Vascular Disease William R. Flinn, MD Professor, Department of Surgery, and Chief, Division of Vascular Surgery University of Maryland School of Medicine
Oct 30, 2014
Vascular Disease
William R. Flinn, MD
Professor, Department of Surgery, and Chief, Division of Vascular Surgery
University of Maryland
School of Medicine
Cardiovascular Disease
• The #1 killer of Americans
• Approximately 1,000,000 deaths annually
• An American dies from cardiovascular disease every 30 seconds
• More than any cancer– 2-3 times more than any single (lung) cancer– Almost more than all cancer deaths combined
vascular
Vascular Disease
• Abdominal aortic aneurysm (AAA)
• Carotid artery disease
• Peripheral arterial disease (PAD)
Vascular Disease
• Abdominal Aortic Aneurysm (AAA)– An aneurysm is a ballooning of the
aorta. As the vessel gets larger, like a balloon it can rupture!
– Aortic aneurysm rupture is the 10th leading cause of death in men over 50.
– More than 15,000 people die needlessly each year in this country from the rupture of an aortic aneurysm.
Vascular Disease
• Carotid Artery Disease – Vascular disease can block the
carotid arteries to the brain and cause paralyzing strokes.
– Stroke is the third leading cause of death in this country and the leading cause of permanent disability among older Americans.
– More than $50 billion is spent annually on the care of stroke patients.
Vascular Disease
• Peripheral Arterial Disease (PAD)– Vascular disease can block circulation to
the legs, leading to serious disability. – Between 25 and 30 million people over 70
years of age have peripheral arterial disease (PAD).
– PAD begins by simply limiting the amount you can walk, but when it worsens it could lead to gangrene and leg amputation.
– Even people with mild PAD are three times as likely to die of heart attacks and strokes as those without the disease.
The AVA is a Foundation within SVS.
Its goal is to increase public awareness of vascular disease.
American Vascular Association
The AVA is a public health advocacy organization whose mission is to reduce death and disability due to vascular disease.
American Vascular Association
CAROTID SCAN -A painless ultrasound
test to reduce the risk of stroke
AORTIC SCAN - To detect aneurysms
that could rupture and be fatal
PAD Testing - Measurement of circulation
to your legs to detect peripheral arterial disease (PAD)
American Vascular AssociationNational Screening Program
American Vascular Association
Screening Program 2004
132 Centers - 40 States132 Centers - 40 States
0
1000
2000
3000
4000
5000
6000
2002 2003 2004
MenWomen
American Vascular Association
National Screening Program
YES NO YES NO
Diabetes 16% 84% CHOL 52% 50%
HBP 57% 43% Smoke 7% (43) 49%
Over 5000 older Americans
American Vascular Association
Screening Program 2004
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Total Sex BP Meds
NO YES
Hypertension was found in 22% of older Americans
Hypertension - BP > 160mmHg
22%
63%
30%
PAD (ABI < 0.85) was found in 9% of older Americans
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2002 2003 Total Sex
No PAD PAD
7% 10% 10.5%
12%
9.6%
p = 0.001
Peripheral Arterial DiseasePeripheral Arterial Disease
PAD (ABI < 0.85) was found in 10.5% of older Americans
Peripheral Arterial DiseasePeripheral Arterial Disease
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Total Anti-platelet Lipid
NO YES
10.5%
52%
50%
Women with PAD were significantly less likely to be receiving antiplatelet medications.
Peripheral Arterial DiseasePeripheral Arterial Disease
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men Women Lipid Anti-platelet
NO YES
11%
43%
54%
7.5%
42%
57%
p=0.008
Carotid disease was found in 7.6% of older Americans.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2002 2003 Total Sex
NO YES
7.8% 7.4% 7.6%
8%
5.8%
p = 0.03
Carotid Artery DiseaseCarotid Artery Disease
Carotid disease was found in 7.6% of older Americans.
Carotid Artery DiseaseCarotid Artery Disease
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Total Antiplatelet Lipid
NO YES
7.6%
48% 50%
Women with Carotid disease were significantly less likely to be receiving lipid-lowering medication and antiplatelet medications.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men Women Lipid Anti-platelet
NO YES
8%
42%
56%
5.8%
32%
60%
p=0.03
Carotid Artery DiseaseCarotid Artery Disease
p=0.001
YES NOAAA 84 3219
2.5% 97%
0
10
20
30
40
50
60
>3 cm >4 cm > 5 cm
16%16%
Abdominal Aortic AneurysmsAbdominal Aortic Aneurysms
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
YESNO
Hypertension – BP > 160 systolicHypertension – BP > 160 systolic
P < 0.03
30% 22%
AAA No AAA
Men WomenAAA 63 21
4.76% 1.05%
0
2
4
6
8
10
Men Women
P < 0.0001
Abdominal Aortic AneurysmsAbdominal Aortic Aneurysms
0%
20%
40%
60%
80%
100%
50's 60's 70's 80's
AAA - Men & WomenAAA - Men & Women
• There is significant undiagnosed noncardiac vascular disease in a broad segment of our population.
• 30% - 50% of patients with vascular disease are not receiving treatments that might be significantly beneficial.
• There is a significantly higher prevalence among women than has been historically reported.
• Women receive a significantly lower intensity of treatment.
• There is significant opportunity for patient and physician education with the potential for measurably improved outcomes.
AVA National Screening Program
• 64 year old man– NFL quarterback for 17
years
– Senior Pro golf circuit for 13 years
• Acute stroke without prior symptoms
• Urgent CEA• Prolonged rehab with
permanent disability• All potentially preventable
with screening