Massachusetts General Hospital has established a specialized vascular surgery clinic designed to provide coordinated care for unhoused individuals with serious vascular conditions. The clinic, operating quarterly since 2023, aims to fill gaps between primary care and emergency treatment by offering comprehensive evaluations and interventions in a single visit.

The initiative grew from recognition that traditional healthcare pathways often fail to reach unhoused patients effectively. Many individuals with vascular issues—such as peripheral artery disease, blocked carotid arteries, or abdominal aortic aneurysms—typically present to emergency rooms only after symptoms worsen significantly, sometimes resulting in dire interventions like amputations. The clinic’s approach seeks to reverse this trend by providing scheduled, integrated care that prioritizes prevention and timely treatment.

Working closely with the Boston Health Care for the Homeless Program, the vascular clinic receives referrals primarily from primary care providers who identify patients at risk during routine visits. These patients often start their care in shelter-based clinics or respite programs but previously lacked streamlined access to specialist services. The new clinic brings together vascular surgeons, nurse practitioners, ultrasound technicians, and medical trainees to conduct wound care, imaging studies, and evaluations of vascular health, including compression sock fittings, all during the same appointment. This model reduces barriers such as transportation difficulties and the complexity of multiple healthcare visits.

For patients like Carlton Haynes, 56, the clinic offers potentially limb-saving treatment: he was quickly referred to the emergency room and then the operating room for removal of damaged tissue from an infected wound to avoid amputation. Others, like 63-year-old Kenneth Bolster—a veteran with a complex medical history including prior amputation and blocked carotid arteries—attended for follow-up on vascular imaging with reassurance and ongoing monitoring rather than immediate surgery. Patients also receive supportive care including meal vouchers and staff escorts to ease their hospital experience.

Providers emphasize that building trust over time is essential for engaging patients who may be hesitant to seek intermediate care. David Munson, medical director for Boston Health Care for the Homeless, noted that many patients come to the clinic based on relationships developed through outreach on the street or in shelters. The vascular program itself was established following the launch of the Limb Evaluation and Preservation Program at Massachusetts General, which focuses on avoiding amputations in peripheral artery disease.

While some patients still arrive with advanced disease requiring urgent intervention, the clinic’s founders aim to reduce reliance on emergency care by promoting earlier detection and management. This preventive model contrasts with traditional healthcare that often intervenes only after complications become severe. By meeting patients “where they are,” the program hopes to improve outcomes for a vulnerable population frequently underserved by existing healthcare structures.