Lower Limb Revascularization Associated With Reduced Death and Amputation in England

Patient outcomes after lower limb revascularization have improved over the past decade in England, according to a study published Jan. 9 in Circulation.

Katriina Heikkila, PhD, et al., examined 103,934 patients who underwent endovascular or surgical lower limb revascularization for infrainguinal peripheral artery disease (PAD) in England between January 2006 and December 2015. Results showed that 77,213 patients underwent endovascular revascularization and 26,721 patients underwent surgical revascularization during the 10-year period. Most patients were men and aged 65 years or above.

The authors found that the estimated one-year risk of major amputation reduced from 5.7 percent to 3.9 percent following endovascular revascularization, and from 11.2 percent to 6.6 percent following surgical revascularization. In addition, the one-year risk of death also reduced, from 9.5 percent to 6.0 percent following endovascular revascularization, and from 11.1 percent to 6.4 percent following surgical revascularization. These findings were observed for all categories of PAD severity, with the largest reductions among patients who had severe limb ischemia with ulceration or gangrene.

Overall, morbidity increased over the study period, and a larger proportion of patients were treated for the severe end of the PAD spectrum using less invasive procedures.

The authors conclude that despite higher morbidity, "these trends suggest overall improvements in the outcomes for patients with severe PAD during a period of centralization and specialization of vascular surgical services in the U.K."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and Vascular Medicine

Keywords: Peripheral Arterial Disease, Gangrene, Lower Extremity, Vascular Surgical Procedures, Amputation, Ischemia, England

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