By Kym McNicholas, Host of The Heart of Innovation Podcast
You will love this story of physicians reaching across borders to save lives and limbs!
While Dr. Phillips had the day off “saving those piggies” (as we like to say), I was joined by guest co-host Jill Somerset, a world-renowned vascular technologist who was recently named the Global PAD Association’s Pioneer of Diagnostics for 2024. Jill has developed a groundbreaking technique called Pedal Acceleration Time (PAT) that’s changing the game for patients with peripheral artery disease.
Our special guest, Dr. Fernando Javier Martinez-Irigoyen, joined us all the way from El Salvador to share how this innovative approach is helping reduce amputations in his country, where approximately 12.5% of the adult population struggles with diabetes.
A Pandemic Partnership
What I loved about their story was how this life-saving collaboration began. During the height of the pandemic when travel was impossible, Dr. Fernando was searching Twitter (now X) for better ways to evaluate diabetic feet. After discovering Jill’s research on PAT Doppler, he reached out through a mutual friend.
“I text Jill and I hope to get an answer,” Dr. Fernando shared during our conversation. “But the amazing thing is that I had an answer in a very, very, very short time. And Jill text me and say, ‘Do you have a WhatsApp? Can we talk?’”
What happened next shows the power of technology to bridge gaps in global healthcare. Jill offered Dr. Fernando a two-hour masterclass via Zoom that Sunday. This virtual training session launched a partnership that has since saved countless limbs in El Salvador.
Why Traditional Methods Fall Short
In El Salvador, like many places, doctors traditionally relied on the Ankle-Brachial Index (ABI), where they measure the differential in pressures from blood pressure cuffs placed on the legs and arms, to evaluate blood flow in the legs. But as both our guests explained, ABI has significant limitations for diabetic patients.
“ABI for people with diabetic foot is not the best thing to perform to know the vascular artery in the foot,” Dr. Fernando explained. The problem? Diabetic patients often have calcified arteries that give false readings when using blood pressure cuffs.
This is where PAT comes in. By using ultrasound to directly visualize the small arteries in the foot, doctors can get an objective measurement of blood flow that’s reliable even in diabetic patients with heavily calcified vessels.
Changing the Amputation Equation
The impact of implementing this technique has been nothing short of remarkable. Dr. Fernando revealed that five years ago, his practice performed about two major amputations every month. After integrating PAT Doppler into his practice?
“Right now we only perform in this year one major amputation,” he told us. One amputation in 2025 so far, despite seeing more patients than ever before.
What makes this even more impressive is that he’s achieving these results in a healthcare system with limited resources. While angioplasty (the procedure to open blocked arteries) is available in El Salvador, it’s expensive and primarily accessible in private practice.
The Technical Breakthrough
What makes PAT so valuable is its ability to classify blood flow into four categories. As Jill explained during our show:
“Class one and class two have pretty decent flow to a diabetic foot ulcer. If the waveform is abnormal and now you have a different class of PAT, which is three or four, we know that a wound is not gonna heal and we need to do some work to open up those blood vessels.”
This clear classification system gives physicians like Dr. Fernando actionable information. If the PAT shows good flow, they can focus on wound care and medical management. If not, they know intervention is needed to restore circulation.
From Virtual to In-Person Collaboration
What began as a virtual partnership soon evolved into hands-on collaboration. In 2023, Jill Somerset and interventional radiologist Dr. Mary Costantino traveled to El Salvador to work directly with Dr. Fernando and his team.
"Dr. Costantino and I went down there and we actually did a case all together," Jill explained during our conversation. "Dr. Fernando and I were down at the foot monitoring the PAT, and Dr. Fuentes and Dr. Costantino were doing the procedure."
This highlights a crucial point about PAT Doppler: identifying poor blood flow is only the first step. The real innovation comes in the comprehensive approach—diagnosis followed by intervention. Dr. Fernando works closely with interventional radiologists like his colleague Dr. Marco Fuentes to open up even the smallest arteries in the foot using specialized wires and balloons.
"We have 0.3 millimeters catheters and balloons to do the angioplasty," Dr. Fernando noted, explaining how they can target vessels that are incredibly tiny.
Their collaborative case demonstrated the full power of this approach. After identifying blocked arteries with PAT, the team performed angioplasty to restore blood flow, and then immediately confirmed the improvement using PAT again. This real-time feedback loop is what makes the technique so valuable in clinical practice.
The Real-Time Validation
One of the most powerful aspects of this technique is the ability to see immediate results. Dr. Fernando described the incredible moment when they perform angioplasty and then use PAT to confirm improved blood flow:
“After they perform the angioplasty, you can measure with the PAT and see the difference after the angioplasty and before the angioplasty.”
This real-time feedback loop not only confirms the success of interventions but also gives patients visible proof that their treatment is working.
Beyond the Technical: The Human Impact
The human impact of this work is incredible. Dr. Fernando described the transformation he witnesses in his patients:
“When we start treating diabetic foods and see the afraid of the face of our patient, come in without not walking, and then you saw the patient return to your clinic, walking by day on with a big smile. That is the best thing I ever saw in my patient when we saved the foot in a diabetic patient.”
Jill and Dr. Fernando regularly exchange WhatsApp messages about challenging cases, with Dr. Fernando sharing before-and-after pictures of patients who were candidates for amputation but now have healed wounds and preserved limbs.
Global Impact and Challenges
Dr. Fernando is now taking this knowledge around the world, with particular interest from physicians in Italy. However, he acknowledged that ego sometimes gets in the way of adoption:
“When you say you have to perform an ultrasound, [some doctors say] go to the radiology. I’m a surgeon. I only perform the surgery.”
This siloed approach to medicine is precisely what our show aims to break down. Innovation happens when specialists collaborate across disciplines and borders.
The Path Forward
For those interested in implementing this technique, Dr. Fernando’s advice is refreshingly simple: just start learning. He began with Zoom training and then took his first post-pandemic flight to Oregon to train with Jill in person.
Now they’re bringing this knowledge back to El Salvador, with plans for a workshop at their upcoming vascular congress where Jill will teach the technique to interested clinicians.
Why This Matters
As we always emphasize on The Heart of Innovation, blood flow is absolutely critical for wound healing. Without it, as Dr. Fernando succinctly put it: “There’s no oxygen, there are no nutrients getting to it. It’s basically starving the tissue of any nutrition.”
He added that there are two primary ways patients end up with major amputations: uncontrolled infection or inadequate blood flow. PAT gives physicians the tools to address the latter with precision and confidence.
This story embodies everything we celebrate on The Heart of Innovation – physicians who refuse to accept the status quo, who reach across borders to share knowledge, and who implement new techniques to save lives and limbs.
To hear the full conversation and learn more about PAT and diabetic limb salvage, listen to the complete episode above.
If you have diabetic foot and/or peripheral artery disease — or even if you simply have neuropathy, leg pain, leg cramps, and/or a wound that won’t heal on your foot, call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS to get more information, assistance with a testing site and advanced skilled diabetic foot and PAD specialist. You can also go to PADhelp.org and join our Facebook Group www.PADsupportGroup.org
The Heart of Innovation podcast is dedicated to sharing stories of medical breakthroughs and the innovative physicians behind them. Join us each week as we explore the cutting edge of vascular care.
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