Together, let’s change the lives of PAD patients
Our growing community of physicians is dedicated to raising awareness and improving how we diagnose and treat PAD. With your help, we can make a significant impact on your patients’ lives.
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Dr. Fujitani | Vascular Surgeon
Diagnosing symptoms earlier may help prevent progression of the PAD.
Dr. Mustapha | Interventional Cardiologist
PAD awareness is key to treating patients earlier and improving outcomes.
Dr. Katzen | Interventional Radiologist
Communities of physicians are collaborating with one another to set a new standard for limb salvage programs.
Detecting & Treating PAD
Detecting & Treating PAD
Peripheral arterial disease (PAD) may be asymptomatic or present with a variety of signs and symptoms of extremity ischemia. Patients in the early stages of PAD often do not report symptoms or mistake them for normal signs of aging. Detection of asymptomatic PAD is important as it may also identify patients at increased risk of atherosclerosis in other arterial beds. These patients can benefit from medical therapies and lifestyle changes that reduce their risk for PAD progression and myocardial infarction (MI), stroke, and death.1
Risk Factors
Risk factors for PAD are similar to those that promote the development of coronary heart disease. For PAD, markers of inflammation and tobacco smoking are more influential while total cholesterol and body mass are less important though relevant. Other important predictors for PAD are age, high-sensitivity C-reactive protein, systolic blood pressure, socioeconomic status, and lipoprotein(a).2 Diabetes mellitus is a powerful predictor of PAD and has been associated with increased rates of Critical Limb Ischemia (CLI) and amputation.3
Age
High cholesterol
High blood pressure
Diabetes
Tobacco use
Kidney disease
Family history
Ethnicity
Screening Guidelines
The American College of Cardiology/American Heart Association (ACC/AHA) guidelines on PAD have identified the following groups with a higher prevalence of PAD where screening may be appropriate12:
- Age ≥65 years
- Age 50 to 64 years with risk factors for atherosclerosis (e.g., diabetes mellitus, history of smoking, hyperlipidemia, hypertension) or family history of PAD
- Age <50 with diabetes mellitus and one additional risk factor for atherosclerosis
- Known atherosclerosis at other sites (e.g., coronary, carotid, renal artery disease)
- A history of claudication, other non-joint related exertional lower extremity symptoms, impaired walking function, and/or ischemic rest pain
- Physical presentation with abnormal lower extremity pulses, vascular bruit, non-healing lower extremity wound or gangrene, or other suggestive physical findings (e.g., elevation pallor/dependent rubor)
Diagnosis of PAD
Patients at risk for PAD should undergo a comprehensive vascular examination and PAD screening should always include questions related to a history of walking impairment, extremity pain that might be due to ischemia, and the presence of non-healing wounds. Since the presentation of PAD can vary, patients with risk factors for PAD who report no or few symptoms should be asked about functional capacity and decline in activity over time, including exertional non-joint related pain.12
For many patients, a history of risk factors or symptoms of PAD, in combination with physical examination findings, is sufficient to establish a diagnosis of PAD. Patients with atypical symptoms or abnormal physical findings require confirmation with an Ankle-Brachial Index (ABI) to establish the diagnosis of PAD. The ACC/AHA guidelines recommend for patients with a history or physical examination findings suggestive of PAD, a resting ABI, with or without segmental pressures and waveforms, is recommended to establish the diagnosis.12
Clinical classification of chronic lower extremity PAD is based upon the severity of symptoms and differentiates the advanced signs of PAD, tissue loss, such as ulceration and gangrene. The later stages of the disease, ischemic rest pain and tissue loss, are considered critical limb ischemia (CLI).13
Rutherford Clinical Classification
Critical Limb Ischemia
Critical limb ischemia presents as ischemic rest pain with or without tissue loss, such as skin ulceration, diabetic ulcer or gangrene. CLI is estimated to occur in 1 to 2 percent of patients with symptomatic PAD.14
Patients with CLI are at risk for limb loss with an associated 1-year limb loss rate of 20% and a 1-year mortality rate of 20%.15 Estimates show that 33% of CLI patients with amputation will have a contralateral amputation within 3 to 5 years.16 It has been reported in a retrospective analysis, however, that 54% of CLI patients had no vascular procedures performed in the year before major lower extremity amputation.17 Early intervention with the right network is key to reduce the chances of amputation.
Learn More About Detecting & Treating PAD:
Essential Keys to Diagnosing and Treating PAD in Patients with Diabetes
An article featured by Podiatry Today discusses diagnosing PAD in patients with diabetes and associated synergies between PAD and diabetes.
Limb Salvage Programs
A multidisciplinary and integrated approach involving the primary care provider, podiatrist and/or wound care, interventional specialist, and other hospital resources provides optimal medical and surgical care. PAD is a manageable condition. When recognized early and appropriately managed by a limb salvage team, complications that can lead to amputation can be minimized.
Early Intervention With The Right Team Is Key
The key physicians on a limb salvage team are determined by the pathology and stage of the disease. The core team includes clinicians caring for the foot and wounds (podiatrist and/or wound care) along with clinicians focused on the vascular integrity of the lower extremity (interventional specialist). Additional participants in a comprehensive care model may include internal medicine, endocrinology, infectious disease, physical therapy, plastic surgery, nursing, emergency medicine and prosthetics.18 Multiple global studies have shown the effectiveness of a multidisciplinary team in reducing ulceration rates and preventing amputations related to diabetic foot conditions, including PAD.19
Learn More About Limb Salvage Programs:
CLI Advocacy
Economics Of PAD
The total cost of amputation goes far beyond the operating room.
At 5 years, a purely endovascular approach was projected to have a cost savings of approximately 21% versus amputation.*20 Factors influencing the total cost of amputation include procedural costs, nursing home and rehabilitation costs, home healthcare, and medical equipment such as prosthetics and wheelchairs.21
| Years | Primary Amputation | Purely Endovascular Intervention |
|---|---|---|
| 1 | $64,627 | $70,099 |
| 2 | $21,694 | $12,342 |
| 3 | $20,961 | $11,410 |
| 4 | $20,252 | $11,089 |
| 5 | $19,566 | $10,906 |
| Estimated total cost at 5 years | $147,100 | $115,846 |
Quality Of Life
People with limb loss due to CLI experience significantly lower health status, high rates of mortality, and increased risk for cardiovascular disease, obesity, joint and bone issues, plus high rates of depression, and emotional distress.22-27
Studies estimate the 5-year mortality rate for people with an amputation, due to PAD, to be between 50% and 74%, which is higher than colorectal cancer, breast cancer and coronary artery disease (CAD).28-29
Learn More On How To Be A CLI Advocate:
Join The Community
The communities of healthcare professionals involved in the Love Your Limbs™ campaign are taking steps to redefine what it means to treat PAD. Building greater awareness about PAD requires a united effort. Stand with us to help change lives for millions of patients with PAD.
Are you a referring physician looking to connect your patient with a specialist who can treat PAD? If so, use our physician finder tool to discover PAD specialists in your area. If you’re a physician that’s currently treating PAD, join our community of physicians below. You’ll have access to other specialists in your area who are dedicated to improving the treatment of PAD.
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Together, We Can Make A Difference
With the help of a growing community of physicians and healthcare professionals, we can make a difference in the lives of PAD patients.
Dr. Barry T. Katzen | Interventional Radiologist
“If we think about the future of treatment for PAD, we have to start with awareness.”
Dr. Roy M. Fujitani | Vascular Surgeon
“What I as a clinician am most concerned about is when a patient presents with a common PAD symptom, what other areas is the disease affecting.”
Dr. Constantino S. Peña | Interventional Radiologist
“It’s important that we consider the treatment of peripheral arterial disease from a team perspective.”
Dr. Imran Ali | Cardiologist
“Communication is the cornerstone of any successful medical program. And that’s extremely true of a limb salvage program.”
Dr. Jaafer Golzar | Interventional Cardiologist
“The biggest and most important hurdle we overcame was the ability to work with other specialties.”
Dr. David A. Gerst | Podiatrist
“The success of the program is measured by how many amputations are not done. And by the smiling faces of patients who come in and say, ‘I feel so much better.'”
