Improving Outcomes for Peripheral Artery Disease

Peripheral Artery Disease (PAD) is a common circulation problem where buildup of plaque in arteries causes reduced blood flow in the toes and legs. Left undiagnosed or untreated, PAD can lead to the more severe disease known as critical limb ischemia, or CLI.  Without diagnosis and intervention, CLI may result inamputation.

Risk Factors

One of the most significant risk factors for PAD is diabetes, especially for those who are over the age of 50.  Other patients who are at high risk include those who are obese, have a history of heart disease or kidney disease, high blood pressure, high cholesterol, other circulatory issues or family history of PAD. Smokers are also at higher risk.

Symptoms for PAD and CLI include:

• Painful cramping in hips, thighs or calf muscles with walking or other activity
• Leg numbness and weakness
• Coldness in lower leg or foot
• Discoloration of the legs or toes
• Sores on toes, feet or legs that won’t heal
• Leg and/or foot pain at rest

“If you have any of these symptoms, you may be at risk of having PAD,” said Richard Neville, MD, director of Inova Vascular Services, associate director of Inova Heart and Vascular Institute (IHVI) and vice-chairman of the Inova Department of Surgery.” We encourage you to schedule time for a screening – either through your primary care physician or a vascular physician. An initial screening is a quick and simple exam – and can help you recognize, diagnose and treat PAD before it becomes CLI.”

Treatment options for PAD include:

• Minimally invasive endovascular procedures, including balloon angioplasty, stents and atherectomy
• Surgical bypass
• Pharmaceutical therapy, including antiplatelet, anticoagulants, statins and aspirin
• Healthy lifestyle
• Proper wound care management and follow up

Closing the Treatment Gap for Women and Black People

In the United States 5 to 10 million people are affected with as many as 10 percent of adults over 40  and 20% of those over 70 having PAD.  Females are equally likely to develop PAD as males and females account for  about 1.5 times more PAD due to longevity. . Although Black people have high rates of PAD, they often are underdiagnosed and, therefore, untreated. And females of all races are less likely to receive PAD treatment than males. Trends in nearby communities like Alexandria,Mount Vernon, Fairfax and Loundoun reflect these national statistics.

“ Both females and Black people tend to ignore the symptoms of PADand when they do have symptoms they often don’t tell their doctor,” said Dr. Neville. “At Inova Health System, we’re working to increase PAD awareness and close this treatment gap.” This can save both life and limb by preventing amputation and preventing death from stroke or heart attack as both can that accompany PAD.

A variety of factors can affect whether patients receive necessary healthcare services.  These can include:

• Lack of reliable or affordable transportation
• Cultural or language barriers
• Financial difficulties
• Lack of insurance
• Time and scheduling constraints (e.g., inability to take time off from work)

Inova’s Outreach Efforts

Inova has a multipronged approach to improving PAD outcomes for people of color and females.  Efforts around our Initiative for Healthcare Equity Disparity and Outreach include:

• Collaborating with the American Diabetes Association on an amputation prevention campaign
• Creating a Limb Preservation Program that creates a collaboration between Vascular Surgery and our Wound Healing specialists
• Educating fellow clinicians on health disparities and early signs of PAD and CLI through events such as the 2022 Wound Healing and Limb Preservation Symposium
• Working with primary care providers to increase PAD screening and referrals
• Increasing patient education and awareness

“Each September, we work to raise awareness of PAD so we can stop CLI in its tracks and prevent amputations” said Dr. Neville. “The statistics are sobering —  as many as 85 percent of diabetes-related amputations are preventable.”

As a member of the CLI Global Society, Dr. Neville is committed to the early diagnosis and treatment of PAD and CLI – and ultimately preventing amputations. As one of the #CLIFighters, he recognizes that amputation leaves patients in pain, with reduced mobility, and at risk for further health complications, including death – when there are other treatment options available

Diabetes management and wound healing strategies are important to help avoid amputation. Learn more about Inova’s Wound Healing Center.