TY - JOUR
T1 - Population-Based Trends in Amputations and Revascularizations for Peripheral Artery Disease From 1990 to 2009
AU - Nienaber, Jeffrey J.
AU - Smith, Carin Y.
AU - Cha, Stephen
AU - Correa, Mateus
AU - Rowse, Phillip G.
AU - Bailey, Kent R.
AU - Kalra, Manju
N1 - Funding Information:
Grant Support: This research was supported by funds from the Gonda Vascular Center and Department of Surgery , Division of Vascular Surgery, at Mayo Clinic in Rochester, Minnesota. These funds were used for statistical analyses. This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (CTSA, REDCap). The REDCap software was used for data entry and distribution. Dr Nienaber obtained a CTSA Certificate while working on this study. Data were obtained from the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health . The funding sources were not involved in the interpretation of data or preparation, review, or approval of the manuscript or in the decision to submit the manuscript for publication.
Publisher Copyright:
© 2021 Mayo Foundation for Medical Education and Research
PY - 2022/5
Y1 - 2022/5
N2 - Objective: To determine trends in amputations and revascularizations for peripheral artery disease (PAD) in a well-defined population. Methods: A population-based cohort study of Olmsted County, Minnesota, residents with PAD undergoing amputation or revascularization was conducted between January 1, 1990, and December 31, 2009. Population-level 5-year incidence trends for endovascular, open surgical, and hybrid revascularizations and major and minor amputations were determined. Limb-specific outcomes after revascularization, including major adverse limb events and amputation-free survival, were compared between initial surgical and endovascular or hybrid revascularization groups using Kaplan-Meier analysis. Results: We identified 773 residents who underwent 1906 limb-procedures, including 689 open revascularizations, 685 endovascular or hybrid revascularizations, and 220 major amputations. During the 20-year study period, the incidence of endovascular and hybrid revascularizations increased, whereas the incidence of open surgical revascularizations and major amputations decreased. Incidence of revascularizations for chronic limb-threatening ischemia (CLTI) did not change. Among residents with CLTI undergoing their first revascularization on a limb, endovascular revascularization was associated with more major adverse limb events and major amputations compared with surgical revascularization during the ensuing 15 years. Conclusion: The rising incidence of endovascular and hybrid revascularizations and the decreasing incidence of open surgical revascularizations for PAD were associated with a decreasing incidence of major amputations in this population between 1990 and 2009, despite a stable incidence of revascularizations for CLTI. With more major adverse limb events and major amputations after endovascular revascularization, these trends suggest that additional emphasis should be placed on improving limb salvage efforts beyond just mode of revascularization.
AB - Objective: To determine trends in amputations and revascularizations for peripheral artery disease (PAD) in a well-defined population. Methods: A population-based cohort study of Olmsted County, Minnesota, residents with PAD undergoing amputation or revascularization was conducted between January 1, 1990, and December 31, 2009. Population-level 5-year incidence trends for endovascular, open surgical, and hybrid revascularizations and major and minor amputations were determined. Limb-specific outcomes after revascularization, including major adverse limb events and amputation-free survival, were compared between initial surgical and endovascular or hybrid revascularization groups using Kaplan-Meier analysis. Results: We identified 773 residents who underwent 1906 limb-procedures, including 689 open revascularizations, 685 endovascular or hybrid revascularizations, and 220 major amputations. During the 20-year study period, the incidence of endovascular and hybrid revascularizations increased, whereas the incidence of open surgical revascularizations and major amputations decreased. Incidence of revascularizations for chronic limb-threatening ischemia (CLTI) did not change. Among residents with CLTI undergoing their first revascularization on a limb, endovascular revascularization was associated with more major adverse limb events and major amputations compared with surgical revascularization during the ensuing 15 years. Conclusion: The rising incidence of endovascular and hybrid revascularizations and the decreasing incidence of open surgical revascularizations for PAD were associated with a decreasing incidence of major amputations in this population between 1990 and 2009, despite a stable incidence of revascularizations for CLTI. With more major adverse limb events and major amputations after endovascular revascularization, these trends suggest that additional emphasis should be placed on improving limb salvage efforts beyond just mode of revascularization.
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U2 - 10.1016/j.mayocp.2021.10.021
DO - 10.1016/j.mayocp.2021.10.021
M3 - Article
AN - SCOPUS:85124609852
VL - 97
SP - 919
EP - 930
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
SN - 0025-6196
IS - 5
ER -