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Effects of vascular surgery on amputation rates and mortality
1Kirurgkliniken, Norra Alvsborgs Länssjukhus, Trollhättan, Sweden.
Objectives:
To study the relation between rates of vascular interventions, amputations and mortality in a defined population.
Design:
Retrospective comparison between two consecutive 4-year periods.
Setting:
Swedish district hospital covering a population of 125,000.
Material:
Three hundred and sixty-seven lower limb amputations and 1080 vascular procedures.
Results:
The number of legs treated for limb-threatening ischaemia with either revascularisation or amputation increased from 269 to 289. The rate of vascular interventions for limb-threatening ischaemia increased from the first to the second period by 65%, while the rate of amputations decreased by 23%. Limb salvage rate at 30 months increased from 37% to 53% (p < 0.0000). The reduced amputation rate was entirely related to primary amputations. The adjusted risk of amputation for patients treated in the second period was half of that for patients treated in the first period (relative risk = 0.49, p = 0.0001), while mortality was similar in both periods. Among survivors, the proportion of patients with intact legs was higher in the second period than in the first, while no difference was found between the two periods among deceased patients.
Conclusions:
Increased vascular intervention leads to improved limb salvage rates and reduced amputation rates. It is important for both ethical and economical reasons to identify good responders to revascularisation, because the choice of initial treatment will only influence limb salvage but not survival.