Diabetes Shouldn't Cost Patients Their Legs

January 6, 2020
Bret Wiechmann, MD
Bret Wiechmann, MD

Dr. Wiechmann has been in private practice for 22 years with Vascular & Interventional Physicians in Gainesville, Florida, with a particular interest in peripheral arterial disease (PAD) and critical limb ischemia, abdominal aortic aneurysms, carotid intervention, and venous disease. He has been elected a fellow in 3 different medical associations, including the Society of Interventional Radiology, the Society of Vascular Medicine, and the American Heart Association. He has given over 170 invited lectures and has been principal investigator in numerous clinical trials in peripheral arterial intervention, carotid stenting, medical therapy for PAD, and stem cell therapy for critical limb ischemia. Dr. Wiechmann is a founding member of the Outpatient Endovascular & Interventional Society (OEIS), serves on the board, and is currently president-elect of OEIS. The practice has 5 interventional radiologists and has been involved with the treatment of arterial and venous disorders for numerous years, both hospital-based and at an office-based lab, which opened in 2006.

Heart disease and kidney disease are widely known comorbidities of diabetes, but a lesser-known complication that dramatically effects between 10 million and 20 million American adults is peripheral arterial disease (PAD). In its most extreme form, PAD can lead to limb loss.

In the United States, someone is diagnosed with diabetes every 17 seconds. And every day, 230 Americans with diabetes will suffer an amputation. The incidence is even higher for minority groups because of a variety of clinical, and social factors that contribute to the nation’s health disparities. The loss of mobility associated with amputations can have a particularly devastating effect on the lives of patients and their families, and also significantly increase the cost of care.

Heart disease and kidney disease are widely known comorbidities of diabetes, but a lesser-known complication that dramatically effects between 10 million and 20 million American adults is peripheral arterial disease (PAD). PAD in its most severe form, or critical limb ischemia (CLI), is a significant cause of lower extremity amputations because, unfortunately, PAD can often go undiagnosed, and therefore untreated, until its most serious complications develop, sometimes resulting in limb loss.

PAD is the narrowing or blockage of the vessels that carry blood from the heart to the legs. It is primarily caused by the buildup of fatty plaque in the arteries. Classic symptoms of PAD are pain and cramping in the legs, hips, thighs, or calf related to exertion such as walking. However, the disease can also progress without leg pain, so patients (especially those with diabetes) are encouraged to check their legs or feet for wounds that are slow to heal, as well as skin problems or discoloration on the legs and feet. Because these symptoms can be easily ignored or dismissed, millions of people with diabetes, hypertension, and hyperlipidemia, along with those who smoke, are unaware that they are at high risk for developing PAD or CLI.

This lack of awareness was nearly catastrophic for Gloria Hutchinson, a 68-year-old diabetes patient from Gainesville, Florida, who almost lost both legs because of diabetes and PAD.

Five years ago, Gloria was rushed to the hospital with kidney failure. The news got worse when doctors found she also had a limb-threatening wound that had infected her bone.

Because Gloria had been unaware of the PAD that had already worsened her condition, she was shocked when her physicians recommended amputation. As a new grandparent and an active member of her church, Gloria was devastated and hoped for other options. She also was unaware of the statistics at the time, that 50% of diabetic amputees will die within 2 years of a lower extremity amputation.

This is when her daughter sought out an interventional radiologist. .After performing a full assessment of her vascular status, something that is critical for understanding the severity of the disease and developing treatment options. Gloria was deemed a candidate for revascularization, a treatment to re-establish adequate blood flow to the foot to enable wound healing. This minimally invasive treatment was paired with improved medical management and intensive wound care, which ultimately saved Gloria’s leg.

About 4 years later, Gloria was told once again that she needed her other leg amputated, but this time she knew her options, and returned to the team for another revascularization procedure on her other leg. Five years later she still has both her legs and maintains her active lifestyle.

Many patients like Gloria, who are from rural areas, wait until it’s an emergency to seek medical care, at which point they are left making potentially permanently life-altering decisions. Interventional radiologists are trained and equipped to identify patients who are at risk for or already have PAD and offer an array of treatments that can improve a patients’ quality of life.

When physicians are faced with recommending an amputation related to PAD/CLI or other co-morbidities related to diabetes, conferring with an interventional radiologist will help them present all treatment options to their patients. IRs have a combined knowledge of the vascular system and expertise in advanced imaging and minimally invasive treatment techniques that can help with the diagnosis and management of PAD and the discovery of a limb-saving path forward.

Reference

Chow EA, Foster H, Gonzalez G, McIver L. The disparate impact of diabetes on racial/ethnic minority populations. Clin Diabetes. 2012; 30(3):130-133. doi:10.2337/diaclin.30.3.130.