Rising Incidence Of PAD Should Spur Greater Diagnostic Vigilance And Multidisciplinary Cooperation

David G. Armstrong DPM MD PhD

Evidence continues to mount that the incidence of peripheral arterial disease (PAD) is a devastating complication of diabetes. In the United States, PAD afflicts 2 million to 3.7 million people with diabetic foot ulcers (DFU), according to an analysis published by the Sage Group.1 The group adds that approximately 1 million patients with DFUs suffer from critical limb ischemia.

The analysis drives home the point that the presence of PAD increases the risk of developing foot ulcers. Diabetic foot ulcers accompanied by PAD are more likely to become infected, can be slower to heal and have a higher risk of major amputations and mortality.1

I was surprised at the enormous numbers reported in this analysis. In 2008, my colleagues and I reported on a rather large proportion of both PAD as well as a very high fiscal burden.2 However, these new figures dwarf both of those figures by nearly a factor of two.

I think this is really shocking. We really have our work cut out for us with the extensive nature of this problem. Unfortunately, it is a silent problem so it is very often ignored.

At the Southern Arizona Limb Salvage Alliance (SALSA) clinics, we have approximately 13,000 visits per year, 80 percent of which are for people with PAD. The vast majority of our patients are at the end stage of the disease. The way our clinic is organized, in the “toe and flow” model, podiatric and vascular surgeons work quite literally side by side.

The really important thing this Sage Group study tells us is how critical it is for us to team up with our colleagues on the vascular surgery side and have a really high index of suspicion for vascular disease in patients with diabetes.


1. Diabetic foot ulcers, peripheral arterial disease and critical limb ischemia, Available at http://thesagegroup.us/pages/reports/dfu-statistics.php.

2. Rogers LC, Lavery LA, Armstrong DG. The right to bear legs: an amendment to healthcare. How preventing amputations can save billions for the US health-care system. J Amer Podiatr Med Assn. 2008;98(2):166-168.

This blog has been adapted with permission. It originally appeared at www.diabeticfootonline.blogspot.com .

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