Chapters Transcript Video Understanding PAD: A Multispecialty Perspective Beyond the Textbook brought to you by the advanced clinical education and training team at BD. Follow and subscribe wherever you get your podcast to stay up to date with the latest expert conversations in clinical practice. This podcast is on behalf of Becton Dickinson and Company. The opinions and techniques presented herein are for informational purposes only, and the decision of which technique to use in a particular interventional application should be made by the physician based on the individual facts and circumstances of the patient and previous medical experience. The participating healthcare professionals have been compensated by Becton Dickinson and company to participate in this podcast. Welcome to Understanding PAD, a multi-specialty perspective. Peripheral artery disease, or PAD, affects millions of people, yet many remain unaware they have it until symptoms become more serious. Today we're joined by Doctor Eric Saszeski, interventional cardiologist, and Doctor Mike Watts, interventional radiologist, to discuss what PAD is, who is at risk, when it can progress to chronic limb threatening ischemia, and the treatment options and lifestyle changes that can help patients improve their health and quality of life. Let's get started. Eric, great to see you. I'm glad to hang out with you virtually here and uh celebrate another PAD Awareness Month. Wonderful to be here, Mike. Great to talk about PAD as usual. Yeah, I'm, uh, I, I'm just, I'm, I'm in my PAD uniform here. I've been working all day. I literally just walked out of, uh, you know, a, a, a, a couple procedures for these patients. Um, super, super rewarding. Um, you know, this, this last guy was somebody I've been seeing actually since 2019. And, and really, I identified him as having PAD when he was referred to me from his primary care doctor. Um, but, you know, it's really, I just did my first procedure and my actual, you know, kind of surgical or, or procedure on him. It's been years. So, um, you know, I think what people really need to kind of need to understand what PAD or peripheral arterial disease is and, and how it affects people and, and kind of how, how it doesn't affect people. So, Um, you know, I, I was talking to people about us doing this, um, interview, and, you know, what I kind of realized was a lot of us treat peripheral arterial disease. You know, we are here as your kind of advocates for PAD and September's PAD Awareness, uh, Month, and I'm an interventional radiologist. You're an interventional cardiologist. There's, um, vascular surgeons, vascular medicine. A lot of people have their hands in this. Um, but really there's still a, a, a significant, um, basically, uh, number of people who have PAD and don't know about it. Um, so, you know, hopefully, you know, you can talk a little bit about that and, and, and why we don't know about this, why we're so bad at identifying it, and, and why it's so important that, that we do. Yeah. Well, it's a great conversation. Obviously timely with PAD Awareness Month and um I will say that your patient is lucky to have you because there's not enough dedicated vascular specialists like you and I would put myself in that bin that can really manage these patients in all aspects of their care, which, as we will talk about, I'm sure is primarily medical and um observation and not necessarily interventional or surgical, but You know, stepping back, you know, I, I wear an odd cap here in the sense that I'm a cardiologist as well. And so, you know, I'm, you know, destined to get a patient who comes in with coronary artery disease and never knew they had peripheral artery disease. And even though peripheral artery disease in that patient may not be the driver of their symptoms, it could be a driver of their Cardiovascular health and eventual outcomes. And so that's why this disease is so important. So just stepping back and we'll have a nice conversation about this. But for those who are not familiar, you know, peripheral artery disease is all encompassing of cardiovascular vessels, all the vasculature outside of the heart. And we know that those vessels can be in the arms, they can be in the neck, they can be in the abdomen. But the most common location for arterial disease outside of the heart is in lower extremities. And I think that what's unique about this, we call it PAD or PAD, is it's so underappreciated where a heart attack, right, stroke. Everybody seems to understand what a heart attack and stroke is. But then all of a sudden, and we're living right now after a very well known senator. Lindsey Graham just had aortic dissection and unfortunately passed away. That is a manifestation of peripheral vascular disease. And so I think we're finally picking up awareness and traction where just like a heart attack and stroke, people are starting to understand what the vasculature bed looks like outside of the heart, how it can influence outcomes and why we need to take it seriously. Yeah, it's, it's funny you say that, right? Because people know what a heart attack is, people know what a stroke is, but, you know, there's nobody knows what a leg attack is, right? But it's not, it's not really that different, right? If you don't get the blood flow to your heart, and the, the, the, the tissues in your heart start to basically lose blood flow and die, you know, it's chest pain and it's a heart attack and it needs to be taken care of immediately. Um, peripheral arterial disease when it comes to the legs tends to be a little bit more chronic and a little bit slower in onset, but it's basically the same thing. We're losing tissue in our feet, um, sometimes with, with ulcers and things like that because, you know, we're not getting the blood flow. But a lot of people don't, don't ever experience that. So, um, you know, when there are times when, um, you know, I talk to people, they're, they're patients or referring doctors, I do a lot of outreach to, um, uh, Primary care physicians, podiatrists, and the, the kind of odd, um, converse of that whole statement is, well, why would I be looking for peripheral arterial disease if my patient's leg doesn't hurt? And so I thought it was really funny when you said, I'm a cardiologist, people come to me for their coronary artery disease, and they don't know that they have peripheral arterial disease. So I'm the complete opposite direction. People Come to me because they've been screened or found to have peripheral arterial disease, and I say, yeah, you have some, some narrow spots in your arteries in your legs, but they're not causing any problems. However, this is an absolute marker that you are extremely likely to have coronary artery disease or cerebrovascular disease. Do you have a cardiologist? Have you had a carotid ultrasound? Have you had, you know, a cardiac evaluation? They say, no, I've never had a problem with my heart. So then it's like, OK, well, Uh, you don't have to worry about your legs so much. You really need to get your heart and, and everything else taken care of because what's affecting the vascular beds in your legs is affecting the other vascular beds, and we don't want you to have a heart attack or a stroke, and this needs to be evaluated and When we treat these patients kind of medically with the best treatments that we have that are not surgical, that helps them live longer because it decreases the risk of stroke, it decreases the risk of heart attack, and it decreases the problem with their limbs. Yeah, I love, I love where you're going. That's exactly right. And if we throw some numbers around that, you know. Just for the audience, you know, more than 12 million and up to 20 million US adults have peripheral artery disease, and that's without us having a dedicated screening indication. You can imagine if we had US PTF, say we got to screen everybody who smoked over the age of 50, we probably double that number. The other amazing part is just as you're mentioning. More than half of patients who have lower extremity PAD have either coronary disease or cerebrovascular disease. So as you really nicely put out there, this is a systemic condition. So when I see someone with PAD, the first thing I tell them is our goal here isn't necessarily to focus on the legs, it's to focus on your cardiovascular health because the The majority of people with a PAD diagnosis do not die from anything related to their limbs. They die from a stroke or heart attack. So it's our job to lower cholesterol, lower blood pressure, stop the smoking, get the diabetes under control, not only for the legs, but just so that they can live a long, healthy life without heart attack, stroke, and related to the legs amputation. The other thing we talk a lot about in my clinic, and I'm sure you had these same conversations, I break it down a little bit like I break down coronary disease. You know, there's stable disease where people have chest pain, but it goes away when they stop, like you mentioned. Then there's a heart attack. Those are two different things. And the legs, I think about this as stable and unstable disease. Stable disease might be PAD picked up on a study but no symptoms and up to 40% of people have no classic leg symptoms or they can be symptomatic PAD where they walk, they get cramping, and then they have to slow down or stop and that's all stable disease and we can put that in a different bin because we manage that differently. We don't rush procedures, we don't necessarily need procedures, we need good medical therapy, exercise, and other injunctives and then procedures play a role in the right patient. Then there's unstable disease. And although that's smaller, about 5 to 10% of patients with PAD develop unstable disease. They have a cold foot. They have an ulcer that's not healing. They have pain at rest. And then that's when I tell my patients, call me right away. It doesn't matter day or night. This is the amount of time to get to the cath lab or the procedure suite or the IR lab is, you know, it's like we say muscle is, you know, time is muscle. Same thing in the leg, you know, time is toes and foot and leg. And so we try to get those patients revasculars as soon as possible. So I'll pause there, but Mike, does that resonate my messaging with my patients? How does that fit your practice? 100%. So, um, you know, when I see someone who says, you know, that, you know, I used to be able to play 18 holes of golf, and now, you know, I can't play 9 because, you know, if, if I have to get off the cart, um, and it's, you know, cart paths only, and I have to walk to the green, I get cramping in my legs, and then, you know, I need to sit back down in the cart. So something has changed in their life, they have cramping in their legs, they find out they have peripheral arterial disease, and they have claudication, right? So, this is a stable. So, when I meet these people, um, they may think, what they often say is, so I need a stent, right? That seems to be like what people think when it comes to peripheral arterial disease. It's like, well, no, you don't, you don't need a stent. We, what we need to do is get you started on a statin, uh, cholesterol medication. They say, well, wait, wait a second. You know, uh, I'm, I'm here because, you know, you do procedures like, well, no, you know, we need to make sure that you're on the right medications. Everything you said, you're not smoking, we're on the, you know, blood pressure is under control, statin medications because it's going to increase your life expectancy. You're gonna decrease your heart attack, all those risk heart attack and stroke, and then we're gonna deal with your legs. We're gonna give it time. We're gonna see how exercise therapy works and all these things. So I think that's exactly. Right, and when you're talking about this unstable disease and you're talking about chronic limb threatening ischemia, that's when your limb is threatened. So that's pain at night when you're trying to sleep, when your foot is elevated, that's um gangrene or ulcers that don't heal and sores. That's not a lot of people with PAD. Most people don't have any symptoms or they have symptoms that probably are very unlikely to become critical, and so that's why we have time to deal with all the cardiovascular risk factors. So you said something that was really interesting before about screening. And so you said, well, what if we screen everybody who smokes who's over 50? Well, we don't have screening guidelines set up, but who does need to be screened? So, you know, I, I was thinking about our PAD awareness marketing that we do for our practice every September. We say, here, if you think you may have PDAD or you think you know somebody who has PAD come get screened. So maybe that course of the month, most people we see are women in their thirties who have spider vein, right? So they say, I want to get checked out. I think I have, I think I have problems with my blood vessels. But when, and clearly they're all, they're all wonderful, and they're beautiful, and, um, you know, we're happy to talk to them. Um, but if there were, if there were guidelines of who should be screened, I mean, who should that be? Who should we, we be worried about? Yeah, yeah, this is a great question and again we're, we've always been frustrated because you know we feel like in the right population screening is the right thing to do, um, but we also have to be particularly sensitive that there are the concerns that people will over proceduralize if we just start screening everyone so that's always been the caution. Nonetheless, what's the right thing for a patient is to know if they have PAD or not. And so kind of my mantra just to review for the audience if you're not familiar with peripheral artery disease, you know this is really strongly uh tied to just certain comorbidities. So I'll give you a few. Um, tobacco use, so it's rare, and I always joke whenever I see a female patient with PAD, the first question I ask them is, are you still smoking and how long did you smoke for? And it's like a 95% hit rate, you know, it's almost impossible to be in your fifties, sixties, seventies with PAD and be female and not have had a history of smoking or still smoking. Diabetes, we all know diabetes is a significant risk factor. And that's a risk factor for the large vessels and the small vessels. So the small vessels, you can get diabetic foot ulcers that are related to local circulation issues, but you also can get classic large vessel peripheral artery disease in your leg or pelvis. Age, we know as you age, you're a higher risk. And so we really see this condition most often in people who are 60, 70, and 80. Every decade adds additional risk. And then chronic kidney disease is the other one that I think really ties in nicely. People have really advanced kidney disease, in particular end stage renal, and that overlaps a lot with people who are diabetic because a lot of people might have kidney disease from diabetes. Those patients really deserve some extra attention. We, we put out in 2024 the most recent ACCAHA guidelines, and we made a suggestion about uh kind of enhancers for screening for PAD and I'll just list them to you. So it's age greater than 65. Anybody between 50 and 64 who have risk factors for atherosclerosis, so smoking, hypertension, hyperlipidemia, chronic kidney disease, diabetes, history of PAD. If you're under the age of 50 but you have diabetes, and at least one additional risk factor, high blood pressure, high cholesterol, or if you have known atherosclerotic disease in other vascular beds such as abdominal aortic aneurysm, subclavian disease, carotid disease, coronary disease, we recommend screening. And again, the key with screening here is I always tell my fellows and trainees, I'm like, what do I love almost the most about vascular is we have amazing Screening and diagnostic studies that are of zero harm to the patient and are cheap. Like putting a cuff on someone's ankle to get an ABI is probably the most simple test, but most informative test for people like me and you, Mike, who can make a diagnosis and even have an understanding of what blockages are. Ultrasound also is a really important test which guides our intervention strategies, but nonetheless helps you make a diagnosis, no risk to the patient, no radiation, fairly accessible and not very expensive. So We have these great tests and pretty much how I always say is any really risk factors, diabetes, chronic kidney disease, advanced age with cardiovascular risk factors should get screened and anybody with any limb symptoms. Some people come in with atypical symptoms. My leg feels heavy when I walk. My left leg feels numb when I walk. It may not be classic pain, but those patients that they have risk factors should be screened because it's so easy to do so. Absolutely, and you kind of touched on screening tests, but. Um, you know, an ABI is an ankle brachial index. So, you know, we are basically built kind of in parallel, if you think about us, you know, how our plumbing works. And so, the blood pressure here should be more or less the same as the blood pressure on your ankle. I mean, it's a little bit different for, you know, vascular resistance, but it's a really quick, easy way to say, is the blood flow to your leg the same as the blood flow going to your arm? Yes, OK, we're probably good if there are other reasons to look further, like you said with an ultrasound. Ultrasound basically means just like, you know, when you're getting your baby looked at with the ultrasound, we'll do the same thing, but they look at the legs and they use Doppler, like Doppler weather radar, and they actually look at the blood flow, um, and we can see the, the speed of the blood flow, the direction of the blood flow, and make sure that it is what it should be. And if it's not, just like you said, that ultrasound is helpful for us to plan if we need to treat something and how we treat it. So, um, you know, really anybody who can do a blood pressure in the office should be able. To do an ABI, but if they can't, that's fine. They can send it out to any vascular lab or radiology practice, and they'll do it for them, um, and very, very quick and easy. The ultrasounds, you know, are a little bit more involved, but you know, that's kind of the second level of screening and, and, you know, we're, we're happy to see those done because if somebody has a concern, and it really gives us a definitive yes or no answer. So now that we, now that we've screened people, right, so screening is done and we've, we've found somebody, so somebody has. peripheral arterial disease, you know, what's the benefit of that? So you said before, you know, people really should know that they have peripheral arterial disease. I agree 100%, but what's the benefit? Are we doing something now to, you know, not only we talked about a couple of, you know, medical interventions to increase their overall cardiovascular health, does that really help? And what are we doing about their legs? Do we have, do we have ways now to, to fix them, that's gonna keep their leg attached and gonna keep them alive longer? Yeah, well, let's, let's spend a minute just talking about contemporary medical therapy for PD because I think it's worth repeating and then. Maybe we could talk a little bit about therapeutic options and so even for the asymptomatic through the symptomatic PAD patient. You know there's appropriate medical therapy that should be considered in everyone. And you really, Mike already talked about the cornerstone, which is how do we get your cholesterol lower? Because just like a person who has coronary artery disease or a coronary blockage, it's a very similar disorder in the peripheral artery. And as mentioned, when we see it in the peripheral arteries, we consider that a systemic problem, meaning that there's probably other vascular beds. That has cholesterol narrowing them. And so cholesterol lowering therapies are key. And the cornerstone of that has always been a statin, which is a specific medication to lower cholesterol that's been around for decades, and we use it in every heart attack patient, everybody with coronary disease, and similarly for everybody with peripheral vascular disease. We try to start a high dose. We like the high dose stances. We want to get those cholesterol levels really low. On top of that though, outside of statins, we have newer medications in that cholesterol area, such as agents called PCSK9 inhibitors. These are new, hot, they've been around for a little bit now they've gone from being injectables to orals, but these agents have shown in trials to reduce limb events, limb events meaning amputation, need for intervention, or even getting that cold leg we talked to Blatt. The other things that are really important are just like how we looked at cardiovascular patients, we like them to be patients with PAD to be on some sort of anti-thrombotic or antiplatelet agents. So we start everybody on low dose aspirin, baby aspirin 81, and in the right patients, we like to also put on a little bit of a blood thinner called low dose Xarelto or rivaroxaban. In the recent guidelines, I got a class one recommendation for patients, in particular if you had a procedure to your leg. So we've got cholesterol, we've got the platelets, we've also got blood pressure. And if you have an elevated blood pressure or hypertension, we like to put you on an ACE inhibitor or an ARB, ARB. These are blood pressure meds that work not only in your blood pressure, but could also independently reduce the risk of a limb event. And then it's the classic one, don't smoke, control your diabetes. And we don't have much more recommendations. I'd have don't smoke, get your diabetes under control, but this is medical therapy. Doctor, I came in because I have peripheral arterial disease. It hurts when I walk two blocks. You just kept putting me on all these medications. Is any of that can make me feel better? Wonderful question. So unlikely to start. It'll make you feel better because you'll be out of the hospital and not having a heart attack or a stroke, but it's a really important one. And so I always say our first goal is to reduce your cardiovascular risk. Let's focus on that and I go through this list. Hopefully a lot of these patients have had other events. Cardiovascular maybe and they are in some of these or all of these agents, but we go through that checklist antithrombotics or platelets, uh, hypertensive, your statins, your smoking cessation, and so forth. And then we talk about how do we make you feel better, right? And I always say that's a separate question and I have patients who are like. You know what, doc, I get this cramping when I walk a mile, but that happens like once a year. I'm kind of a couch guy and I feel great. Do I need to do anything for my symptoms? I say no, right? We got, you got my goal is to make your quality of life better. And if your quality of life is already where it wants to be, then I can't really change that for you, and we're good. We just gotta get. Medications on to reduce your cardiovascular health. Absolutely. But we are symptomatic. Yeah, how do you approach it, Mike? No, I think, I think it's great. And you know what I love, what I love to hear is when people kind of come in with the same idea as me, and that is, all right, it hurts when I walk two blocks. I say, OK, well, what happens when you walk two blocks and it hurts? Well, I'm afraid that I'm hurting myself, so I stop. And I say, well, I think if it hurts you and you're able to walk another block, you're actually helping, you know, with what we know is, you know, this kind of thought of supervised exercise therapy. We know database. You know, great evidence that you can walk through claudication and actually make it better as you're recruiting more blood vessels and bringing more blood vessels past those more blood past those blockages. So I tell the patient, look, you can walk a little bit further. Sometimes they get really excited. So I, I would love to. I'm just worried that I'm in pain, that I'm doing something, I'm damaging myself in some way. So I say, you know, we're gonna walk through that, you're gonna walk past that and see how far you can get, you know, and then there are, there are apps, there are, you know, different kind of logbooks, there are different ways for patients to say, hey, you know, I can walk this far, yesterday I walked this far, today I walked this far. And then I actually review those with those patients. Um, and what I'll see is I'll either see somebody say, yeah, I'm, I can continue to walk all the time. I used to be able to get to my mailbox, but no further. Now I take the dog around the block, and they, they get motivated by that. Then some people bring me the logbook and it's like, well, they really haven't walked or they haven't really done much, and that's another conversation because either they really are in significant amounts of pain, um, and they really can't do that, which is completely reasonable, you know, or they have some deconditioning and maybe that it's not the leg, it's not the, the, maybe they've been a couch guy for too long, and the car it's a cardiovascular issue, they get out of breath after a block, and so their legs don't necessarily hurt, but they're out of breath. Um, but if they do, you know, try to, to exercise and try to do their best, um, and, you know, really can't, then, you know, then, then it is reasonable to talk about treatment options and, um, and, you know, there a lot of multidisciplinary discussions kind of go into that and, and, and what we can do. Um, and it's a different discussion whether it's someone who has cramps when they walk or if they have a sore on their toe or a non non-healing surgical site or, um, you know, a gangrenous part of their toe. That's, that's when we're talking about that other disease, that, that, that, that limb threatening ischemia, chronic limb threatening ischemia, which is a small subset of PAD, but that's something that we can, we can help with and kind of keep that leg, um, preserve that leg for long term, hopefully. Yeah, no, I love that, you know, I, I always Think about it in the same framework and I and and that patient who is struggling to walk because they're having recurrent pain, you know, and it's stable, right? It goes away when rest but it comes down with exercise. You know, we, we really have a discussion about three options. One is there's one FDA indicated, uh, medication called silosazol or Pletal. It's poorly tolerated. I would say it works in 15% and causes, uh, symptoms in 50%, usually GI or, or, or headache. And so we tried, we tried that in the select population. There's a black box warning for anybody who has a history of heart failure just to warn people, so you have to be careful. But really the cornerstone of therapy is exactly like you said, Mike, and, and it's different than corona disease. When people have chest pain, um, we don't like them to keep going and exercise, but when they have leg pain, we want them, I want you to push, you know what I mean? I tell them I take a break and push through it. So supervised or structured exercise is indicated. It's reimbursed by Medicare. It's poorly accessible, unfortunately. And so you can do this in cardiovascular rehab centers. We trained all our physical therapists to do this around Boston. So we have 6 sites around Boston where the physical therapist will do that supervised exercise program. But if you can't get to a center, you do exactly like Doctor Watts said, you do structured exercise at home, you push yourself, you find an incline, and there's some great tools online that can show you some programs to do that. And then if people are not responding to medication and they're not responding to exercise therapy or if they tried and failed on cilostazol, you know, that's when revascularization is a really great option. And when I talk about patients with revascularization. I tell them, you know, at this day and age we do a lot of this endovascularly for clot for stable disease, um, and our risks of the overall procedure are quite low. We usually can do the procedure successfully with a low acute risk. I tell the patients that. The biggest risk is this disease is a chronic disease and it's progressive and we might get you 1235, 10 years but we're not sure exactly when or if it will come back and so I would say this is kind of the biggest challenge because a lot of time patients come to the lab and when we do a good job the next day their pain's gone right? and they're on cloud nine and it's the best, right? And again we have patients I have patients and you have patients and they've gone. 10 years and that pain's never come back, but some people, even when you do the best job, a year or two comes by and then they're still diabetic and they're still smoking and that disease comes back and that's always how I phrase it to my patients and then for the procedure that's listening to this or those interested in this, you know, the larger the vessel, the better the patency, the better the outcomes and so above the waist, those are big vessels tend to do really well and we even when we did the guidelines gave it a little. Bit of a nudge towards an earlier intervention because those tend those vessels tend to stay open below the waist is when we see a little bit more of the recurrent disease over time and you know we see long and multi-segment disease and so um both are great options we have so many great tools that are available now but again I think we both are on the same page as we don't rush an intervention in this condition when it's stable. We optimize medical therapy, we push them on the exercise, and only when they're either failing to improve and have a poor quality of life, or if they become that unstable patient with the wound or the ulcer, um, that we really push the cath lab or the IR suite or the surgical suite. Yeah, you said something really nuanced earlier on that I kind of want to, you know, kind of, uh, expand upon. And you said one of the reasons that we don't always do screening is we don't want, you know, to kind of push people into getting procedures. So, I think that's for the general audience who, who are listening, you know, you go and you get evaluated for PAD, you find out you have PAD, um, your primary care doctor or whoever, you know, recommends you somewhere, you, you get a recommendation from a family online, whenever you go to a place, and they say, yes, you have PAD. I'm gonna sign you up, you know, there's a narrowing in your artery, there's a blockage. I'm gonna sign you up for a procedure next week. You need this procedure because you have PAD. Um, that's, you know, unless you're, you know, unless you're having one of these, you know, really advanced, um, symptom kind of, uh, uh, constellations of, of ulcers and sores, and, you know, um, uh, you know, really, really throbbing pain that goes away when your foot goes down and gravity can kind of help blood, foot, you know, help your blood down there. You know, that's not really something that we rush into and, and that can actually be harmful, like rushed into a procedure for a stable or asymptomatic disease is not recommended in these guidelines, absolutely not recommended. Um, that doesn't mean that, you know, it can't be done and people won't do it, but if you feel like, you know, you want to go talk to someone about the options, you want to talk about optimizing your medications, you want to talk about your cardiovascular health, and the first thing that happens is, you know, you're, you're, you're basically told. You know, that they're recommending a procedure, you always have a chance to say, you know what, I appreciate it. I'll get back to you. I do want to get another opinion or I do want to talk to somebody else, um, just to see what else is out there. Um, I think that's a really important part of, of patients being their own advocate, um, and understanding a little bit about what PAD is and, and hopefully, you know, there's more of this information that comes out, you know, not just in September, really. But all the time because, you know, this disease happens all the time and it happens to, I mean, what do we decide, you know, 20 million people, right? You know, every, every year. Um, so it's not, it's not, you know, it's it's not an uncommon disease. Yeah. Yeah, I love that comment again. You made this in such an easy conversation because your first story was about that patient you'd been following since 2019 and 2026, and you actually finally needed a procedure, but they spent a long time with you not needing a procedure, and that speaks to what our role is in this condition. Yeah, yeah, and, and, and it really, it, it also. Really gives me the confidence and really should give, give other people the confidence that, you know, your diagnosis of PAD today. It doesn't mean it's going to become something that's critical tomorrow or next year or the year after the year after. Your risk every year of going from stable disease to unstable or advanced or limb threatening disease is less than 5% a year, right? So, so, so, you know, you can really go many, many years with, with good medical therapy and, and really not have it become an issue that has to be a surgical or a procedural issue. Yeah, absolutely. I think we covered a lot there. That was good. That was good, Mike. Yeah, great work there. I, I think we, I think we covered a lot, um, but as far as, you know, PAD and awareness, I mean, I think it's like, like, um, you know, Doctor Sasevski said, right? So, um, age, smoking, diabetes, kidney disease, um, cholesterol. Hypertension, those are the things that, you know, more than one of those kind of is, is, is going on. Sure, let's, let's go ahead and get checked out. And once you get checked out, you know, then it is, you know, then it is, you know, kind of all of these other things. All right, well, now I know I have a cardiovascular risk. Now I should talk to my cardiologist, um, I should talk to my primary care doctor, make sure that all this is taken care of and make sure that I have a good vascular opinion. Um, but you know, there are people who deal with this all the time. You're not on your own, uh, and, and, you know, the, uh, the, the, the resources are, are out there. Just, I would say, um, you know, chat GBT, but you know, chat GBT just asks Eric Sasenski. Uh, so, so, you know, if you're gonna get it call me directly. You're gonna get it off from this conversation anyway. I love it. That's very nice to summarize, and I, and, and it's great to have this conversation leading into an important month with PAD Awareness Month and Um, it's wonderful to share a conversation with, with you, Mike, who, as you, everybody should be aware, is in a different specialty in my as mine but shares the exact same opinion. I couldn't trust him more and um we're all out there to help. So I really um appreciate the conversation. Thank you, buddy. Me too. Doctor Sasski and Doctor Watts, thank you for sharing your expertise and insights. The key takeaway from today's discussion is that PAD is common, serious, and often underdiagnosed, but early recognition and treatment can make a significant difference. Knowing the symptoms, understanding your risk factors, and seeking medical attention when concerns arise can help improve outcomes and reduce the risk of complications. Thank you for listening to Understanding PAD, a multi-specialty perspective. We hope this conversation helps you take a more proactive role in your vascular health. Until next time, take care and stay informed. Thanks for being part of the BD Advanced Community. This podcast is intended for educational purposes only. Follow and subscribe so you never miss an episode. For more clinical education, visit advancedEDU.BD.com. We look forward to continuing the conversation in our next episode. BD and the BD logo are trademarks of Becton Dickinson and Company or its affiliates. Copyright 2026 BD. All rights reserved. Published Created by
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