PAD – Roughly 20 million Americans are at risk

An estimated 200,000 patients will suffer avoidable amputations caused by PAD.

Peripheral arterial disease (PAD) is a very significant health risk in the U.S. PAD affects roughly 20 million Americans. The expected number of people with PAD is expected to be 24 million by 2025. Of those diagnosed with PAD, it is estimated that 200,000 patients will suffer avoidable amputations.

Diabetes and smoking are the principal causes of PAD, and about 1 out of every 5 diabetics will develop a limb-threatening problem in their lifetime. When I counsel patients with diabetes about PAD virtually every patient knows a family, friend, or co-worker that has had an amputation. Many patients believe that it is inevitable that they will lose a limb once the process of diabetic foot wounds develops. Patients also know that many of those friends or family have died shortly after losing a limb. The mortality rate after a below the knee amputation is about 50% at 1-2 years. However, limb loss is one of the things today in medicine that can be significantly prevented. Saving limbs ultimately improves life expectancy. Early detection as well as both minimally invasive and surgical treatments are important for limb preservation.

Early detection starts with those that are at greatest risk — diabetics and smokers. This starts with a routine visit with a Podiatrist who is an expert at diabetic foot care along with an evaluation by a cardiovascular expert. Screening for vascular disease with a simple ankle-brachial index test (ABI) will help determine if you have PAD. Controlling diabetes, and smoking cessation are essential parts of medical therapy. Controlling cholesterol with statin drugs and as well as an aspirin regimen will also help prevent or delay the progression of PAD.

Once PAD has progressed to the point of severe rest pain, or wounds that do not heal or are poorly healing, treating the PAD with peripheral intervention is necessary to save limbs. This is termed critical limb ischemia. Patients should seek out an interventionist who does a significant number of procedures each year to have the greatest chance of success. It has been shown that those physicians that intervene on greater than 175 patients a year have the best results. The problem for many patients is that the physician that they see does not do a high volume of patients and if they are unsuccessful with treating, they are then recommended an amputation. Patients should seek second opinions when they have been told they need an amputation below or above the knee as most of these patients have options in experienced hands.

I see about 4 patients a month that have been recommended a major amputation and 95% of these end up with minor (toe or forefoot) or no amputations at all. With technology always evolving it is important to find a doctor that knows how to use multiple modalities. This is another reason why you need to see a physician who does many procedures each year and specializes in endovascular intervention. Knowing how to use multiple new modalities and being on the cutting edge of technology is key to the best outcomes. I pride myself on always staying at the forefront of research, development, and innovation.

Office-based labs (OBL’s) allow patients to be treated safely. These patients go home the same day, often within just a couple hours. OBL’s allow patients to be treated in a more comfortable setting while avoiding hospitals. Staying out of hospitals leads to decreased infections and lower complication rates.

Saving limbs and saving lives is my passion. If you or someone you know may be suffering from PAD please contact us @ 586-944-2800.

Dr. Tom Davis