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