Peripheral arterial occlusive disease (PAOD), like coronary artery disease and cerebrovascular disease, occurs as a consequence of ongoing atherosclerosis, a common and progressive vascular disorder with a high risk of cardiovascular complications and death. The importance of these diseases is increasing, also due to the increase in cases and the high costs of their treatment.
Mortality data for PAD is high. And so much so that it even surpasses breast cancer, whose 5-year mortality is estimated at 15% and similar to that of colon and rectal cancer at 38%, or non-Hodgkin’s lymphoma at 48%, against 44% of ‘EAOP .
EAOP has a large incidence in habits such as smoking or diabetes, which can be associated with up to 70% of amputations performed each year. To avoid fatal outcomes of the disease, it is essential to diagnose it as soon as possible and to start an appropriate medical treatment, given that today an amputation is performed every 20 seconds somewhere in the world. (Read here: Is stress an occupational disease?)
“We are facing a little known disease, it is classified worldwide as an underdiagnosed, underestimated and undertreated disease, for this reason complications in most cases occur when patients arrive in very advanced stages and we have to do what call limb save. This disease is growing due to the increase in the diabetic population and smoking,” said Dr. Guillermo Garelli, president of the Argentine Association of Vascular Surgery and Angiology.
As the EAOP progresses, chronic or critical ischemia appears, the symptoms of which are severe and its mortality is high, reaching 80% at 15 years in patients who surrender, or even 100% in the most critical forms of ischemia.
The chronic ischemia that threatens the extremities produces very intense pain, even at rest, and also chronic skin ulcers, so that the quality of life is affected to such an extent that, in some cases, it is necessary to amputate the legs due to the involvement of adipose tissue, muscle or bone.
Dr. John Jairo Berrío, president of the Colombian Association of Vascular Surgery and Angiology, points out: “It is always possible to avoid a major amputation; especially if we control risk factors, have quality medicines and ensure timely access to health services”.
Treatment of PAD has advanced at a breakneck pace. So much so that today it is possible to intervene on the patient with interventions known as endovascular surgery, which are less invasive and with very positive results in the short and medium term. However, despite this, in our environment, the number of amputations does not decrease and, on the contrary, increases.
Despite advances in surgical and endovascular interventions, there are many patients who have poor revascularization options, who are not eligible for revascularization, or in whom this procedure does not resolve PAD. In them, drug treatment is decisive, because it provides an opportunity to preserve the limb and improve the patient’s quality of life.
Dr. Héctor Vásquez Ledesma, executive director of the Jaasiel Foundation Colombia, says: “The experience we have had with patients requiring medication management has been quite complex, mainly due to delays in authorizations, applications or patients leaving the hospital without receive the drug. Sometimes the doctor finds it necessary to amputate the patient due to lack of timely treatment.”
“It is important to clarify that, depending on the clinical stage of the disease, different treatments will be required. For this reason it is essential to be able to diagnose the disease in time to avoid the arrival of threatening moments, which are the most serious of the disease, being in them where ischemic pain occurs to a greater extent”, Berrio points out.
