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Trends and Outcomes of Lower Limb Vascular Procedures in a Multiethnic Asian Population in Singapore: A 10 Year Study
Sanchi Dua Avinashi1, Andrew M T L Choong2, Tessa Riandini3
1Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Objectives:
The global burden of peripheral artery disease (PAD) has increased, contributing to rising rates of lower limb vascular procedures (LLVPs), yet data from Asia remain limited. This retrospective, observational cohort study examined national trends in LLVPs and evaluated post-procedural outcomes, factors associated with these outcomes, and amputation free survival (AFS) following LLVPs.
Methods:
National administrative data were used to analyse individuals aged 16 - 100 years from 2012 - 2021 retrospectively. Age and sex standardised LLVP rates were estimated overall, and among populations with diabetes mellitus (DM), end stage renal disease (ESRD), and cardiac disease (CD), including DM with SRD, and DM with CD subpopulations. Trends were assessed using joinpoint regression. Median times to repeat LLVP, minor and major amputation, and all cause death were estimated, and Cox regression identified factors associated with AFS and major AFS.
Results:
Between 2012 and 2021 20 597 LLVPs were performed in 10 703 unique individuals, 88% of whom had DM. Overall, LLVP rates increased by 3.22% annually (p = .001). Risk attributable to DM increased from 85.8% to 92.4% (p = .004). In 2021, LLVP rates were highest among the ESRD (6 072.68 per 100 000) population. Within the DM with ESRD population, ESRD increased LLVP risk by 19 fold. The post-LLVP all cause mortality rate was 111.86 per 1 000 person years, with a median survival of 22.7 months. AFS and major AFS were 42.0% and 52.0% at 3 years. Older age, lower socioeconomic status, poorer cardio-metabolic-renal profiles, and higher comorbidity burden were associated with poor outcomes.
Conclusion:
LLVP rates increased nationally, reflecting a growing burden of PAD and were associated with high repeat intervention and mortality rates, particularly among patients with DM and ESRD. Marked ethnic and socio-economic disparities further underscore the substantial burden of PAD and highlight the need for earlier prevention, improved risk factor control, and targeted strategies to improve long term outcomes.
