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Ask The Epert: It's Leading Cause of Amputations - What Can Be Done About It?

Ask The Expert: It’s Leading Cause of Amputations – What Can Be Done About It?


Have you ever heard of this circulatory condition that impacts some 20-million Americans?


It’s actually the leading cause of amputations worldwide.



But how often do you hear people talk about it? It’s called Peripheral Artery Disease and if people understood it a bit better it could possibly reduce serious outcomes.


This prevalent condition that can lead to serious outcomes may often go underdiagnosed & undertreated1


Called Peripheral Artery Disease (PAD), when advanced, it’s the leading cause of amputations worldwide, and results in high rates of fatal and non-fatal cardiovascular events2,3


Peripheral artery disease (PAD) is a common chronic circulatory condition that often goes undiagnosed and undertreated.1 In fact, PAD impacts an estimated 20 million Americans,4 yet only 8.5 million are diagnosed.5 


Here's Why You May be Suffering From Diabetic Nerve Pain (and How to Treat It)


If left undiagnosed and untreated, PAD can increase the risk of serious health outcomes such as heart attack, stroke, acute limb ischemia or even a lower limb amputation.6 Despite being largely preventable, amputations can be a devastating complication of PAD associated with high mortality.3



Earlier this year, the American Heart Association (AHA) issued a charge to reduce nontraumatic lower-extremity amputations by 20% by 2030. Despite a steady decline in the rate of amputations in two previous decades, the amputation rate among patients with peripheral artery disease (PAD) and diabetes – the patient group among the highest risk for lower extremity amputations – increased by 50% over a span of only six years (from 2009 to 2015) and the rate of amputations continues to rise in the U.S.3


Ask The Expert: It's Leading Cause of Amputations - What Can Be Done About It?


Further, significant health disparities exist in the prevalence, diagnosis and care of patients with PAD. For example, Black Americans – who have a higher prevalence of asymptomatic PAD, less access to quality vascular care,6 and are at risk for delays in care8 – are up to 4x more likely to have an amputation as a result of PAD compared to White Americans.3


Serious outcomes, including lower-extremity amputation, cannot be effectively prevented if its leading cause, PAD, is not diagnosed and managed.6 By elevating PAD awareness and increasing access to screening and treatment, both patients and physicians can be empowered to better understand the symptoms of PAD, seek care at the optimal time, and have the right conversations at their visits to help reduce the chance of serious outcomes.5



Dr. Geoffrey Barnes, Cardiologist, vascular medicine specialist, and faculty member at the University of Michigan Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, joined me to discuss the importance of early identification, intervention and management of PAD.



About Our Guest



Dr. Geoffrey Barnes is a board-certified cardiologist, vascular medicine specialist, and faculty member at the University of Michigan Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation. His clinical work focuses on anticoagulation care, especially for patients with atrial fibrillation and venous thromboembolism, as well as the care of patients with other vascular disorders.


He is the co-director of the Michigan Anticoagulation Quality Improvement Initiative (MAQI2), a Blue Cross-Blue Shield of Michigan sponsored collaborative quality initiative aiming to improve anticoagulation care for patients in Michigan.


Dr. Barnes received his MD from the University of Michigan Medical School, followed by residency training and a chief medical residency in Internal Medicine at the University of Michigan Health Center. He completed cardiovascular medicine and vascular medicine fellowships at the University of Michigan Frankel Cardiovascular Center. He completed his Master’s in Health and Healthcare Research from the University of Michigan Rackham Graduate School.



Afzal N, Sohn S, Scott CG, Liu H, Kullo IJ, Arruda-Olson AM. Surveillance of Peripheral Arterial Disease Cases Using Natural Language Processing of Clinical Notes. AMIA Jt Summits Transl Sci Proc. 2017;2017:28-36. Retrieved June 2, 2021 from
Norgren L, Hiatt WR, Dormandy JA, Hirsch AT, et al. The next 10 years in the management of peripheral artery disease: perspectives from the ‘PAD 2009’ Conference. Eur Vasc Endovasc Surg. 2010;40(3):375-380. 
Creager MA, Matsushita K, Arya S, et al. Reducing nontraumatic lower-extremity amputations by 20% by 2030: time to get to our feet: a policy statement from the American Heart Association. Circulation. 2021;143(17):e875-e891. doi:10.1161/CIR.000000000000096.
Racial Disparities in Vascular Care. (n.d.). Retrieved June 17, 2021 from https://cardiovascularcoalition.com/our-patients/racial-disparities-in-vascular-care/.  
American Heart Association. Peripheral Artery Disease (PAD) Resources for Patients and Providers. Retrieved April 29, 2021
from https://www.heart.org/en/health-topics/peripheral-artery-disease/pad-resources.
National Heart, Lung, and Blood Institute. Peripheral Artery Disease. Retrieved January 19, 2021, from https://www.nhlbi.nih.gov/health-topics/peripheral-artery-disease
Schuivens PME, Buijs M, Boonman-de Winter L, et al. Impact of the COVID-19 lockdown strategy on vascular surgery practice: more major amputations than usual. Ann Vasc Surg. 2020;69:74-79. doi:10.1016/j.avsg.2020.07.025. Retrieved June 2, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402273/.
Winta Ghidei, Tracie C. Collins, “African Americans and Peripheral Arterial Disease: A Review Article”, International Scholarly Research Notices, vol. 2012, Article ID 165653, 9 pages, 2012. https://doi.org/10.5402/2012/165653 


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