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About 400 leg amputations per day are performed a day in the United States to treat advanced critical limb ischemia (CLI) caused by severe peripheral artery disease (PAD). The majority of these are in Black, Hispanic and Native American populations, but they are also common in rural communities where healthcare access is limited. The mortality rate for patients who undergo an amputation is about 70% at three years because of the major impact on the patient's quality of life and ability to care for themselves independently.
Jim Melton, DO, a vascular surgeon and co-founder of the CardioVascular Health Clinic in Oklahoma City, runs mobile cardiovascular outreach clinics in rural and Native American communities in remote areas of Oklahoma. He said patients from this part of the United States who require amputations due to CLI face about a 60% morality rate at two years. His goals are to screen more patients earlier and raise awareness about PAD among patients and general practitioners in these remote areas.
"If you have an amputee that's got one good leg, we surveil the good leg really close. If they go on to get another amputation on the other side, their mortality rates are 35% at one year and almost 60% in two years. That's not very good odds. And I think that if you just have a one-sided amputation, it just depends on their coronary status and their ability to get up on a prosthetic and whether they will live independent, which significantly influences their mortality rates," Melton explained.
His practice started the mobile cardiovascular clinics in 2015. Nearly a decade later, these clinics have saved "thousands" of limbs, he said, highlighting the potential impact of treating patients before it is too late.
"I think it's so important to go to the rural markets and in my opinion, you're doing a service. Again, there's not a lot of ROI on it when you're just going out and seeing patients as office visits and testing. But it's about starting that cycle of seeing a patient is at high risk for this and this, and then it's on the patient's plate. But at least they've been seen by a specialist and they know what they should do and we really try to follow up with them well in our clinic and make sure they're getting taken care of," Melton explained.
He said the biggest barrier to improving outcomes in rural and in areas facing significant health disparities is simply access to care. Often patients in these areas also have diabetes and coronary disease that compound overall cardiovascular risks.
"Putting these rural clinics together in different areas where the access is not as good, it just makes you feel like you're doing something. Hopefully I can take care of somebody today that didn't have a chance to get seen by a physician," Melton said.
