Chapter 9: Peripheral Vascular System
Alex Hodson
Background
Evidence has shown that racialized groups tend to experience complications from peripheral vascular disease (PVD) earlier than patients who are White (Alasaad et al., 2019). Racialized patients also experience a higher incidence of amputations as a result of PVD (Collins et al., 2019; Loewen et al., 2017; Weissler et al., 2022). This increases their risk of death (Cai et al., 2021). Early assessment and intervention are essential to counter the associated risk factors (Arya et al., 2018).
The Social Determinants of Health in Relation to Peripheral Vascular Health:
There are no definitive causes for the increased incidence of PVD and amputations, but some possible reasons can be linked to the social determinants of health. These reasons include:
- lack of health care access and presenting to the medical system at later stages of disease (Fayman et al., 2020; Loewen et al., 2017)
- increased rates of smoking (Clark et al., 2019)
- higher rates of comorbidities such as diabetes and kidney disease (Misra et al., 2019)
- less likelihood of accessing follow-up care after initial diagnosis or medical intervention (Alasaad et al., 2019)
- inadequate nutrition (Loewen et al., 2017).
Culturally Responsive Practice Points for Health Care Providers
Published information on differences in assessment findings for racialized patients is lacking. Some research has shown that assessment of intermittent claudication may not be as reliable an indicator for PVD in racialized populations as it would be for White patients (Bennett et al., 2011). This may be due to the inability to see these changes as prominently on black or brown skin tones. Do not exclude consideration for referral for further peripheral vascular tests in the absence of intermittent claudication.
When working with racialized patients, as with all patients, it is important to be proactive by discussing the prevention of foot ulcers (Fayma et al., 2020).
Take cultural considerations such as diet, values, etc. into account when providing teaching.
Allow for peer-to-peer educational support. This can build patient capacity and allow for focused, culturally appropriate care (Fayma et al., 2020).
References
Alasaad, M., Zaitoun, A., Szpunar, S., Lalonde, T., Rosman, H. S., Mehta, R. H., Yamasaki, H., & Othman, H. (2019). Association of race with long-term outcomes in patients undergoing popliteal and infra-popliteal percutaneous peripheral arterial interventions. Cardiovascular Revascularization Medicine, 20(8), 649–653. https://doi.org/10.1016/j.carrev.2018.10.014
Arya, S., Binney, Z., Khakharia, A., Brewster, L. P., Goodney, P., Patzer, R., Hockenberry, J., & Wilson, P. W. F. (2018). Race and socioeconomic status independently affect risk of major amputation in peripheral artery disease. Journal of the American Heart Association, 7(2). https://doi.org/10.1161/JAHA.117.007425
Bennett, P., Gregory, L., Silverman, S., Blann, A., & Gill, P. (2011). Validation of the Edinburgh Claudication Questionnaire in 1st generation Black African-Caribbean and South Asian UK migrants. BMC Medical Research Methodology, 11(85). http://www.biomedcentral.com/1471-2288/11/85
Cai, M., Xie, Y., Bowe, B., Gibson, A. K., Zayed, M. A., Li, T., & Al-Aly, Z. (2021). Temporal trends in incidence rates of lower extremity amputation and associated risk factors among patients using veterans health administration services from 2008 to 2018. JAMA Network Open, 4(1), e2033953. https://doi.org/10.1001/jamanetworkopen.2020.33953
Clark III, D., Cain, L. R., Blaha, M. J., DeFilippis, A. P., Mentz, R. J., Kamimura, D., White, W. B., Butler, K. R., Robertson, R. M., Bhatnagar, A., Butler, J., Correa, A., Benjamin, E. J., & Hall, M. E. (2019). Cigarette smoking and subclinical peripheral arterial disease in blacks of the Jackson Heart Study. Journal of the American Heart Association, 8(3), e010674. https://doi.org/10.1161/JAHA.118.010674
Collins, T. C., Lu, L., Ahluwalia, J. S., Nollen, N. L., Sirard, J., Marcotte, R., Post, S., & Zackula, R. (2019). Efficacy of community-based exercise therapy among African American patients with peripheral artery disease: A randomized clinical trial. JAMA Network Open, 2(2), e187959. https://doi.org/10.1001/jamanetworkopen.2018.7959
Fayfman, M., Schechter, M. C., Amobi, C. N., Williams, R. N., Hillman, J. L., Alam, M. M., Rajani, R. R., Ziemer, D. C., Kempker, R. R., & Umpierrez, G. E. (2020). Barriers to diabetic foot care in a disadvantaged population: A qualitative assessment. Journal of Diabetes Complications, 34(12), 107688. https://doi.org/10.1016/j.jdiacomp.2020.107688
Loewen, K., Vigliarolo, J., Lance, B., Rockley, M., Schreiber, Y., Kivi, C., Dwyer, C., & Kelly, L. (2017). Rates of diabetes-related lower limb amputation in northwestern Ontario: an incidence study and introduction of a standardized diabetic foot ulcer management protocol. Canadian Journal of Rural Medicine, 22(3), 100–107.
Misra, S., Shishehbor, M. H., Takahashi, E. A., Aronow, H. D., Brewster, L. P., Bunte, M. C., Kim, E. S. H., Lindner, J. R., Rich, K., & Stroke, N. (2019). Perfusion assessment in critical limb ischemia: principles for understanding and the development of evidence and evaluation of devices: A scientific statement from the American Heart Association. Circulation, 140(12), e657–e672. https://doi.org/10.1161/CIR.0000000000000708
Weissler, E. H., Ford, C. B., Narcisse, D. I., Lippmann, S. J., Smerek, M. M., Greiner, M. A., Hardy, N. C., O’Brien, B., Sullivan, R. C., Brock, A. J., Long, C., Curtis, L. H., Patel, M. R., & Jones, W. S. (2022). Clinician specialty, access to Care, and outcomes among patients with peripheral artery disease. American Journal of Medicine, 135(2), 219–227. https://doi.org/10.1016/j.amjmed.2021.08.025