September is Peripheral Artery Disease (PAD) Awareness Month, a time designated to raise awareness of health problems caused by PAD. In a way, the term “Peripheral Artery Disease” is an unfortunate misnomer – this disease impacts so much more than the periphery of a patient’s life.
Peripheral artery disease causes narrowing or blockage of the arteries that carry blood from the heart to the legs (i.e., the “periphery”), typically due to plaque buildup in the vessel. Patients who smoke, are over age 60, or who have high blood pressure, diabetes, or high cholesterol are at increased risk for PAD. Because these risk factors are more common among African Americans and Hispanics, they are more than twice as likely as whites to have PAD.
Patients with PAD are at increased risk for heart attack, stroke, and even death. If left untreated, PAD may advance to a condition called critical limb ischemia (CLI), which is associated with lower limb amputation. While the rate of lower limb amputations among Medicare patients has declined over the years, health disparities still influence amputation rates; African-Americans are about twice as likely to be amputated as are Caucasians and Hispanics are 50-75% more likely to be amputated as Caucasians.
Patients who have undergone amputation have a higher mortality risk, are often unable to walk again, and are at higher risk for depression. Limb preservation treatments, on the other hand, reduce mortality, improve mobility, and patients are typically able to live independently in their own homes. Not only that, major amputation and associated care costs make it among the most expensive surgical procedures in the country, and Medicare pays for nearly two-thirds of them each year.
Raising awareness and advancing education about peripheral artery disease is part of my professional mission, which I work to advance as a board member for the CardioVascular Coalition and the Outpatient Endovascular and Interventional Society. Both organizations aim to advance quality, community-based care for patients with PAD. As a cardiologist practicing in East Texas, many of my patients come to me suffering from PAD.
Patients often live with debilitating pain in their lower legs for years. The pain, unfortunately is ascribed to various things, such as too much walking, or obscure medical conditions, for which patients may be prescribed ineffective medications and told to perform leg stretches.
For these reasons, many patients do not receive the appropriate diagnosis and necessary vascular intervention, which is due in part to a national lack of understanding of PAD.
Now, during PAD Awareness Month, is the time to change that.
All patients deserve the appropriate, limb-preserving treatment for their PAD, which is why we must work with lawmakers in Congress to advance policies to ensure all Medicare beneficiaries receive appropriate screening and intervention for PAD, so that no one loses a limb that could have been spared. No patient should face amputation without first ensuring that all limb-preserving treatment options are considered.
The first step to reducing avoidable amputations is knowledge. This month, I encourage everyone to understand the symptoms, signs and risks of PAD. Doing so can literally save limbs and save lives.
Dr. Jeff Carr, a board member at the CardioVascular Coalition and the founding and immediate past president of the Outpatient Endovascular and Interventional Society.