Results:

The proportion of patients with classic risk factors such as hypertension, dyslipidemia, and smoking declined with higher Rutherford categories (each p < 0.001), while diabetes, chronic kidney disease, and chronic heart failure increased (each p < 0.001). Angiographies and revascularizations were performed less often in advanced PAD (each p < 0.001). In-hospital amputations increased continuously from 0.5% in Rutherford 1-3 to 42% in Rutherford 6, as also myocardial infarctions, strokes, and deaths (each p < 0.001). Among 4,298 amputated patients with chronic limb ischemia (CLI), 37% had not received any angiography or revascularization neither during index hospitalization nor in the 24 months before. During follow-up (mean 1,144 days), 7,825 patients were amputated and 10,880 died. Kaplan-Meier models projected 4-year mortality risks of 18.9, 37.7, 52.2, and 63.5% in Rutherford 1-3, 4, 5, and 6, and for amputation of 4.6, 12.1, 35.3, and 67.3%, respectively. In multivariable Cox regression models, PAD categories were significant predictors of death, amputation, myocardial infarction, and stroke (each p < 0.001). Length of in-hospital stay (5.8 ± 6.7 days, 10.7 ± 11.1 days, 15.2 ± 13.8 days, and 22.1 ± 20.3 days; p < 0.001) and mean case costs (3,662 ± 3,186 €, 5,316 ± 6,139 €, 6,021 ± 4,892 €, and 8,461 ± 8,515 €; p < 0.001) increased continuously in Rutherford 1-3, 4, 5, and 6. While only 49% of the patients suffered from CLI, these produced 65% of in-hospital costs (141 million €), and 56% during follow-up (336 million €).