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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