Peripheral Vascular Disease:!! Burden In Saudi Arabia. Owayed Al Shammeri, MD Qassim University Prince Sultan Cardiac Center in Qassim

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1 Peripheral Vascular Disease:!! Burden In Saudi Arabia Owayed Al Shammeri, MD Qassim University Prince Sultan Cardiac Center in Qassim

2 Introduction All individuals with PVD, regardless of limb symptoms, have a significant decrease in functional capacity and marked increase in cardiovascular morbidity and mortality These impacts can be diminshed by medical therapies, exercise training, and selective use of revascularization techniques

3 Prevalence of PVD in Saudi Arabia 471 pt age >44 attended PHC at KKUH PVD No PVD Symptomatic Asymptomatic 11% 7% 89% 93% Alsheikh SO et al. Saudi Med J Mar;28(3):412-4

4 Prevalence of PVD and Claudication Survey in USA > 40 Claudication age >59 PVD No PVD Claudication 4% 5% 96% 95% Selvin E et al. Circ 2004;110:738 Weitz JL et al. Circ 1996;94:3026

5 Prevalence of PVD and Claudication Survey in USA > 40 Claudication age >59 PVD No PVD Claudication 4% 5% ENHANCES: 4% at age> 40 PARTNERS: 30% at age>70 96% 95% Selvin E et al. Circ 2004;110:738 Weitz JL et al. Circ 1996;94:3026

6 Prevalence of PVD in defined population, Saudi Arabia n=214 PVD No PVD n=78 55% 45% 54% 46% Diabetes n=402 IHD 14% n=60 38% n=50 62% Chronic Renal Failure 86% Control Al Zahrani HA et al. Int Angiol 1997 Jun;16(2):123-8.

7 Prevalence of PVD in defined population, Saudi Arabia n=214 PVD No PVD n=78 55% 45% 54% 46% Diabetes n=402 IHD 43% 57% 14% n=60 38% n=50 62% Chronic Renal Failure 86% Control Al Zahrani HA et al. Int Angiol 1997 Jun;16(2):123-8.

8 Prevalence of PVD in High Risk population 2146 asymtpmatic pt >54 PVD No PVD OR of PVD 2.2 Absence of 1 or more pulses 59% 41% NQMI Smoking age >80 CKD ELLIPSE study. J Vasc Surg Sep;50(3):572-80

9 Risk and severity of PVD in Arabian patients Diabetes Non-diabetes Risk and Extent of PVD A case 32% 68% Elsharawy MA et al. Int Angiol 2009 Oct;28(5):367-72

10 Risk and severity of PVD in Arabian patients Diabetes Non-diabetes Risk and Extent of PVD 8 32% A case % 2 Diabetes 0 DM+Smoking+dyslipidemia Elsharawy MA et al. Int Angiol 2009 Oct;28(5):367-72

11 Risk and severity of PVD in Arabian patients Diabetes Non-diabetes Risk and Extent of PVD 8 32% A case 6 Lethal Combination 4 68% Elsharawy MA et al. Int Angiol 2009 Oct;28(5): Diabetes 0 DM+Smoking+dyslipidemia 2

12 Physician s attitude in PVD, Saudi Arabia Cross-sectional self-administered survey General Internist Family Physician Vascular Surgeon Result os physician s survey Cardiologist 22.5 Antiplt ACEI Nicotine Replacement Statin 0 Al-Omran M. Vascular Health Risk Manag. 2007;3(6):

13 PVD patient post-vascular surgery, Saudi Arabia Parallel to Canadian publications PVD Surgery upon discharge Antiplatelet Statin 0 Aldawood AS, Jaeschke R. Saudi Med J 2002;23(5):585

14 One-year Cardiovascular Events in outpatient with Atherothrombosis One year CVE % Non-fatal MI Non-fatal stroke CV death MI/Stroke/death 5 0 Asymptomatic PVD Symptomatic PVD Prior revascularization Prior Amputation (n=670) (n=5,558) (n=4,252) (n=1,153) REACH Registry JAMA 2007;297:1197

15 Critical Limb Ischemia Quality of life postamputation <50% achieve mobility Wound healing <40% healed at 1 year Mortality <50% alive at 2-3 year PVD and Diabetes 25% of all diabetics will face CLI

16 Critical Limb Ischemia Quality of life postamputation <50% achieve mobility Wound healing <40% healed at 1 year Mortality <50% alive at 2-3 year Every 30 sec somewhere in the world a human being loses a limb due to diabetes PVD and Diabetes 25% of all diabetics will face CLI

17 Amputation Rate, USA Rowe et al. J Vasc Surg 2009;49:910

18 PVD population (50 years and older)

19 PVD population (50 years and older) Initial Clinical Presentation Asymptomatic PAD 20-50% Atypical leg pain 40-50% Claudication 10-35% Critical Limb Ischemia 1-2%

20 PVD population (50 years and older) Initial Clinical Presentation Asymptomatic PAD 20-50% Atypical leg pain 40-50% Claudication 10-35% Critical Limb Ischemia 1-2% 1-year outcomes

21 PVD population (50 years and older) Initial Clinical Presentation Asymptomatic PAD 20-50% Atypical leg pain 40-50% Claudication 10-35% Critical Limb Ischemia 1-2% 1-year outcomes Alive with 2 limbs 50% Amputation 25% CV Mortality 25%

22 PVD population (50 years and older) Initial Clinical Presentation Asymptomatic PAD 20-50% Progressive Functional Impairment 5-year outcomes Atypical leg pain 40-50% Claudication 10-35% Critical Limb Ischemia 1-2% 1-year outcomes Alive with 2 limbs 50% Amputation 25% CV Mortality 25%

23 Asymptomatic PAD 20-50% Atypical leg pain 40-50% Claudication 10-35% 5-year outcomes

24 Asymptomatic PAD 20-50% Atypical leg pain 40-50% Claudication 10-35% Limb Morbidity 5-year outcomes CV morbidity and mortality

25 Asymptomatic PAD 20-50% Atypical leg pain 40-50% Claudication 10-35% Limb Morbidity 5-year outcomes CV morbidity and mortality Stable Claudication 70-80% Critical Limb Ischemia 1-2% Worsening Claudication 10-20%

26 Asymptomatic PAD 20-50% Atypical leg pain 40-50% Claudication 10-35% Limb Morbidity 5-year outcomes CV morbidity and mortality Stable Claudication 70-80% Critical Limb Ischemia 1-2% Non-fatal CV event (MI or stoke) 20% Mortality 15-30% Worsening Claudication 10-20%

27 Atypical leg pain 40-50% Asymptomatic PAD 20-50% Claudication 10-35% 5-year outcomes CV morbidity and mortality Limb Morbidity Stable Claudication 70-80% Critical Limb Ischemia 1-2% Non-fatal CV event (MI or stoke) 20% Mortality 15-30% Worsening Claudication 10-20% CV causes 75% Non-CV causes 25%

28 Conclusion The prevalence of Peripheral Vascular Disease in Saudi Arabia is more than the reported International publications Peripheral Vascular Disease is more extensive Saudi Arabia, probably related to the higher prevalence of diabetes in Saudi Arabia Physician s attitude and knowledge of peripheral vascular disease is poor worldwide Peripheral Vascular Disease associated with higher mortality and morbidity even in asymptomatic patient

29 THANK YOU