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He said many of the patients he sees have diabetes, high blood pressure and a history of smoking. Often we start feeling pain in our legs and have to stop and rest before we can move again, and we blame it on aging. But Madassery said the underlying problem is often his progressive PAD. If left untreated, it can progress to CLI, which often leads to amputation of toes, feet, and lower extremities if not treated in time to restore blood flow to the tissues.

If a patient undergoes a major amputation above the ankle, the mortality rate is greater than 55%. Madassery said it has a higher mortality rate than most cancers.

“From a national and international standpoint, we haven’t done enough education or awareness about how to prevent patients from getting into this condition. I love the fact that we’re working together to save lives, but we have to work together better to make sure we never have a patient in the later stages of this arterial disease,” Madassery said.

He said many of the patients he helps are admitted to wound care clinics with leg ulcers that won’t heal. He works with wound care physicians, diabetes and infection control specialists who refer patients for suspected PAD.

Symptoms of peripheral artery disease that should be seen

Dr. Madassery said primary care physicians and office physicians should recognize the signs of PAD and ensure these patients are referred to vascular specialists, such as interventional cardiologists, interventional radiologists, and vascular surgeons. said it should. Most of her PAD and CLI patients have diabetes, a history of smoking, and high blood pressure. If you start to experience pain in your legs or thighs when walking, you should be tested for PAD and possibly see a specialist.

A non-invasive test can be performed using the ankle-brachial index (ABI) screening. These testing systems measure blood pressure from the arms and legs and assess the amount of blood circulating in the legs or feet compared to the amount of blood that the patient’s heart is pumping. These measurements can indicate whether a patient is likely suffering from her PAD.

Patients can then be managed conservatively with medications to treat hypertension, diabetes, and cholesterol. If that is not enough because the disease has already progressed to a critical stage, a vascular specialist can intervene with catheter-based or surgical approaches to restore blood flow.

Chicago’s black and low-income neighborhoods reflect higher amputation rates

Rush is located on the west and south ends of Chicago and has a large population of black and Hispanic patients. These areas also include many low-income patients. Madassery said these populations are disproportionately affected by PAD, CLI and amputation rates compared to white and affluent neighborhoods in the Chicago area. He pointed to a heat map from a 2021 American Heart Association (AHA) study that looked at Chicago and several other major cities, noting that these health disparity trends were similar across the country.[1]

“What we are seeing in Chicago does not reflect what we see across the country. Medical deserts with low access to care and late-stage disease detection It’s the same area that has the highest rate,” he explained. He added that these regions often lack healthy food options, which directly contributes to patients’ ability to stay healthy.

Madassery said if patients don’t have easy access to treatment or fear the cost of treatment, they may not even seek help until it’s too late. Black and Hispanic patients sometimes don’t trust mainstream health care providers, where the majority of doctors and nurses are white, he added. Madassery suggests working with community organizations and churches in affected communities to reach these people.

“Everyone needs to work more collaboratively. The biggest thing we’re seeing that is detrimental to patients is that many physicians are working in silos and in fragmented care. If we all keep in mind what the end goal is, it will be easier to treat these patients.” There aren’t many doctors who can treat these patients, but together we can make a big difference. You can make an impact. ”

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