Population-based study of mortality and major amputation following lower limb revascularization

Area of Science:

• Vascular Surgery
• Public Health
• Biostatistics

Background:

• Peripheral artery disease (PAD) affects lower limb circulation.
• Revascularization aims to restore blood flow but carries risks.
• Accurate risk estimation for amputation and death is crucial for patient management.

Purpose of the Study:

• To estimate the risks of major lower limb amputation and death after PAD revascularization.
• To utilize competing risks analysis for more precise outcome assessment.

Main Methods:

• Analysis of routinely collected Hospital Episode Statistics (HES) data in England (2005-2015).
• Inclusion of patients undergoing endovascular or open lower limb revascularization for PAD.
• Application of Cox proportional hazards and Fine-Gray competing risks regression models.

Main Results:

• Over 164,000 revascularizations were analyzed; most patients were male, median age 71.
• 5-year amputation risk varied: 4.2% (endovascular, claudication) to 25.3% (open, tissue loss).
• 5-year death risk ranged from 24.5% to 39.8%; competing risks methods yielded lower estimates.

Conclusions:

• The 5-year risk of major amputation following PAD revascularization is lower than previously estimated.
• Patients with tissue loss and those undergoing open revascularization have the highest risk of limb loss.