Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication...

Area of Science:

• Vascular Surgery
• Public Health
• Epidemiology

Background:

• Peripheral artery disease (PAD) affects a significant population, necessitating revascularisation procedures.
• Understanding long-term outcomes, including amputation risk and mortality, is crucial for patient management.
• Pre-operative comorbidities influence outcomes in PAD patients undergoing revascularisation.

Purpose of the Study:

• To determine mid- to long-term amputation risk following lower limb revascularisation for PAD.
• To assess the cumulative incidence of death or amputation in PAD patients.
• To identify differences in pre-operative comorbidities between patients with intermittent claudication (IC) and critical limb ischaemia (CLI).

Main Methods:

• Observational cohort study utilizing Swedish national healthcare registries and patient medical records.
• Inclusion of 16,889 patients aged 50+ undergoing revascularisation for IC or CLI between May 2008 and May 2013.
• Data linkage for comorbidities, mortality, and major amputations.

Main Results:

• Amputation incidence was 0.4% annually for IC patients.
• CLI patients experienced a 12.0% amputation rate within 6 months post-revascularisation, declining to ~2% annually thereafter.
• Three-year cumulative incidence of death or amputation was 12.9% for IC and 48.8% for CLI patients.
• CLI patients exhibited higher prevalence of diabetes, stroke, heart failure, atrial fibrillation, and renal failure compared to IC patients.

Conclusions:

• Amputation risk is notably elevated in the initial 6 months post-revascularisation for CLI.
• Lower limb loss is infrequent in IC patients following revascularisation.
• Substantial mortality rates are observed in both IC and CLI patient groups.
• CLI patients present with a distinct and more severe comorbidity profile compared to IC patients.