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PAD Program Produces Endovascular Success Story

Testing and treating patients with peripheral arterial disease (PAD) can save legs and lives, as evidenced by one health system’s program that reduced amputation rates by almost 80%.

Julio Sanguily III, MD, recently presented results from a limb salvage program at Martin Health System in Stuart, Florida, at the International Symposium on Endovascular Therapy (ISET) in Hollywood, Florida. The number of amputations at Martin Health System fell by 79% over five years after the center implemented a limb salvage program that provided patients with PAD an angiogram and education program for both patients and physicians about new endovascular treatment options. Approximately 150,000 Americans have leg or foot amputations every year, primarily as a result of poor circulation caused by PAD. Eight to 12 million Americans—one in 20 who are 50 or older—have PAD, according to ISET.

“Fifty percent of patients who have an amputation will never walk again and half of them will die within 18 months,” Sanguily said in an interview with Florida television station CBS 12 last year. “It also costs more to amputate a leg than to prevent it. Amputations cost the US $10.6 million a year. It just doesn’t make sense when you have better options.”

Both angiography and education about new endovascular treatment options—including the option to refer patients with PAD into such a program—are the keys, according to Sanguily.

“Most PAD patients don’t undergo testing to analyze blood flow first, they just have a leg or foot amputated,” Sanguily said in a statement announcing the study presented at ISET. Sanguily is the lead author of the study and a vascular surgeon with Martin Health System. “In recent years there has been a revolution in endovascular therapy, and we’re able to treat calcified and smaller vessels, meaning we can significantly improve blood flow and save limbs that once weren’t considered salvageable. And that saves lives.”

Martin Health System’s program features a multidisciplinary team, including endovascular therapy specialists, podiatrists, and other support staff. Minimally invasive treatments include angioplasty, atherectomy, and hyperbaric oxygen therapy.

As the program expanded, more patients were evaluated and treated each year, but the number who had amputations plummeted. In 2010, 24 of the 84 patients (29%) who were evaluated had amputations; in 2011, 146 were evaluated and 18 (12%) had amputations; in 2012, 228 were evaluated and 10 had amputations (4%); in 2013, 249 were evaluated and 6 had amputations (2%) and in 2014, 500 were evaluated and five had amputations (1%).

That’s a success story.

— Jim Knaub is editor of Radiology Today.