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Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia : A Population Based Study

Baubeta Fridh, E. LU orcid ; Andersson, M. ; Thuresson, M. ; Sigvant, B. ; Kragsterman, B. ; Johansson, S. ; Hasvold, P. ; Falkenberg, M. and Nordanstig, J. (2017) In European journal of vascular and endovascular surgery 54(4). p.480-486
Abstract

Objectives The aims of this population based study were to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD). Methods This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records. All patients who underwent revascularisation in Sweden between May 2008 and May 2013 for intermittent claudication (IC) or critical limb ischaemia (CLI), aged 50 years and older, were identified through the Swedvasc database. The mandatory national health... (More)

Objectives The aims of this population based study were to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD). Methods This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records. All patients who underwent revascularisation in Sweden between May 2008 and May 2013 for intermittent claudication (IC) or critical limb ischaemia (CLI), aged 50 years and older, were identified through the Swedvasc database. The mandatory national health care registries and medical records provided data on comorbidities, mortality, and major amputations. Results A total of 16,889 patients with PAD (IC, n = 6272; CLI, n = 10,617) were studied. The incidence of amputations in IC patients was 0.4% (range 0.3%–0.5%) per year. Among CLI patients, the amputation rate during the first 6 months following revascularisation was 12.0% (95% CI 11.3–12.6). Thereafter, the incidence declined to approximately 2% per year. The cumulative combined incidence of death or amputation 3 years after revascularisation was 12.9% (95% CI 12.0–13.9) in IC patients and 48.8% (95% CI 47.7–49.8) in CLI patients. Among CLI patients, compared with IC patients, the prevalence of diabetes, ischaemic stroke, heart failure, and atrial fibrillation was approximately doubled and renal failure was nearly tripled, even after age standardisation. Conclusion The risk of amputation is particularly high during the first 6 months following revascularisation for CLI. IC patients have a benign course in terms of limb loss. Mortality in both IC and CLI patients is substantial. Revascularised CLI patients have different comorbidities from IC patients.

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author
; ; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
Amputation, Arterial occlusive diseases, Comorbidity, Intermittent claudication, Mortality, Peripheral arterial disease
in
European journal of vascular and endovascular surgery
volume
54
issue
4
pages
480 - 486
publisher
Elsevier
external identifiers
  • scopus:85026830716
  • pmid:28797662
ISSN
1078-5884
DOI
10.1016/j.ejvs.2017.07.005
language
English
LU publication?
no
additional info
Publisher Copyright: © 2017 European Society for Vascular Surgery
id
39051973-c683-4d91-9a8a-42ff3319d8d5
date added to LUP
2022-04-04 10:58:04
date last changed
2025-07-15 02:42:31
@article{39051973-c683-4d91-9a8a-42ff3319d8d5,
  abstract     = {{<p>Objectives The aims of this population based study were to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in pre-operative comorbidities in patients revascularised for lower limb peripheral artery disease (PAD). Methods This was an observational cohort study. Data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) were combined with mandatory national health care registries and patient medical records. All patients who underwent revascularisation in Sweden between May 2008 and May 2013 for intermittent claudication (IC) or critical limb ischaemia (CLI), aged 50 years and older, were identified through the Swedvasc database. The mandatory national health care registries and medical records provided data on comorbidities, mortality, and major amputations. Results A total of 16,889 patients with PAD (IC, n = 6272; CLI, n = 10,617) were studied. The incidence of amputations in IC patients was 0.4% (range 0.3%–0.5%) per year. Among CLI patients, the amputation rate during the first 6 months following revascularisation was 12.0% (95% CI 11.3–12.6). Thereafter, the incidence declined to approximately 2% per year. The cumulative combined incidence of death or amputation 3 years after revascularisation was 12.9% (95% CI 12.0–13.9) in IC patients and 48.8% (95% CI 47.7–49.8) in CLI patients. Among CLI patients, compared with IC patients, the prevalence of diabetes, ischaemic stroke, heart failure, and atrial fibrillation was approximately doubled and renal failure was nearly tripled, even after age standardisation. Conclusion The risk of amputation is particularly high during the first 6 months following revascularisation for CLI. IC patients have a benign course in terms of limb loss. Mortality in both IC and CLI patients is substantial. Revascularised CLI patients have different comorbidities from IC patients.</p>}},
  author       = {{Baubeta Fridh, E. and Andersson, M. and Thuresson, M. and Sigvant, B. and Kragsterman, B. and Johansson, S. and Hasvold, P. and Falkenberg, M. and Nordanstig, J.}},
  issn         = {{1078-5884}},
  keywords     = {{Amputation; Arterial occlusive diseases; Comorbidity; Intermittent claudication; Mortality; Peripheral arterial disease}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{480--486}},
  publisher    = {{Elsevier}},
  series       = {{European journal of vascular and endovascular surgery}},
  title        = {{Amputation Rates, Mortality, and Pre-operative Comorbidities in Patients Revascularised for Intermittent Claudication or Critical Limb Ischaemia : A Population Based Study}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2017.07.005}},
  doi          = {{10.1016/j.ejvs.2017.07.005}},
  volume       = {{54}},
  year         = {{2017}},
}