Related Experiment Videos
Changing trends in the management of lower-limb ischaemia: a 17-year review
R D Sayers1, M M Thompson, K Varty
1Department of Surgery, Leicester Royal Infirmary, UK.
Insights
Vascular surgery for chronic lower-limb occlusive disease increased, with more revascularization attempts before amputation. While amputation rates remained stable, patient age and treatment complexity rose over 17 years.
Area of Science:
- Vascular Surgery
- Cardiovascular Diseases
- Peripheral Artery Disease
Background:
- Chronic lower-limb occlusive disease (CLOD) poses significant challenges in vascular surgery.
- Treatment trends for CLOD have evolved, impacting surgical workloads and patient outcomes.
- Understanding long-term changes in CLOD management is crucial for optimizing patient care.
Purpose of the Study:
- To analyze trends in vascular procedures for CLOD over a 17-year period.
- To evaluate changes in amputation rates, revascularization strategies, and patient demographics.
- To assess the impact of these trends on mortality and hospital stay.
Main Methods:
- Retrospective analysis of 2930 vascular procedures for CLOD.
- Data collection over a 17-year period.
- Comparison of procedural rates, amputation ratios, patient age, revascularization attempts, mortality, and hospital stay.
Main Results:
- Significant increase in overall vascular surgical workload, driven by arterial reconstruction and percutaneous transluminal angioplasty.
- No significant change in major lower-limb amputation rate, but a decrease in the above- to below-knee amputation ratio.
- Increased proportion of patients over 75 years and more revascularization attempts prior to amputation.
- No significant change in mortality rates for any procedure; increased hospital stay for amputation, decreased for arterial reconstruction.
Conclusions:
- Vascular surgical practice for CLOD has shifted towards increased revascularization attempts, particularly in older patients.
- While amputation rates are stable, the management strategy prioritizes limb salvage.
- These trends necessitate careful resource allocation and ongoing evaluation of treatment efficacy and patient outcomes.
Abstract:
Over a 17-year period, 2930 vascular procedures were performed for chronic lower-limb occlusive disease. During this time, the total vascular surgical workload rose significantly as a result of an increase in the rates of arterial reconstruction and percutaneous transluminal angioplasty. Although the major lower-limb amputation rate did not change significantly, there was a decrease in the above- to below-knee ratio. In addition, there were significant increases in the percentage of patients treated over the age of 75 years and the proportion of attempted revascularizations before amputation. The mortality rates for arterial reconstruction, percutaneous transluminal angioplasty and amputation did not change significantly during the study period. The duration of hospital stay increased significantly for patients undergoing amputation and decreased significantly for those receiving arterial reconstruction.