Congress: Support the ARC Act to prevent amputations

For most Americans, encountering someone in their community who is missing a lower limb due to amputation isn’t terribly uncommon. Thanks to modern surgical techniques and advances in mobility devices, amputations don’t shock us — and many people don’t give any thought as to why the limb loss occurred in the first place.

But what is shocking is the number of Americans whose lives are forever changed by amputation — especially when such a traumatic outcome can likely be prevented.

Each year in the United States, more than 200,000 Americans undergo non-traumatic lower limb amputations. These amputations are not the result of motor vehicle collisions or some sudden accident, but rather because of advanced, undiagnosed or untreated peripheral artery disease (PAD), which can occlude arterial blood flow to the limbs and cause pain, infection and tissue death.

In severe cases, amputation is the only way to save a patient’s life. But it’s all too often the final destination of a journey that is protracted, painful, and, most tragically of all, preventable.

As health care professionals who treat patients with vascular conditions every day, we see far too many people who are forced to undergo amputations because it’s the only lifesaving option available to them. That’s why we are committed to working with lawmakers and the health care community more broadly to spread awareness about PAD and how we can take steps to educate and treat patients before amputation becomes their only option.

There are, in fact, many opportunities to intervene before things worsen to the point of requiring an amputation. The risk factors for PAD are well established. Those most at-risk are individuals who smoke, are over the age of 65, or have a history of high blood pressure, diabetes or high cholesterol. Racial, ethnic and geographic disparities compound the serious problem of PAD in the United States, as many PAD risk factors are more common among African, Native and Hispanic Americans, making them two to four times more likely to develop PAD and, over time, undergo an amputation.

By focusing on what we know about PAD and the communities most at-risk, we’re already well on our way to stopping unnecessary amputations. But we can’t get there without the support of lawmakers and sound health care policies that encourage prevention and treatment.

Fortunately, we have the commitment of the bipartisan Congressional PAD Caucus who want to see amputations become an absolute last resort — after all other prevention and treatment options have been tried and exhausted.

Most recently, Reps. Donald Payne, Jr. (D-N.J.), Bobby Rush (D-Ill.) and Ruben Gallego (D-Ariz.) introduced the Amputation Reduction and Compassion (ARC) Act to disallow payment for non-emergent amputations — unless anatomical testing has been done in the three months prior to amputation. The legislation also establishes a PAD education program to support, develop, and implement educational initiatives that inform health care professionals and the public about the existence of peripheral artery disease and methods to reduce amputations, particularly with respect to at-risk populations, such as racial and ethnic minorities.

The PAD Task Force strongly supports this legislation because it would help save many lives — and limbs — by actually mandating better preventative and proactive care for PAD.

We are fortunate to live in a society where patients can survive the traumatic impact of an amputation. But we simply shouldn’t accept amputation as an acceptable outcome of a condition like PAD when so many other, less invasive, less expensive, and less life-altering options are easily available. We urge lawmakers to support the ARC Act so that we may stop normalizing amputation as the end result of PAD.

Jeffrey Carr, MD, is a board member of the CardioVascular Coalition (CVC). Joaquin Cigarroa, MD, FSCAI, is co-chair of the Society for Cardiovascular Angiography and Interventions (SCAI) Government Relations Committee. Lola Coke, PhD, APRN-BC, CNS, FAHA, FPCNA is a board member of the Preventative Cardiovascular Nurses Association (PCNA). Michael D. Dake, MD, FSIR is president of the Society of Interventional Radiology (SIR). Lee Kirksey MD, MBA is the co-chair for the Association of Black Cardiologists (ABC) PAD Initiative.