Healio: Increased awareness of CLI necessary

Increased awareness of peripheral artery disease and critical limb ischemia is essential to ensuring better management of the disease, according to a speaker at the International Symposium on Endovascular Therapy.

“In the United States right now, undiagnosed and poorly managed PAD, as well as a lack of recognition and aggressive treatment of its risk factors — diabetes, hypertension, hyperlipidemia, kidney disease, tobacco abuse — contribute to fuel the CLI epidemic,” Jihad A. Mustapha, MD, FACC, FSCAI, of Metro Health Hospital in Grand Rapids, Michigan, said during a presentation. “It affects about 1 million Medicare patients per year, with an estimated annual cost of more than $3 billion.”

According to data from CMS, approximately 120,000 amputations are performed annually, and at about $800,000, the estimated lifetime health care costs for a patient who has undergone amputation can be considerable, he noted. Using these data, the expected lifetime cost for all of these patients totals $95 billion.

“When we combine all of these costs, we can see the tremendous burden it places on our government,” he said.

The clinical burden also cannot be underestimated, according to Mustapha. After an initial extremity amputationdue to vascular causes, 27% of patients have at least one re-amputation within 1 year, and 40% progress to a higher level of limb loss within 1 year of an initial toe, foot or ankle amputation — a rate that increases to 62% with comorbid diabetes. Moreover, 55% of those with PAD will have the other limb amputated within 2 or 3 years. In addition to the actual limb loss, this postprocedure transition places a significant burden on patients and their families, he noted.

The mortality rate after amputation is also extremely high and increases with time and ascending level of amputation. Compared with cancer rates, 5-year survival is significantly greater for breast cancer (89.7%) and colon cancer (65.1%) than CLI, which hovers around 17%, according to Mustapha. Raising awareness of breast and colon cancer has led to increased funding and research and decreased mortality, he said, noting that doing the same for CLI would potentially have the same benefit.