Impact Of Open And Endovascular Caseload In Lower Limb Amputation In Portugal - An Analysis From 2000 To 2015.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Public Health Policy

Background:

• Chronic limb-threatening ischemia (CLTI) necessitates effective revascularization for limb salvage.
• Endovascular techniques have become primary, raising questions about their impact compared to traditional surgery.
• Assessing national trends in revascularization and amputation rates is crucial for understanding treatment evolution.

Purpose of the Study:

• To evaluate the nationwide evolution of endovascular revascularization techniques in Portugal.
• To determine the impact of these evolving techniques on lower limb amputation rates from 2000 to 2015.
• To analyze changes in the types of revascularization procedures and amputation incidence over time.

Main Methods:

• Retrospective analysis of patients with peripheral arterial disease admitted to Portuguese public hospitals (2000-2015).
• Data sourced from the National Health Service administrative database.
• Categorization into three time periods (2000-2004, 2005-2009, 2010-2015) to assess trends.

Main Results:

• Revascularization episodes increased significantly, with endovascular procedures rising 5.8-fold and open surgery 1.3-fold.
• Total limb amputations increased by 1.5 times, driven by a two-fold increase in minor amputations; major amputations remained stable.
• Hospital mortality associated with revascularization decreased from 10.6% to 8.2% over the study period.

Conclusions:

• A substantial rise in revascularization procedures suggests improved healthcare access and diagnostic capabilities.
• The shift towards endovascular techniques coincided with an increase in minor amputations and stable major amputation rates.
• This study contributes valuable insights into the ongoing debate on revascularization strategies for CLTI.