This cohort study shows that, from 2006 to 2015, the overall survival rate increased and the risk of major amputation decreased following lower limb revascularization. These population observations indicate that outcomes after lower limb revascularization have improved during the assessed period, and so have the centralization and specialization of interventional services.
The availability and diversity of sites where lower limb revascularization procedures can be carried out have increased all over the world in the last decade (although this work provides information regarding England, specifically). This study sought to determine whether the mastery of skills by interventional professionals and technology development (with many more improvements for peripheral disease than for coronary disease) have had an impact on patient prognosis.
Researchers used a database with information on 103,934 patients who underwent endovascular (angioplasty) or surgical (endarterectomy, profundaplasty, or bypass) treatment for infrainguinal peripheral vascular disease between 2006 and 2015.
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The estimated 1-year risk of major amputation decreased from 5.7% (in 2006-2007) to 3.9% (in 2014-2015) after endovascular revascularization, and from 11.2% (in 2006-2007) to 6.6% (in 2014-2015) after surgical revascularization. The risk of death after both types of revascularization also decreased. This trend was observed for all indications. The largest reduction was found in patients with critical ischemia, ulceration, or gangrene.
Conclusion
Overall survival improved and the rate of major amputation decreased between 2006 and 2015, with a higher number of revascularizations. Results improve over time due to the emergence of specialized sites where procedures are centralized. However, this still has not happened in many places, and many patients have amputations without even undergoing a diagnostic angiography.
Original title: Improving 1-Year Outcomes of Infrainguinal Limb Revascularization: A Population-Based Cohort Study of 104 000 Patients in England.
Reference: Katriina Heikkila et al. Circulation. 2018 May 1;137(18):1921-1933.
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