Peripheral Arterial Disease
As many as 12 million Americans are dealing with peripheral arterial disease (PAD), a progressive blockage of the blood vessels that carry blood to the lower extremities. For many of these patients, amputation is the outcome, leaving them without a foot, or in others, half or more of their leg. Medical literature has shown that in these patients, their risk of death within 1 to 5 years of their amputation they have a 40% likelihood of amputation of the remaining leg and a significant risk of death. It’s clearly a serious problem.
But we can reduce the rate of amputation among these patients and we can also reduce the severity of intervention required to address the problem if we catch it early. Dr. Joseph Ricotta, vascular surgeon and director of the Northside Hearth & Vascular program, stopped by the studio to talk about what can be done to improve patient outcomes for those with PAD. We talked about the troublesome statistics around peripheral arterial disease, including the fact that among diabetics with PAD who develop a non-healing wound resulting in amputation, as many as 50% of them never receive a non-invasive study that could prevent the loss of their leg.
That means we need our partners in primary care and foot/ankle surgery to take an aggressive stance when presented with patients who are at risk for PAD or who have a poorly-healing wound on their leg or foot. There are numerous non-invasive studies that take only minutes in the vascular surgeon’s office that can readily identify patients who have blockage affecting blood flow to their feet. In these cases, if caught early, surgeons like Dr. Ricotta have more options and greater probability they can reestablish adequate blood flow that helps a wound to heal, preventing or mitigating extent of amputation.
We talked about the fact that Northside offers access to 2 of the country’s 10 robotic devices that significantly improves the effectiveness of minimally-invasive procedures by allowing the vascular surgeons to access and treat previously-inaccessible locations. Additionally, with the assistance of the robot, the surgeons are able to reduce damage that can occur on the inside of the vessel being treated, which reduces the likelihood that scarring after the procedure will block the vessel off again (a leading cause of reocclusion in PAD lesions).
I also spoke with foot and ankle surgeon, Dr. Michael Bednarz of Ankle & Foot Centers of Georgia, whose office is located in Woodstock, just north of Marietta. He talked about treating PAD patients with wounds from the perspective of the specialist who is tasked with managing the wound and ultimately, treating it surgically as necessary (including amputation when efforts to heal the wound fail and serious infection is a risk).
We talked about the fact that amputation should be viewed as a last-ditch option. And Mike shared that no patient should face amputation without having had a vascular study to determine if poor flow is contributing to the wound not healing. He talked about the fact that when he’s presented with a poorly-healing wound, particularly in a patient with PAD risk factors such as diabetes, one of the first things he does is request a vascular study to assess blood flow. He also utilizes Transcutaneous Oximetry, a non-invasive test that shows how well the tissue at the surface where a wound is located is getting oxygen.
With the results of those studies, he is able to address poor blow flow by referral to a vascular surgeon and/or to hyperbaric medicine (readily available in Atlanta and surrounding suburbs) to address poor oxygen levels in the skin. He also evaluates other risk factors such as glucose levels and presence of infection, often resulting in consults with infectious disease and/or endocrine specialists to help heal the limb-threatening wound. We talked about the fact that a multi-specialty approach insures that more patients can avoid amputation and the resultant high mortality rates that come with them.
Early involvement with an experienced wound specialist, vascular diagnostics/intervention, infection control, and endocrinology are all vital in helping patients avoid an amputation that might also cost them their life.
Joseph Ricotta, MD, Medical Director, Heart & Vascular Institute, Northside Hospital
- Doctor of Medicine, Thomas Jefferson University School of Medicine
- Surgical Residency, Johns Hopkins University School of Medicine
- Fellowship, Vascular Surgery, Mayo Clinic
- Fellowship, Advanced Endovascular Surgery, Cleveland Clinic Foundation
- Associate Professor of Surgery, Georgia Regents University, University of Georgia School of Medicine
Michael Bednarz, DPM, Ankle & Foot Centers of Georgia
- Doctor of Podiatric Medicine, Kent State University School of Podiatric Medicine
- Residency, Department of Veteran Affairs Medical Center, Miami
- Board Certified, American Board of Foot/Ankle Surgery
- Recognized as a “Top Doc” in the WellStar Health System