August 15, 2018
For people with heart disease and diabetes, the possibility of amputation can be a serious concern. They run a higher risk of a blood flow blockage to the legs, which can sometimes become so severe that it leads to the loss of toes, feet, or lower legs.
A new study published August 15, 2018, in the Journal of the American Heart Association has found that procedures to restore circulation may not only save limbs but also improve the odds of living longer compared with amputation. Plus, these revascularization treatments can be less costly.
“Many patients are told amputation is their only option because their healthcare providers lack awareness of currently available methods of revascularization to ward off amputation,” says Jihad Mustapha, MD, lead author of the study and an interventional cardiologist and critical limb ischemia specialist at Advanced Cardiac & Vascular Amputation Prevention Centers in Grand Rapids, Michigan. “This study has shown that both endovascular revascularization and surgical revascularization provide almost equal success for the same patients that were told they have no options [other than amputation]. In my opinion, every patient that has been told they need an amputation should ask for a second opinion.”
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Treatment Options for Peripheral Artery Disease
Both these revascularization procedures are used to treat a severe form of peripheral artery disease called critical limb ischemia. The condition, which most commonly affects the legs, is caused by atherosclerosis, a buildup of plaque on the artery walls that narrows the blood flow. If the blockage becomes too extreme, patients risk developing tissue death (gangrene), deadly infection, and other possible health complications.
The endovascular procedure is a minimally invasive method that widens the narrowed or obstructed arteries, with or without using stents (tubular supports placed inside blood vessels). Surgical revascularization, on the other hand, requires comparatively more invasive cutting into the body so blocked blood vessels can be bypassed with vein grafts.
Longer Lives and Lower Costs With Revascularization
Dr. Mustapha and colleagues analyzed outcomes and healthcare costs over four years from the records of 72,199 Medicare patients who had a diagnosis of critical limb ischemia. They found that survival rates were:
- 38 percent for people with endovascular revascularization (median survival: 2.7 years)
- 40 percent for people with surgical revascularization (median survival: 2.9 years)
- 23 percent for people with with major amputation (median survival: 1.3 years)
Vascularization procedures also proved to be money savers. Annual healthcare costs averaged $49,700 for those who had endovascular treatment, $49,200 for surgical revascularization, and $55,700 for amputation.
Amputation costs more due to extended hospitalization, rehospitalizations, expensive prostheses, rehabilitation, and home care or nursing home care, says Mustapha.
“Early major amputation is both very costly and, more importantly, is associated with very high rates of mortality,” explains Mitchell Weinberg, MD, director of peripheral intervention at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, New York.
“Revascularization with both minimal invasive techniques and surgery reduces costs and is associated with better survival when compared with early amputation,” adds Dr. Weinberg, who was not involved in this study.
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Educating Patients on Treatment Options for Critical Limb Ischemia
Mustapha emphasizes there are no major drawbacks with any type of revascularization, while amputation can have many, including loss of independence, decreased quality of life, and earlier death.
“Those who do survive without a limb have a high chance of losing the other limb within 18 months,” notes Mustapha. “Many with amputation never regain the ability to ambulate again.”
In an editorial response published in August 2018 in the Journal of the American Heart Association, cardiologists Javier Valle, MD, and Stephen Waldo, MD, wrote: “Education about the importance of revascularization for limb salvage among primary care practitioners and ancillary services, like podiatry, are critical to improve outcomes for this condition.”
A Concern for People With Diabetes
People living with diabetes, be it type 1 diabetes or type 2 diabetes, may especially take note of these study results. Well over one-half of all limb amputations (about 67 percent) in the United States are attributable to diabetes and related complications, according to TheDiabetesCouncil.com.
For people with diabetes, managing blood sugar is one of the best ways to prevent amputation or revascularization procedures.
“Every patient with diabetes should take the disease seriously and control their hemoglobin A1C by following their diet, exercise, and medical therapy program,” says Mustapha.
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