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PAD

Blausen_Peripheral_Arterial_Disease_engPeripheral Arterial Disease (PAD) is a disorder characterized by decreased blood flow to the limbs due to an obstruction or narrowing of the blood vessels, most commonly due to thickening of the arteries and atherosclerotic plaque. Depending on the degree of obstruction of the affected vessel, clinical manifestations can be asymptomatic or can progress from intermittent claudication to Critical Limb Ischemia (CLI, rest pain, ulceration and gangrene), which, in the absence of proper treatment, can lead to amputation:

PAD may causally promote cardiac and cerebrovascular disease by reducing ambulation and therefore reducing the ability to improve cardiovascular status by exercise, as well as by impaired vasodilation and/or vasoconstriction. It is thought that the latter may reduce ejection fraction and cardiac output, reducing oxygen delivery to vital organs during stress, thereby increasing mortality in patients with PAD. PAD is associated with a mortality rate of 32% over 5 years.

Published facts about PAD and CLI:

  • PAD affects 20 million Americans and is expected to grow more than 7% per year [1,2].
  • In the US, PAD's direct costs are estimated to be between $212 and $389 billion[1].
  • PAD affects 12-20% of Americans age 65 and older(3). PAD prevalence increases with age(4).
  • The strongest risk factors for PAD are diabetes and smoking(5)
  • Quality of life for CLI is poor and has been compared to terminal cancer(6-9).
  • 25-40% of CLI patients will not be candidates for traditional revascularization procedures(10-13) and their only option is eventual amputation.
  • There are approximately 150,000 cases of CLI per year in the United States(14)
  • There are more than 130,000 amputations per year in the United States(15).

Sources:

  1. http://thesagegroup.us/pages/news/pad-aware-2015.php
  2. Deloitte report for Artgene (available upon request)
  3. Becker GJ, McClenny TE, Kovacs ME, Raabe RD, Katzen BT. The importance of increasing public and physician awareness of peripheral arterial disease. J Vasc Interv Radiol. 2002;13:7-11.
  4. Allison MA, Ho E, Denenberg JO, Langer RD, Newman AB, Fabsitz RR, Criqui MH. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32:328-333.
  5. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ,
    White J, White RA, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). Circulation. 2006;113:e463-e654.
  6. Albers M, Fratezi AC, DeLuccia N. Assessment of quality of life of subjects with severe ischemia as a result of infrainguinal arterial occlusive disease. J Vasc Surg 1992; 16: 54-9.
  7. Chetter IC, Spark JI, Dolan P, Scott DJ, Kester RC. Quality of life analysis in patients with lower limb ischaemia: suggestions for European standardisation. Eur J Vasc Endovasc Surg 1997; 13: 597-604.
  8. Chetter IC, Dolan P, Spark JI, Scott DJ, Kester RC. Correlating clinical indicators of lower-limb ischaemia with quality of life. Cardiovasc Surg 1997; 5: 361-66.
  9. Nehler MR, McDermott MM, Treat-Jacobson D, Chetter I, Regensteiner JG. Functional outcomes and quality of life in peripheral arterial disease: current status. Vasc Med. 2003 May;8(2):115-26.
  10. Iafrati MD, et al. Early results and lessons learned from a multicenter, randomized, double-blind trial of bone marrow aspirate concentrate in critical limb ischemia.J Vasc Surg. 2011 Dec;54(6):1650-8. Epub 2011 Oct 21.
  11.  Norgren L, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).J Vasc Surg. 2007 Jan;45 Suppl S:S5-67.
  12. Fadini GP, et al. Autologous stem cell therapy for peripheral arterial disease meta-analysis and systematic review of the literature.Atherosclerosis. 2010 Mar;209(1):10-7. Epub 2009 Aug 21.
  13. Sprengers RW, et al. Progenitor cell therapy in patients with critical limb ischemia without surgical options.Ann Surg. 2008 Mar;247(3):411-20.
  14. TASC Working Group. Critical limb ischemia. J Vasc Surg 2000; 31: S20-34.
  15. Dillingham TR, et al. Limb Amputation and Limb Deficiency: Epidemiology and Recent Trends in the United States. Southern Medical Journal 2002; 95: 875?83.