We’re Here to Stand Against Amputation with You

A lesser known health condition is making a big impact in the U.S. Every year, about 160,000 Americans undergo an amputation due to peripheral artery disease (PAD).³

That is a significant number for one health condition, and it’s staggering considering that it represents more amputations than all U.S. war-related amputations since the Civil War.

PAD is a common and often underdiagnosed circulatory disease where blood flow to the legs and feet is restricted by the narrowing of blood vessels due to plaque buildup. Left untreated, PAD can lead to amputation and put you or a loved one’s quality of life and long-term health at serious risk.

Amputations result from a variety of factors, including underlying conditions, late-stage diagnosis and healthcare disparities.

• 73,000 amputations per year are patients with diabetes³
• The risk for amputation is 10 times greater in patients who have both PAD and diabetes versus those who have PAD alone¹²
• Critical limb ischemia (CLI) — the advanced form of PAD — carries a high risk of lower limb amputation estimated in 10% to 40% of patients⁶⁰
• African Americans are up to 4 times more likely to have an amputation than Caucasian Americans⁶¹

How to get the best care for PAD

Many people dismiss early PAD symptoms, like pain while walking or cold feet. Instead of talking with a health care professional, they may think these changes are just a normal part of getting older.

But it’s crucial to take these symptoms seriously and to schedule regular medical appointments and have open discussions with your doctor, according to Dr. Jihad Mustapha, Assistant Professor for Medicine at Michigan State University.

“If you have critical limb ischemia (the most severe form of PAD), your chance of dying is higher than colon, breast or prostate cancer,” he says. “Tell your doctor exactly what you’re feeling. With early detection of PAD, there are more treatment options available. Your physician may be able to recommend lifestyle changes or a minimally invasive procedure.”

Are you at risk for PAD?

• Over 50 years old
• A current or former smoker
• Have diabetes
• Struggle with high blood pressure or cholesterol
• Suffer from kidney disease

Reduce the risk of amputation

There are ways to reduce the possibility of amputation in addition to making lifestyle changes.

1. If you exhibit risk factors, talk to your doctor about PAD.
2. If you have received a PAD diagnosis, keep in-office or telehealth appointments to avoid more serious surgical interventions.
3. If a doctor recommends amputation, you can ask for a second opinion. Use our Find a Doctor tool to locate a PAD specialist.

For More Information

There are treatment options available for PAD. Using the Find a Doctor tool to locate a specialist today and talk to them about your options.

Reducing Health Disparities: Black Americans and PAD

Peripheral arterial disease (PAD) is more common in Black Americans than any other racial or ethnic group.⁶³ Black Americans are also twice as likely to get an amputation than White Americans due to PAD.⁴⁷

Why do these health disparities exist? And what can be done to reduce the possibility of amputations for Black Americans who have PAD?   

Black Americans at Higher Risk for PAD

The risk of PAD varies between races, sexes, ages, smokers and people with diabetes. The risk of PAD is about 30% for Black men and 28% for Black women, according to a recent study. In comparison, White Americans and Hispanics have a 20% chance to develop PAD.⁶³

The higher risk for PAD may be due to the prevalence of a number of conditions. For example, Black Americans are more likely to have anemia, high blood pressure and diabetes than White Americans.⁴⁷ Diabetes is especially a problem for Black Americans due to biological risk factors including a combination of body mass index, waist measurement, fasting glucose levels, lipids, blood pressure and lung function, says the National Institutes of Health.

Let’s Not Accept PAD-related Amputations as Inevitable

Unfortunately, amputations as a treatment for PAD have been too normalized within the Black American community:

• Black Americans are approximately twice as like to be amputated as White Americans⁴⁷
• Black Americans have a far greater number of annual amputations⁴⁸

This data suggests that Black Americans have less access to care, are admitted to the hospital when sicker and are more likely to be treated at an Emergency Department.⁴⁷ Additionally, many patients and family members accept amputation as a treatment option from doctors who may not be PAD specialists and/or do not have limb salvage programs.

Amputation should be a last treatment option after exploring other minimally invasive approaches and arterial bypass surgery. Early diagnosis is also important so that PAD can be treated before it even becomes limb and life-threatening. Most physicians will diagnose PAD with a simple non-invasive  ankle-brachial index (ABI). This screening test is one of the best ways to determine if a person has PAD and its level of severity.²³ Not surprisingly due to the higher risk of PAD, African Americans are two times more likely to screen positive for PAD than non-Hispanic whites based on data from the American Heart Association.

Because so many PAD and diabetes-related amputations are believed to be preventable, the American Diabetes Association is working to address this disparity in care and has included The Right to Avoid Preventable Amputations in their Health Equity Bill of Rights campaign that launched in 2020.

For More Information

It’s important for patients and loved ones to question if there are alternatives to amputation. Do your research! Don’t put your mobility and potentially your life at risk. Get a second opinion from a PAD specialist before agreeing to an amputation.

Learn about the treatment options available by using CSI’s Find a Doctor tool. Let’s all work together to reduce the PAD health disparities for Black Americans and the number of unnecessary amputations. 

Partner With Your Doctor for PAD Treatment Options

You’ve suspected for a while that your pain is more than just getting older. Wounds won’t heal. Your skin’s discolored. Maybe you’re experiencing numbness or even burning in your legs and feet.

You might have peripheral arterial disease (PAD). This serious condition can lead to amputation or worse, if left untreated. Fortunately, there are a variety of treatment options available for PAD — from less invasive to more invasive. It’s important to have your doctor or specialist provide a diagnosis early.

Don’t hesitate and suffer with the symptoms in silence. Talk to and partner with your doctor to explore all available treatment options.

The PAD Spectrum of Care

Your doctor or PAD specialist will consider your symptoms comprehensively, evaluate your ankle-brachial index (ABI) results and your overall health. Then they will determine possible treatment strategies. If you receive a PAD diagnosis, your treatment plan may include one or more of the following approaches:

Non-surgical Treatments

• The least-invasive method for treating PAD is through lifestyle modifications.³⁴ These include stopping smoking, managing your diet and exercising regularly.
• In addition, your doctor may prescribe a supervised exercise therapy plan with a healthcare provider before considering medical procedures.
• Your doctor may also prescribe medications to supplement lifestyle changes.⁸ Medicine can help lower high cholesterol and high blood pressure, prevent formation of blood clots and increase mobility while decreasing pain during walks.

Minimally Invasive Treatments

For more advance cases of PAD, your healthcare provider may recommend minimally invasive treatment options²⁰ that are less complicated and safer than open surgery.

• Angioplasty, stenting and atherectomy are endovascular procedures where small catheters are inserted into an artery and maneuvered to the area of blockage where treatment then occurs. Doctors now perform these procedures more commonly than bypass surgery for PAD.³²
  • In angioplasties, doctors insert a small balloon that inflates to reopen an artery.
  • During an atherectomy, a physician removes plaque buildup in arteries using a catheter.
  • Both procedures may be followed by placement of stents to keep the artery open.

Invasive Procedures 

• Arterial bypass surgery is a technique in which the surgeon uses a blood vessel or synthetic vessel to create a new path around a blocked artery. As with minimally invasive treatments, doctors can perform an arterial bypass even if your PAD has developed into critical limb ischemia (CLI)¹⁶ — the worst form of PAD.⁵
• Amputation — the removal of a leg, foot or toe — should be the last option after all other forms of treatment are considered.

See the entire treatment spectrum below. You can use it as a reference when discussing treatment options with your doctor.

For More Information

 Discuss your symptoms with your doctor or PAD specialist to determine if you have peripheral artery disease. Then determine the best treatment plan for you. There is hope!

To get a second opinion on your PAD diagnosis, please use CSI’s Find a Doctor tool to locate a PAD specialist near you.

PAD Treatment Evolution Helps Stop the Disease from Getting Worse

More than 20 million Americans have peripheral artery disease (PAD).¹ However, while so many Americans are affected by PAD, too few are receiving treatment.

PAD is a complex disease. Early detection and getting treatment could help stop the disease from getting worse — and potentially save a toe or leg from amputation.¹⁷

The good news is that there are more treatment options available now for PAD, according to Dr. Chris Boyes, vascular surgeon at Coastal Vein and Vascular Specialists in Palm Beach Gardens, FL.

“Previously, if people had severe disease in the small arteries below the knee, we typically took X-rays and said, ‘okay, we’re done,’ ” says Dr. Boyes. “Then we sent them to the wound care center, crossed our fingers and hoped that the wound healed. If the wound didn’t heal, then we would do an amputation.”

Current PAD Treatment Options

While patients 5 to 10 years ago didn’t have many options for therapy, now there’s a range of possible treatments that avoid amputation, according to Dr. Boyes.

• Lifestyle modifications: Managing diabetes, quitting smoking, eating healthier, being more physically active, and managing cholesterol and high blood pressure may help treat early-stage PAD.
• Minimally invasive procedures: These procedures are safer and provide faster recovery and healing with less pain and scarring. Your doctor may discuss angioplasty or atherectomy procedures to help open blocked arteries.
• Arterial bypass surgery: While minimally invasive procedures are performed now more often for PAD treatment,³² doctors sometimes recommend bypass surgery to treat critical limb ischemia (CLI) ― the worst form of PAD.⁵

The effects of PAD can lead to other severe health problems. If you’re concerned about new symptoms or ones that aren’t getting better, don’t wait to explore your treatment options. There is hope!

For more information

If you’re experiencing nighttime leg pain, pain while walking, numbness or burning sensations, or wounds that won’t heal, talk to your doctor about your symptoms so you can get help as soon as possible. To find a doctor or get a second opinion, use CSI’s Find a Doctor tool to help explore the variety of PAD treatment options available.

Gangrene — A Dangerous Sign of PAD

Do you or a loved one have blackened areas or ulcers on your feet or toes? These are not just effects of old age — and they should not be ignored. In fact, this could be a sign you have gangrene.

Gangrene is the localized death of body tissue, due to a loss of blood supply. This infection can be a serious complication of peripheral artery disease (PAD).

Gangrene is often a sign of critical limb ischemia (CLI), a severe form of PAD. Talk to a doctor now if you suspect you have this limb- and life-threatening problem.

Symptoms of Gangrene

Gangrene is caused when you have restricted blood flow due to infection, injury or a chronic disease. Tissues will die from a lack of oxygen. CLI may be the culprit because it causes plaque buildup in your arteries and a reduction in blood circulation to the legs and feet. Without that circulation, the legs or feet are losing oxygen.

Symptoms of gangrene you should know about include:¹⁹

• Dry and shriveled skin
• Color changes – from blue to black
• Skin that feels cold and numb
• A clear line between the healthy and damaged skin
• A foul-smelling discharge from a leaking sore
• Severe pain near the affected part of the leg, foot or toe

Don’t Risk Amputation

Patients with CLI that goes untreated are at risk for amputation due to gangrenous tissue. Even worse, CLI can put your life at risk.⁴

The amputation rate for CLI patients is estimated to be 25%.⁵ Fortunately, treatment may be able to lessen the amount of amputation that is necessary — or even prevent amputation altogether.

For More Information

Pay attention to changes in your body. Talk to your doctor as soon as possible if you see any signs of gangrene. Only a healthcare professional can diagnose gangrene.

Explore our website to learn more about all of the symptoms of PAD including gangrene, and use our Find a Doctor tool to locate a PAD specialist.

Clearing Up Misconceptions About PAD

Peripheral arterial disease (PAD) affects up 20 million Americans.⁴¹ Yet the disease is not well known — and many people have never even heard of it.

Maybe you know of PAD, but we want you to have the most accurate information! PAD is a dangerous disease and should not be ignored. Read here about common misconceptions so you can recognize the symptoms.

 7 Myths (and Facts) About PAD Symptoms

 There are many false assumptions about PAD, including:

• Myth 1 – PAD isn’t a risk because no one talks about it. Many people don’t understand that PAD is the equivalent of a heart attack for your legs. The disease affects a larger population than cancer, stroke and congestive heart failure.^41–43
• Myth 2 – PAD causes obvious symptoms. One myth about PAD is that it would show up with obvious symptoms, like leg cramping or visible skin or nail changes. However, only 10% of people who have peripheral arterial disease in their legs actually have classic leg pain symptoms, says Medscape. Some people also think that if they have PAD but don’t have any symptoms, that it isn’t that bad. The lack of symptoms may, in fact, be because people cut back on their physical activity and that led to the symptoms going away. If the symptoms return when you walk or exercise more, the PAD is still affecting your health. 

• Myth 3 – PAD only affects older people. While it’s true that PAD disproportionately affects the elderly, abnormal blood flow can occur in people under age 40 due to smoking, diabetes, family history of vascular disease, high blood pressure or elevated cholesterol. 

• Myth 4 – PAD only affects men. PAD was once believed to be a problem mostly for older men. That idea may have caught on because men were more likely to complain to their doctors about the pain. Men are also more likely to be cigarette smokers, with the largest group of smokers between ages 45 and 64. This age range is when PAD is often diagnosed.

• Myth 5 – PAD doesn’t affect a person’s overall health. Some people don’t understand how healthy legs are important to overall health — especially to cardiovascular health. They might not realize that atherosclerosis (or the hardening of arteries) in the legs and feet are potential signs of blockage elsewhere in the rest of the body. PAD could be a sign that you’re at risk for a heart attack or a stroke in addition to PAD’s serious consequences.²¹ 

• Myth 6 – PAD is not fatal. A particularly deadly belief is that PAD only affects a person’s quality of life. But PAD, if left undiagnosed and untreated, can lead to a heart attack, stroke or death regardless of symptoms.¹⁹ 

• Myth 7 – PAD is difficult to diagnose. Patients may not realize the severity of their disease because they’ve just accepted PAD symptoms over time, blaming old age. They may also associate the symptoms with other, more manageable conditions like arthritis. Consequently, a patient may not even mention their pain to their doctor, which limits the likelihood of diagnosis. If you discuss your symptoms with your doctor, there are tests like the non-invasive ankle-brachial index (ABI) test to properly diagnose PAD.

For More Information

People pay a lot of attention to clogged arteries in the heart, chest and neck because we all know that they can lead to heart attacks and strokes. It’s important to remember that arterial blockage can occur anywhere in the body — especially the legs.

Don’t dismiss the signs of PAD due to these myths. Educate yourself and contact a healthcare professional by using CSI’s Find a Doctor tool if you’re concerned about PAD.