A growing prevalence of peripheral arterial disease (PAD) across the world parallels a deteriorating PAD landscape in the U.S., underscoring a need for more vascular surgeons and risk-factor reduction globally, according to a leading expert in the field.
Vincent Rowe, MD, chief of vascular surgery at the University of California, Los Angeles (UCLA), was speaking during the VAM 2024 World Federation of Vascular Societies (WFVS) Educational Session yesterday morning (Wednesday, June 19), telling the audience, “It is pretty apparent, that in both the U.S. and globally, we are heading down this dark road to the complications that occur with PAD: if we don’t do something soon it could be an issue, not only for the United States, but also globally.”
Risk factors in the U.S. include tobacco use and glucose and blood pressure control, Rowe explained. Across the world, it is a similar picture, he said, adding low physical activity and diet to the list.
He raised the twin specter of diabetes, with “a tsunami” expected across the U.S. in the next 20 to 30 years, especially among some minority patients, running alongside the global PAD burden. “If we look at diabetes globally, you can see it is increasing, both in terms of prevalence and in terms of incidence, and also deaths.”
Rowe referenced a recent publication that laid out the scope: a 72% increase in global prevalence of PAD, with mortality also continuing to rise.
“The authors stated that this pattern represents a major public health challenge that warrants a coordinated and targeted response from governmental and private medical institutions to try to combat this disease, and especially slow the progression medically,” he said.
The global picture of increasing PAD and associated risk factors— body mass index and food consumption levels among them—plays out across gender and among children, Rowe pointed out.
The bottom line is, according to Rowe, “in the U.S., with all these increases in risk factors, that we predict we’re going to need more vascular surgeons. “The current estimate is a 31% shortfall in the next couple of years, he noted, “and unfortunately we’re not very well distributed across the country.”
Currently, some 2,600 counties in the U.S. have no vascular surgery representation, Rowe said. And they’re not all rural: “Almost half of them are considered urban counties,” he added. “If we look at the world, we can see that the population is going to continue to increase, and our distribution of vascular surgeons across the world in certain countries is not very good at all.” Rowe offered some potential remedies aimed at starting to tackle the increasing disease burden and workforce shortfall. “We can try to increase the number of vascular surgeons, but that is going to be a tall order. But we’re going to really need to, especially globally,” he said.
He also raised the idea of international rotations. “Perhaps if we were allowed to take our fellows and residents internationally, that would increase their interest in going back and serving in those countries,” he elaborated, also suggesting paid service programs as another possible avenue.
“Also, maybe loan forgiveness: we forgive loans for people who go and practice in underserved areas—maybe they should forgive them if someone goes and practices for two to three years internationally as well.”
Rowe added one more remedy from his own circle. “One of my friends is from Nigeria, and he does global grand rounds—not to educate the vascular surgeons but to educate all the other practitioners about vascular disease to help them take care of these patients medically.”
