PAD, CLI, and Amputation: The Urgent Need for Early Diagnosis

Peripheral Artery Disease (PAD) is an alarmingly common condition that affects 8–20 million Americans and involves a blockage of arteries in the lower extremities. If left untreated, PAD can lead to potential amputation.

A lack of visible symptoms often delays diagnosis; 20%–50% of people with PAD show no signs. When PAD progresses, it can lead to Critical Limb Ischemia (CLI), a severe blockage that drastically reduces blood flow, resulting in severe pain and unhealing skin sores or ulcers.

The Alarming Link to Diabetes and Mortality

The greatest urgency surrounds the connection between PAD, CLI, and diabetes:

• Diabetes Prevalence: Over 30 million Americans have diabetes.

  
  

• High PAD Risk: One in three people over age 50 with diabetes likely has PAD.

  
  

• Frequent Amputation: A lower limb (or part of a lower limb) is lost to amputation every 30 seconds as a consequence of diabetes.

  
  

• Mortality: Of the 2 million Americans who suffer from amputation, 54% are due to peripheral artery disease or diabetes. Only 50% of PAD amputees survive more than five years. Furthermore, diabetic foot ulcers double the mortality rate and risk of heart attack, while increasing the risk of stroke by 40%.

  
  

• Risk of Second Amputation: Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within two to three years.

  
  

Without revascularization (a procedure to restore blood flow), up to 40% of patients with CLI will require a lower limb amputation within one year.

The Crisis of Undiagnosed Disease

One of the most concerning trends is the lack of proper diagnostic testing and preventative care:

• Missed Diagnosis: A recent study of over 20,000 Medicare patients receiving amputations showed that 54% did not receive any vascular procedure, including a diagnostic angiogram.

  
  

• Low Testing Rates: Only 50% of patients have an Ankle-Brachial Index (ABI) test done. This is a simple, non-invasive test used to check for PAD.

  
  

• Amputation without Angiogram: Only 1 in every 5 people who have been amputated received a diagnostic peripheral angiogram.

  
  

Who Needs Peripheral Vascular Diagnostic Testing?

Diagnostic testing is necessary for people who are at high risk, including:

• Diabetics: Especially those over 50 years old.

  
  

• Smokers: People who smoke or have a history of smoking are 4x more likely to have PAD.

  
  

• Symptomatic Individuals: Those experiencing pain, coldness, change in color, or numbness in their lower extremities.

  
  

• Wounds: People with sores or wounds in their lower extremities that heal slowly or fail to heal.

  
  

If you fall into any of these categories, talk to your primary care provider about being screened for PAD. Early detection and intervention are critical to preserving your limbs and extending your life.

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