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Low Rates of Revascularization and High In-Hospital Mortality in Patients With Ischemic Lower Limb Amputation:

Nasser M Malyar1, Eva Freisinger2, Matthias Meyborg2

  • 1Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital of Muenster, Germany nasser.malyar@ukmuenster.de.

Angiology
|January 15, 2016
PubMed

Insights

Ischemic lower limb amputations remain high in Germany, with significant in-hospital mortality. Underuse of revascularization before amputation may contribute to poor outcomes in critical limb ischemia patients.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Public Health

Background:

  • Peripheral arterial disease and critical limb ischemia (CLI) lead to lower limb amputation (LLA).
  • Assessing the contemporary burden of cardiovascular risk factors, comorbidities, and mortality in LLA patients is crucial.
  • German nationwide data from 2005 and 2009 were analyzed.

Purpose of the Study:

  • To evaluate the nationwide burden of cardiovascular risk factors, comorbidities, and in-hospital mortality in patients undergoing lower limb amputation (LLA) due to peripheral arterial disease and critical limb ischemia (CLI) in Germany.
  • To analyze trends in LLA rates, revascularization procedures, and mortality between 2005 and 2009.

Main Methods:

  • Analysis of German nationwide data for 2005 and 2009.
  • Inclusion of data on major and minor ischemic LLA, risk factors, comorbidities, surgical and endovascular revascularizations, and in-hospital mortality.
  • Statistical comparison of outcomes between different amputation types and years.

Main Results:

  • A relative decrease of -21.8% in major LLA and a +2% increase in minor LLA rate were observed between 2005 and 2009.
  • The overall revascularization rate before amputation increased from 46% in 2005 to 57% in 2009.
  • In-hospital mortality was significantly higher for major amputees (19.8%) compared to minor (4.6%) and non-CLI (3.3%) amputees.

Conclusions:

  • Ischemic lower limb amputations and related in-hospital mortality remain a significant public health issue in Germany.
  • The high mortality in critical limb ischemia (CLI) patients may be partly attributed to the underuse of revascularization procedures prior to amputation.
  • Further research and interventions are needed to improve outcomes for patients with peripheral arterial disease and CLI.
Abstract

Keywords:
critical limb ischemiaischemic lower limb amputationmortalityperipheral artery disease

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