• Peripheral Artery Disease and Stents

     
     
     
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    Stents have been most closely associated with heart disease since they were first used in patients in the 1980s. That's no surprise, since hundreds of thousands of patients a year undergo angioplasty and stenting procedures to unclog blockages in the arteries of the heart.

    It's less well known, but stents are also often implanted elsewhere in the body to reopen arteries that supply blood to limbs or other organs besides the heart. One example of this is inserting stents in the arteries that supply blood to the legs and/or kidneys, because of the same buildup of fatty material in the blood vessels seen in the heart.

    Peripheral artery disease (PAD) is a serious condition that affects millions of people worldwide, and is characterized by blockages in the arteries that supply blood to the legs and/or kidneys. PAD can be extremely painful and force people to curtail walking and other daily activities. It can progress and result in amputation of feet or legs, the kidneys can be damaged potentially leading to kidney failure, and in some extreme cases, can result in death.

    PAD received prominent news coverage recently in two stories that show the need for perspective and judgment in analyzing the topic of stenting generally, as opposed to sensationalist, "trial by outlier anecdote."

    One story reported on a study in the July 31, 2013, online edition of The Lancet that documented a significant rise in the prevalence of PAD worldwide. Overall the number of people with the disease has risen 23.5 percent, to more than 200 million, according to the study. Significantly, the rise was twice as high in countries classified as low- to middle-income as in high-income countries. The authors called the increases a "major public health challenge" and said "interventions are urgently needed to reverse these trends…".

    However, another story implied an 8 percent rise in peripheral stent sales in the United States last year was driven by economic incentives for hospitals and doctors. It did not explore or even acknowledge the possible role of actual disease prevalence in the increase.

    All of this illustrates the hazard of drawing broad conclusions from a single statistic or even a handful of outlier cases. The normal curve applies virtually everywhere in life, including the field of angioplasty and stenting. It's of course concerning – though not surprising – to find outliers over a period of years when stents are implanted every year in patients – not only to save their lives, but to improve their quality of life.


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