By Melissa Rosequist
Twitter: @mrosequist_

A team of Scottsdale physicians and health professionals are working to curb the rate of amputations due to low-blood flow — a common, and deadly, disease impacting millions of people yearly.

Peripheral artery disease is a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs. Those at risk include people with diabetes, over the page of 65 and smokers.

PAD is the result of the buildup of plaque in arteries, reducing blood flow to the lower limbs and ultimately leading to extreme leg pain, numbness and eventually gangrene, which later results in amputation. As many as 200,000 people with PAD undergo limb amputations each year, according to the CardioVascular Coalition. If left untreated, PAD can be life-threatening.

In the U.S., nearly 2 million people are living with limb loss — with an average of 507 people continuing to lose a limb every day, officials say.

In Arizona, numbers show 3,257 amputations took place during 2014, performed for a variety of reasons including diabetes and peripheral arterial disease complications.

Further, the rate of amputations is expected to double by 2050 because of increasing rates of diabetes and vascular disease, according to the Amputee Coalition.  In the face of these numbers, one coalition of Scottsdale physicians and health professionals is seeking to curb amputation rates.

“It’s a huge problem, especially with diabetes, smoking, atherosclerosis, it’s a huge, huge problem in the United States,” said Dr. Venkatesh Ramaiah, chief of complex vascular services for HonorHealth in Scottsdale.

Of the 4.9 million cases of PAD, Dr. Ramaiah estimates 4% are treated.

“It’s not only a problem of education, detection and prevention. With current technology, people are inclined to do amputation as the first line of treatment,” Dr. Ramaiah explained. “But the population that we’re dealing with, the 70s, 80s, 90s sometimes — and those patients do not do well with an amputation at all. It’s a huge cost to society.”

--- Dr. Venkatesh Ramaiah

Dr. Ramaiah, earlier this year, became the first doctor in Arizona to perform a skin puncture bypass procedure on a patient with complete blockage in the femoral artery.

HonorHealth hopes an ongoing clinical trial could lead to FDA approval for the procedure as early as next year.

Dr. Ramaiah’s new procedure prevents PAD patients from undergoing incisions in the leg and long hours on the operating table.  These efforts are stemming from HonorHealth Scottsdale Osborn Medical Center, across the street from Scottsdale Stadium, at 7400 E. Osborn Road.

Catching the disease early

Through public outreach and education, the amputation prevention team hopes to see a decrease in patients undergoing unnecessary surgery and limb removal.

“Our amputation rate is in the bottom quartile nationally, so we’re kind of the best of the best of what we do here,” said Ashley Arentsen, a HonorHealth network program manager.

“The goal is to catch everything earlier and modify your risk factors so that you don’t progress the disease to require an amputation.”
Diabetic patients are at the highest risk for PAD, as well as people who are obese, smokers, over 65 or have high blood pressure.

Health professionals stressed early testing, as some patients are asymptomatic.

“They can have those risk factors and not even realize they have these blockages in their legs, and so that’s where it’s really important to talk to your primary care doctors or your cardiologists so you can have early screenings; so we can catch this before you have symptoms that lead to pain,” Ms. Arentsen said.

Ms. Arentsen explained how working with primary care doctors can assist in making sure more patients are checked for the common disease, and at-risk patients are assessed sooner.

“When you do come in to your appointment, they focus on taking socks off and assessing patients’ feet, which you may not think about at your regular physical,” Ms. Arentsen explained.

Ms. Arentsen and Dr. Ramaiah both pointed to data recording amputations per hospital.

“That was something we had identified as an area of improvement,” Ms. Arentsen said of the rate per hospital.

Ms. Arentsen said data showed amputations occurring without trying to save the limb prior to removing it.

“That’s concerning, that no one attempted to save the leg,” MS. Arentsen said. “No one else is really serving this patient population and giving them an alternative.”

Ms. Arentsen said some patients were going out of state for complicated procedures in order to open up the blockages.

Through this, HonorHealth knew they could create a program and have the talent and skill set needed to help those facing potential amputation.
Mr. Ramaiah came to HonorHealth and helped to build the amputation prevention center.

“He was the person when no one else could open up a blood vessel to get blood flow restored to that leg — he was the guy you called,” Ms. Arentsen said of Dr. Ramaiah.

Save a limb, save a life

For Dr. Ramaiah, a host of issues come with amputating one’s limb. From needing work on the second limb, to cost to the patient and quality of life following an amputation. Dr. Ramaiah says if you save a limb, you save a life.

“‘Save a limb, save a life’ has been a motto of ours for a very, very long time,” Dr. Ramaiah said. “That’s what we want to do in the HonorHealth system and across Phoenix, is set up a limb salvage or amputation prevention program.”
Dr. Ramaiah says there’s a direct correlation between amputees and dollars.

“You will save millions of dollars to society,” Dr. Ramaiah said of decreasing the number of amputees.

“People need to know that it’s a huge social, as well as economic, cost to society. They need wheelchairs, ramps in their house — it costs a lot of money. People think there’s such sophisticated prosthetics — these patients generally go into a nursing home and just go downhill; they become bedridden.”

Further, Dr. Ramaiah says data shows that if you do an intervention on one leg, one-third of patients will need work on the other leg within 18 months.
“Amputation is not the way to go. Limb salvage is the primary goal of treatment for these patients,” he said.

Methods such as weight loss, smoking cessation and diabetes monitoring can all help some patients if the issue is caught early enough.

But, Dr. Ramaiah says many people with peripheral artery disease wait until it’s too late.

“The blood supply is so bad that even at rest, your leg starts to hurt,” he said. “This is very typical because patients will say ‘oh it hurts the most at night.’ They have to sleep with their leg hanging down the bed, because the only way they can get blood is by gravity.”

The way to combat the disease, Dr. Ramaiah says, is a multidisciplinary approach that begins with education, patient information and reaching out to family care and primary doctors.