of an accredited continuing education program provided by Global are required to disclose all financial relationships with any ineligible company within the past 24 months to Global. All financial relationships reported are identified as relevant and mitigated by Global in accordance with the Standards for Integrity and Independence in Accredited CE in advance of delivery of the activity to learners. The content of this activity was vetted by Global to assure objectivity and that the activity is free of commercial bias. 

In compliance with EBAC guidelines, all speakers/chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CE activities.

All relevant financial relationships have been mitigated.

The faculty have the following relevant financial relationships with ineligible companies:

Name of Faculty or Presenter

Reported Financial Relationship
Fabrizio Fanelli, MD, EBIR 

Consulting Fees: Medtronic
Honoraria: WL Gore, Cook, iVascular
Speaker's Bureau: WL Gore, Medtronic, Cook, Covidien, Penumbra
Advisory Board: Medtronic
Bryan T. Fisher, Sr., MD

Consulting Fees: Philips, Abbott, Shockwave, Veryan, Bard, Cordis
Lorena C. Henderson, APRN, MSN, FNP-C

Honoraria: CSI
Speaker's Bureau: CSI, Philips, Terumo
Jason M. Mendivil, DPM

Nothing to disclose

The planners and managers have the following relevant financial relationships with ineligible companies:

Name of Planner or Manager
Reported Financial Relationship
Kristin Delisi, NP
Nothing to disclose
Lindsay Borvansky
Nothing to disclose
Andrea Funk
Nothing to disclose
Liddy Knight
Nothing to disclose
Ashley Cann
Nothing to disclose 
Maria DelCegno
Nothing to disclose
James Miller
Nothing to disclose
Daniel Romanowitz
Nothing to disclose
Paul J. Gagne, MD, FACS, RVT
Consulting Fees: Boston Scientific, Philips, Medtronic, Endologix
Contracted Research: Vesper Medical, Philips, Medtronic, Boston Scientific
Speaker’s Bureau: Cook, Boston Scientific, Philips, Medtronic

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Educational Awareness Solutions do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

System Requirements

An Internet-connected web browser is required.


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