As chief of UVA Health’s Division of Vascular and Endovascular Surgery, W. Darrin Clouse, MD, FACS, leads a team dedicated to diagnosing and treating complex diseases of the blood vessels. With expertise spanning carotid stenosis, aortic aneurysms, peripheral artery disease, and other supra-aortic and aortic disorders, he brings decades of clinical, academic, and military experience to patients across Virginia.
In this Q&A, Clouse shares practical guidance for referring providers — including what to screen for, key risk factors to watch, when to refer, and how UVA Health partners with clinicians to support patients with vascular disease.
What risk factors should put vascular disease on a provider’s radar?
Hypertension, hyperlipidemia, diabetes mellitus, smoking history, and a family history of cardiovascular disease should all heighten suspicion for atherosclerotic or vascular problems.
How can providers support early detection?
Screening is essential. Providers should be familiar with guideline-based screening for:
- Abdominal aortic aneurysm (AAA): Any Medicare-age patient with any smoking history should have an abdominal duplex.
- Carotid artery disease: Patients with coronary disease or hypertension should have a carotid duplex.
- Peripheral artery disease: Any patient with atherosclerotic risk factors and leg discomfort should have an ankle-brachial index (ABI).
- Renovascular disease: Patients with difficult-to-control hypertension requiring escalating therapy should have a renal artery duplex.
Providers can always reach out to our vascular surgery program with questions about what to look for — early testing makes a real difference.
What’s one thing every provider could start doing today to help their patients?
Dig in on lipid management and smoking cessation. These interventions truly change and save lives.
When should referring providers send a patient to your program?
These circumstances warrant referral:
- Evidence of thoracic or abdominal aortic aneurysm
- Suspected stroke or TIA symptoms with carotid stenosis
- Leg pain with walking or exercise and a reduced ABI
- Any concerning findings in any artery outside the coronary or intracranial circulation
One rare but potentially life-threatening condition to keep in mind is mesenteric artery disease. Older patients with post-prandial abdominal pain, difficulty eating, and unintentional weight loss — especially after a full GI work-up — should have a mesenteric artery duplex or CTA to evaluate for this.
What’s something about vascular surgery you wish more providers understood?
Vascular and endovascular surgery is a unique specialty managing often-misunderstood diseases. We work with a multidisciplinary team to care for patients medically, interventionally, and surgically — and we create longitudinal care plans to support them over time. The breadth of what we manage is wider than many realize.
What’s your approach to working with referring providers?
I enjoy getting to know the providers who refer to me and helping them however I can. They’re on the front lines of healthcare, and their work makes a major difference. I welcome communication and make a point to keep them updated on their patients and share my thoughts on care plans.
How do you approach seeing a newly referred patient?
It’s satisfying to meet a patient who is unsure of what a new vascular diagnosis may mean. I explain the condition, what it means for them, and the full range of management options — whether medical therapy, a minimally invasive procedure, or surgery. Vascular disease can be serious, and many patients don’t understand it well. Helping them gain clarity and confidence in next steps is a privilege.