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Epidemiology and Prognostic Factors in Acute Lower Limb Ischaemia: A Population Based Study

Andrea Kulezic1, Stefan Acosta2

  • 1Department of Clinical Sciences, Lund University, Malmö, Sweden.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|January 14, 2022
PubMed

Insights

The incidence of acute lower limb ischaemia (ALI) remains unchanged, with high rates of major amputation and death one year post-diagnosis. Factors like severe ALI, older age, female sex, and anaemia increase risk.

Area of Science:

  • Vascular Surgery
  • Epidemiology
  • Public Health

Background:

  • Acute lower limb ischaemia (ALI) is a critical vascular condition with significant morbidity and mortality.
  • Understanding contemporary population-based incidence and associated risk factors is crucial for effective management and prevention strategies.
  • Previous studies may not fully capture the current landscape of ALI management and outcomes.

Purpose of the Study:

  • To determine the current population-based incidence of acute lower limb ischaemia (ALI) in Malmö, Sweden.
  • To identify factors associated with major amputation or death within one year of ALI diagnosis.
  • To evaluate the proportion of ALI patients undergoing revascularisation and assess anticoagulation use in those with atrial fibrillation.

Main Methods:

  • Retrospective observational study analyzing registries for 161 ALI patients in Malmö (2015-2018).
  • Calculation of age and sex-specific incidence rates per 100,000 person-years (PY).
  • Multivariable logistic regression used to identify independent risk factors for one-year major amputation/death.

Main Results:

  • Overall ALI incidence was 12.2/100,000 PY, with no sex differences.
  • Embolism was the most common cause (42.2%). Major amputation/mortality rate at one year was 46.6%.
  • Risk factors for adverse outcomes included Rutherford ≥ IIb ALI, older age, female sex, and anaemia. Patients in nursing homes had a 100% amputation/mortality rate.

Conclusions:

  • The incidence of ALI is stable, but one-year major amputation and mortality rates remain high.
  • A significant proportion of ALI patients do not undergo revascularisation, highlighting a gap in care.
  • Improvements in anticoagulation for atrial fibrillation patients are needed to prevent embolic ALI; further research into gender disparities is warranted.
Abstract

Keywords:
Acute lower limb ischaemiaEpidemiologyIncidenceMajor amputationMortalityPopulation based study

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