Identifying and Managing Vascular Disease in Primary Care: A Q&A With Family Physician Kabiul Haque, MD

At the 2025 Family Medicine Experience (FMX) conference in Anaheim, California, Patient Care® sat down with Kabiul Haque, MD, to discuss the critical role primary care physicians play in identifying and managing vascular disease. Dr Haque shared practical strategies for early detection of peripheral arterial disease (PAD), current abdominal aortic aneurysm (AAA) screening guidelines, and the importance of building strong patient relationships to improve outcomes.

Dr Haque is a clinical assistant professor of family medicine and codirector of population health at Ochsner LSU Health System in Shreveport, LA.

Early Detection and Management of Peripheral Arterial Disease

Patient Care: What are some of the most effective ways primary care physicians can identify and manage peripheral arterial disease early to prevent disease progression?

Kabiul Haque, MD: Primary care has an important role in preventing and diagnosing PAD, or peripheral arterial disease. The first thing is that we have to take a good history. If a patient comes in with leg pain—we call it claudication—the patient feels leg pain after walking 10 or 15 minutes. Taking the history is the first thing to identify this.

If a patient tells you they're having leg pain or claudication, then we have to ask: Are you smoking? Smoking is a big risk factor. Male gender is a risk factor. Also, other cardiometabolic diseases—for example, diabetes or hypertension. Taking the history is very important if the patient has leg pain and risk factors.

Then we diagnose the patient with PAD initially, and we have to run diagnostic tests. We get what we call an ABI—ankle-brachial index test—and then we get an ultrasound for the lower extremity. If the ultrasound confirms that the patient has peripheral arterial disease, we have to make sure we send the appropriate referral depending on the diagnostic findings.

If the ABI is 0.7 to 0.9, that's mild. If it's between 0.4 to 0.7, the ABI is moderate. In that case, you refer the patient to a vascular surgeon. But definitely we have to start the patient on aspirin if there's no contraindication. Aspirin is a blood thinner, so it thins the blood and the patient will feel a little bit better.

"To prevent progression: stop smoking, aspirin, and statin. Those are three things you can do to prevent further progression."

Besides starting aspirin, the other thing you have to do is smoking counseling. You have to make sure you counsel every patient who smokes cigarettes and has PAD. If you can stop smoking, that will further prevent the progression of PAD.

Also, start cholesterol medicine—a statin. Statin is very important. According to the USPSTF recommendation, you have to bring down the cholesterol level almost 50% after the initial diagnosis. If the patient has cholesterol of 100, you need to aim to bring it down to less than 70. Seventy is the cutoff. You can start a statin, and if the statin doesn't work, you can also have other choices like ezetimibe or Repatha.

To prevent progression: stop smoking, aspirin, and statin. Those are three things you can do to prevent further progression. Also, you can recommend the patient do exercises. Exercise will increase the blood flow in the arterial system in the leg, so the patient will feel better. So if I tell you—aspirin, smoking cessation, statin, and exercise—those are four things that as a primary care doctor you can tell patients to prevent further progression of PAD.

AAA Screening: Guidelines and Patient Engagement

Patient Care: Can you walk us through the current screening criteria for AAA and how PCPs can integrate this into routine practice?

Kabiul Haque, MD: The current USPSTF criteria for AAA: men who have ever smoked cigarettes, age between 65 to 75, they should be screened at least one time in their life by ultrasound for AAA. That's the USPSTF guideline.

All primary care physicians should ask the patient—if it's a male—have you ever smoked cigarettes? If the man has ever smoked cigarettes and is between 65 to 75, they should by default offer the patient: Have you ever done an AAA screening test? If the patient says no, then they should convince the patient, yes, you need to get the AAA screening test.

Sometimes it's difficult to convince the patient. The patient might think, I'm going to get an ultrasound—is it going to cost me money? And if I get diagnosed, then what will happen? Sometimes patients can get confused or scared. But as a doctor, as a primary care physician, it's our job to tell the patient, yes, it is needed, and usually the insurance covers it because it's a preventative test. You're 65 to 75, you smoked cigarettes, and you're a man—insurance will cover you for at least one ultrasound to rule in or rule out AAA. And then if it comes back positive, if you have an AAA, we can definitely help you get to the vascular surgeon. Or if your diameter size is not too big, then we can also medically manage that or optimize the care to help you live further.

Managing Stable and Unstable AAA: A Coordinated Approach

Patient Care: Once AAA is detected, what are key steps in management and referral? And how should primary care teams coordinate ongoing follow-up for stable versus unstable patients?

Kabiul Haque, MD: AAA can present as stable or unstable. Let's talk about unstable first. Let's say somebody has AAA and it ruptured. We see this as primary care doctors a lot of times in the emergency department or in urgent care. If it's already ruptured, it's too late—you need to call the vascular surgeon right away. You cannot delay at all.

Sometimes the vascular surgeon tells you it's already ruptured, they cannot help you, it's too big. In that case, the primary care physician, hospitalist, or ER doctor has a big job. Sometimes the family and the patient want to know how long I'll live. It's already ruptured, my condition is bad, I'm having abdominal pain—how long will I live? Research shows that a patient can live between two to seven hours based on their risk factors, comorbidities, and blood pressure. If it's unstable, already ruptured, and the surgeon cannot do anything, at least you can tell the patient or the family it's time, probably, for palliative care. Depending on the situation, the patient can live between two to seven hours. That's for the unstable patient.

Follow-Up Protocols for Stable AAA

Now let's talk about the stable patient. Let's say the patient comes to you and you got the ultrasound done and you see the size of the diameter. If it's less than three centimeters diameter, then usually the risk of rupture is almost zero every year. If it's three to 3.9 centimeters, there's some risk of rupture, so you need to rescreen or do surveillance every three years.

If it's more than 3.9—let's say four to 4.5—then you should do surveillance every 12 months. And definitely, on the initial diagnosis of AAA, you always refer the patient to the vascular surgeon. That's what the Society of Vascular Surgery recommends. Anytime you diagnose a patient with AAA, you refer them to the vascular surgeon. That's the first thing.

If it's between four to 4.5 centimeters, you do surveillance every 12 months. If it's 4.5 and above, it's every six months. The Society of Vascular Surgery usually does the intervention between five to 5.4 centimeters for females and 5.5 centimeters and above for males. Make sure you refer the patient whenever you diagnose. But at four centimeters, definitely you need to keep in touch with the vascular surgeon.

"You also have a big job as a PCP: you have to make sure the patient's risk is mitigated."

You also have a big job as a PCP: you have to make sure the patient's risk is mitigated. For example, if the patient has cardiovascular risk, if the patient has high blood pressure, you have to bring down the blood pressure. Your goal should be 130 over 70, or maybe even less, 120 over 70. That's the first thing—taking care of the blood pressure.

The other thing is statin. You have to make sure the patient is on cholesterol-lowering medicine. You have to bring down the cholesterol to 70. Also, smoking cessation counseling. So three things are very important: as a primary care doctor, you can work with the vascular surgeon to help the patient. That's for the stable patient—definitely work with the vascular surgeon and work together to help the patients.

DVT Diagnosis: Clinical Pearls and Cautionary Tales

Patient Care: What are the most challenging diagnostic scenarios for venous disease that you've encountered, and what clinical pearls can help primary care physicians avoid missing these diagnoses?

Kabiul Haque, MD: Venous disease can be many things, but the most common one we encounter is deep vein thrombosis, or DVT. DVT can be easily diagnosed, but sometimes it can be challenging.

For example, I was working in the emergency department about two months ago. I had a patient—she was about 55 years old, female. She came to the emergency department. Her only complaint was that she passed out. She went to the funeral for her brother, and she was standing and suddenly she passed out. That was her only complaint. She thought maybe she'd go check in the emergency department.

She came in. Her vitals were fine, almost, but she was a little bit tired. Her heart rate was about 105 to 110, but oxygen saturation was normal. She did not have any other symptoms—she did not have any leg swelling, no cough, no blood in the mouth, nothing.

But I asked her, why did you go to the funeral? You have a brother who passed away—when did you come? She told me, my brother passed away and I came to Shreveport about one day ago. I'm from Shreveport, Louisiana, so she lives in Mississippi. That's what I asked: Did you travel recently? She told me, yes, I traveled recently. My brother passed away, so I traveled almost 10 hours from Mississippi to Louisiana. That was the risk factor.

I thought maybe I'd order a D-dimer. D-dimer is a test we do for DVT. The D-dimer came back very high, and I ordered the CT PE. It showed she had a massive pulmonary embolism with right heart strain. That's a big thing, so I had to call cardiology. The patient needed emergent thrombolysis and thrombectomy.

"If somebody doesn't have classical symptoms, you have to take a very good history."

This kind of scenario is very tough to deal with. Sometimes DVT will come with classical symptoms—such as unilateral leg swelling, or sometimes the patient will tell you I'm having one-sided leg pain. That's classical. But if somebody doesn't have classical symptoms, you have to take a very good history. You have to make sure you ask: Do you have any other blood disorder? Do you have any chance of having hyperviscosity? Are you taking any hormones? Do you have sickle cell disease? Have you traveled recently? Are you on any contraception?

You have to take all the history very well in order to come up with a good diagnostic plan. Otherwise, there's a chance you can miss the DVT. And if you miss the DVT, that's not good for your clinical practice, and the patient will suffer for sure.

Key Takeaways for Managing Vascular Disease

Patient Care: If you could emphasize one key takeaway from your presentation that would have the biggest impact on how family physicians manage vascular disease, what would it be?

Kabiul Haque, MD: The key takeaway—I would say that definitely taking the history is very important. If you miss the history, why the patient is having vascular disease, and if you miss the diagnosis, that's the first thing.

The other thing I can tell you: as a primary care doctor, we always have to make sure that we counsel for smoking cessation. We have a lot of patients who are smoking, and it's one of the main causes for vascular disease—if you talk about AAA, if you talk about PAD. Those two things are mainly caused by smoking. As a primary care doctor, we have to make sure we counsel each patient about smoking cessation.

If the patient does not want to try by themselves, we always have to offer them other options: nicotine patch, nicotine gum, or varenicline—Chantix. You can always offer these options to help the patient stop smoking.

Why Choose Family Medicine?

Patient Care: What aspect of practicing family medicine brings you the most professional satisfaction, and why would you still choose this field today?

Kabiul Haque, MD: Honestly, I love primary care because it's one of the specialties where you can build a connection with the patient. If you have a friend and you see that friend all the time every day, you feel like this is my closest friend and you like to talk. You don't go to a friend who you don't see every day for suggestions. Same thing with primary care.

We are the friends of the family members—our patients and their family members. Patients come to you and they ask your opinion. I can give you one example. I have a patient I saw about two weeks ago who has bad peripheral arterial disease. I diagnosed the peripheral arterial disease and referred him to the vascular surgeon. The vascular surgeon told him he needed surgery, but the patient still did not want to get surgery until he got my opinion, because I'm the closest doctor. He always comes to me, and I always show him the pictures.

"We are the friends of the family members—our patients and their family members."

He came to me, and I told him, yes, the vascular surgeon told you you have to get the surgery, and the surgery will benefit you in such a way. After that, the patient went to the vascular surgeon and got the surgery done last week. That kind of connection building—the connection with the patient and the patient's respect—I really like that. It's inspiring for me. That's why I love this profession.

Improving Health Care Access

Patient Care: If you could change one thing about how family medicine is structured or supported in the US health care system, what would it be?

Kabiul Haque, MD: Definitely we have to modify the accessibility. As a primary care doctor, I can feel that we have an accessibility issue. That's the first thing I can tell you. We have a lot of patients who don't have proper access. Either they have poverty, or they don't have insurance, or they have lack of awareness. That's why they don't go to the primary care doctor. Mostly it's the insurance issue—patients cannot afford the doctor. That's one of the number one things we have to help.

If you look at our neighboring country, Canada, they have a universal health care system, so patients can always go to see their doctor anytime. There are some good sides and bad sides too. The good side is that you have accessibility. If you have a simple problem, you can always see the doctor.

Conditions like PAD or DVT—let's say if you don't have accessibility to care, your PAD might get worse and you can have critical limb ischemia, and that's bad. That's too late. But if you have accessibility to the doctor, then you can go to the doctor and you can always get the diagnosis early. I think accessibility is the main issue which we need to work on together so that primary care physicians are always available for patients.

Kabiul Haque, MD, is an emergency medicine physician based in Shreveport, Louisiana. He presented on vascular disease management at the 2025 Family Medicine Experience conference in Anaheim, California.