New Guidelines and Risk Factors for Peripheral Arterial Disease

Multidisciplinary care continues to improve outcomes in patients afflicted with PAD (peripheral arterial disease). Vascular surgery should be part of a team that includes wound care, endocrinology, podiatry, and rehabilitation. When you are suffering from a vascular ailment like PAD, it is vital to look at your doctors as a team. Diabetics under the care of an endocrinologist and podiatrist benefit greatly when vascular surgery is utilized, especially if they are experiencing symptoms of PAD.

Symptoms of PAD include:

• leg pain while walking (claudication)

• cramping while walking, requiring you to stop and wait for the cramp to subside

• a resting pain in the middle of the night that feels like the front of your feet are submerged in ice (a painful sensation caused by restricted blood flow)

• wounds on your legs or feet that are non-healing, pale, or causing blue skin discoloration

• toenails that are yellowish, thick, and lacking growth 

The American Heart Association (AHA) and the European Society for Vascular Surgery (ESVS) have included new PAD Risk Factors and Identification, and they are as follows:

• Advanced age of 65 years and older

• Age 50-64 with risk factors for atherosclerosis (diabetes, history of smoking, dyslipidemia, hypertension), chronic kidney disease, and a family history of PAD 

• Age <50 years with diabetes and one additional risk factor for atherosclerosis 

• Known atherosclerosis in other vascular beds (coronary artery disease, carotid artery disease, subclavian stenosis, renal mesenteric artery stenosis, or abdominal aortic aneurysm)

PAD risk-related amplifiers have been newly updated by the AHA and ESVS to identify grave risks for cardiovascular incidents and limb injury or limb loss: 

• Advanced age (>75 years) and Geriatric Syndromes (frailty, mobility impairment) 

• Diabetic patients 

• Current smokers or tobacco users 

• Chronic kidney disease and end-stage kidney disease 

• Polyvascular disease 

• Microvascular disease 

• Depression

If you are experiencing any of these symptoms and have a history of smoking (even if you have quit), are over the age of 50, have a BMI considered overweight, are diabetic, have high blood pressure or high cholesterol, have wounds that just don’t heal, or have a family history of PAD, it is imperative to get referred to a vascular surgeon like Dr. David Nabi to explore your options for the best course of medical treatment.

If you are a patient with “amplified risk identifiers” for PAD, it is paramount to have your doctor take them into account when producing a treatment plan. When you have PAD, it puts you in jeopardy for MACE and MALE, however the amplified risk identifiers increase this jeopardy. MACE is the medical abbreviation for Major Adverse Cardiovascular Events, such as heart attack or stroke. MALE is the medical abbreviation for Major Adverse Limb Event, which can result in limb loss. Major events like these can be fatal, so it is crucial to have the best multidisciplinary team, including an exceptional vascular surgeon like Dr. David Nabi, to help you find the best course of action to mitigate catastrophic episodes.

Peripheral Arterial Disease in diabetic patients can be a recipe for disaster if left undiagnosed and untreated. “Diabetes is a well-established risk factor for the development of PAD and is also associated with MACE and MALE, including CLTI (chronic limb-threatening ischemia) and risk of amputation.” CLTI is a condition that can lead to death and loss of limbs in diabetic patients. Being a diabetic with PAD often results in poor healing outcomes, infection, and in the gravest circumstances, can even result in loss of limbs and fatality. The good news is that with proper interventions and having an excellent vascular surgeon as part of your care team, you can stay one step ahead of catastrophe.

Vascular surgeons utilize revascularization procedures to restore blood flow to body parts that are in desperate need of oxygenation. The key is to have a vascular surgeon who appreciates how vital interventions are in preventing devastating outcomes, which can dramatically improve quality of life for people afflicted with diabetes. Open surgical bypass and endovascular (minimally invasive) procedures are used to address blood flow and atherosclerosis—the buildup of plaque in the arteries of diabetic patients. Depending on the severity of a patient’s disease, a vascular surgeon can strategically ascertain which intervention would be most effective. 

The AHA and ESVS recommend that all diabetic patients with non-healing ulcers or rest pain undergo prompt vascular assessment, including non-invasive testing and, when indicated, imaging to plan revascularization. Screening people with risk factors, especially diabetics, for PAD is paramount toward assuring patients’ health and wellness. The recommendations from the AHA and ESVS deem it appropriate to utilize diagnostic tests like arterial imaging, not just when revascularization is deemed necessary, but when there is a mere “suspicion” of a patient having PAD. The recommendations further state that a patient can still be considered “clinically susceptible” to being afflicted by PAD despite having “inconclusive ABI and physiological tests.”

PAD has become a public health issue because it is unfortunately so underdiagnosed in the United States. The new recommendations that have been brought forth are a tool to try to bridge the gap and get people properly diagnosed with PAD, so they don’t fall through the cracks and become unfortunate statistics. If you have any of the risk factors, take the first step and get screened for PAD. This can be one of the most important screenings to safeguard your health. To schedule a screening, call Dr. David Nabi at Newport Vascular today.