Impact Of Open And Endovascular Caseload In Lower Limb Amputation In Portugal – An Analysis From 2000 To 2015
DOI:
https://doi.org/10.48729/pjctvs.437Keywords:
incidence, Amputation, Peripheral arterial disease, Endovascular Procedures, Lower extremityAbstract
Objectives: Effective revascularization is the cornerstone of limb salvage in chronic limb threatening ischemia. In recent years, less invasive endovascular revascularization techniques have supplanted surgical bypass as the primary mode of revascularization. The real impact of this transition is being increasingly questioned. This study aims to evaluate the endovascular evolution, and how it impacted the amputation rates nationwide since de beginning of the century.Methods: Patients admitted to Portuguese public hospitals with peripheral arterial disease between 2000 and 2015 were selected. Of these, patients that underwent to limb revascularization and/ or limb amputation were evaluated. The information was obtained through the National Health Service administrative database. Three time periods (2000-2004, 2005-2009, 2010-2015) were considered to evaluate the evolution in amputation rates and type of revascularization.
Results: The global number of revascularization episodes consistently increased along the 15 analyzed years. There were 25252 admissions for revascularization (55.1% open and 44.9% endovascular). The mean incidence of endovascular procedures significantly increased 5.8 times (p<0.01), and open surgery increased 1.3 times (p<0.01) when comparing the three time periods. 34633 limb amputations (65.3% major vs 34.7% minor) were realized along 15 years. The mean incidence of lower limb amputations increased by 1.5 times thanks to minor amputation, whose mean incidence increased two-fold while with the incidence of major amputations remained stable. Additionally, mean hospital mortality associated with revascularization episodes decreased from 10.6% to 8.2% (p<0.01), on 15-year follow-up.
Conclusions: There was a significative increase in revascularization episodes over the 15 years, suggesting better access to health services and/or better diagnostic accuracy. Endovascular procedures were the most practiced. This was along with an increase in the minor limb amputation, a stabilization in major amputations incidence. This nationwide study adds to the increasing body of knowledge in the ever-pertinent discussion of revascularization types and their benefits.
Downloads
References
Mark A. Creager KM, Shipra Arya, Joshua A. Beckman, Sue Duval, Philip P. Goodney, et al. Reducing Nontraumatic Lower Extremity Amputations by 20% by 2030: Time to Get to Our Feet: A Policy Statement From the American Heart Association. Circulation. 2021;Vol 143( Issue 17):e875–e91.
European Stroke Organisation TM, Aboyans V, Bartelink ML, Baumgartner I, Clément D, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011;32((22)):2851-906.
Minar E. Endovascular-first strategy for all patients with peripheral arterial disease? Interv Cardiol 2012;4((4)):393–5.
Wolosker NS, Marcelo. Leiderman, Dafne. Stabellini, Nickolas. Nogueira, Wellington. Szlejf, Claudia et al. Lower Limb Revascularization for Peripheral Arterial Disease in 10,951 Procedures over 11 years in a Public Health System: A Descriptive Analysis of the Largest Brazilian City. Annals of Vascular Surgery; 2020.
John R. Laird KKY. The Treatment of Femoropopliteal InStent Restenosis: Back to the Future. J Am Coll Cardiol. 2012;59((1)):24–5.
Bradbury AA, Donald. Bell , Jocelyn. Forbes , John. Gerry F. Fowkes, R. et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty - first revascularization strategy. J Vasc Surg; 2010.
Benchimol EI SL, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015 Oct;6(10):12.
Vandenbroucke JP vEE, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.: Int J Surg; 2014. p. 1500-24.
Goodal RS, Justin. Davies, Alun. Marshall, Domenic. Shalhoub, Joseph. Trends in peripheral arterial disease incidence and mortality in EU15+ countries 1990-2017. Eur J Prev Cardiol.; 2021. p. 1201-13.
Kreutzburg TP, Frederik. Rieb, Henrik. Huschke, Sandra. Marschall, Ursula.Kriston, Levente et al. Editor's Choice - Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data. Eur J Vasc Endovasc Surg.; 2020. p. 59-66.
Puech-Leão PW, N. Zerati, N. Impact of endovascular technique in vascular surgery training at a large university hospital in Brazil. J Surg Educ. p. 19-23.
Wolosker NF, M. Braga, D. Leiderman, D. Stabellini, N. Nogueira, A et al. Lower Limb Revascularization for Peripheral Arterial Disease in 10, 951 Procedures over 11 years in a Public Health System: A Descriptive Analysis of the Largest Brazilian City. Ann Vasc Surg; 2020. p. 1-7.
Ogurtsova K dRFJ, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract; 2017. p. 40-50.
Sousa-Uva MA, L. Nunes, B. Rodrigues, A. Simões, J. Ribeiro, R et al. Trends in diabetes incidence from 1992 to 2015 andprojections for 2024: A Portuguese GeneralPractitioner’s Network study. 2016. p. 329-33.
Decker JA HM, Bette S, Schwarz F, Kroencke TJ, Scheurig-Muenkler C. Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 Million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018. Cardiovasc Intervent Radiol. 2022 Oct;45(10):1472-82.
Wasmuth SB, I. Willenberg, T. Saguner, A. Zwahlen, M. Diehm, N. Renal Insufficiency is Independently Associated with a Distal Distribution Pattern of Symptomatic Lower-limb Atherosclerosis. European Journal of Vascular and Endovascular Surgery; 2010. p. 591-196.
Khoury H, Morales R, Sanaiha Y, Rudasill S, Jaman R, Gelabert Hu, et al. Trends in mortality, readmissions, and complications after endovascular and open infrainguinal revascularization. Surgery; 2019. p. Pages 1222-7.
Lenti M, Cieri E, Rango P, Pozzilli P, Coscarella C, Bertoglio C, et al. Endovascular treatment of long lesions of the superficial femoral artery: Results from a multicenter registry of a spiral, covered polytetrafluoroethylene stent. Journal of Vascular Surgery; January 2007. p. Pages 32-9.
Moxey PG, P. Hinchliffe, R. Loftus, I. Jones, K. Thompson, M. Holt, P. Lower extremity amputations--a review of global variability in incidence. Diabet Med.; 2011. p. 1144-53.
Jaff MC, Kevin. Yu, Andrew. Birnbaum, Howard. Engelhart, Luella. Clinical Outcomes and Medical Care Costs Among Medicare Beneficiaries Receiving Therapy for Peripheral Arterial Disease. Annals of Vascular Surgery; 2010. p. 577-87.
Klaphake SL, Kevin. Thijsee, Willem. Ho, Gwan. Groot, Hans. Veen, Eelco et al. Reinterventions after Endovascular Revascularization in Elderly Patients with Critical Limb Ischemia: An Observational Study. Annals of Vascular Surgery; 2018. p. 171-6.
Voci D, Fedeli U, Valerio L, Schievano E, Righini M, Kucher N, et al. Mortality rate related to peripheral arterial disease: A retrospective analysis of epidemiological data (years 2008–2019). Nutrition, Metabolism and Cardiovascular
Downloads
Published
How to Cite
License
Copyright (c) 2024 Portuguese Journal of Cardiac Thoracic and Vascular Surgery
This work is licensed under a Creative Commons Attribution 4.0 International License.
