Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Seminars in Cardiovascular Medicine

The Journal of Lithuanian Heart Association

1 Issue per year

Open Access
See all formats and pricing
More options …

The impact of endovascular intervention and open surgery on the incidence of lower extremity amputations

Saulius Sudikas
  • Vilnius University Clinic of Heart and Vascular Diseases, Vilnius, Lithuania
  • Vilnius City University Hospital, Vilnius, Lithuania
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Vytautas Triponis
  • Vilnius University Clinic of Heart and Vascular Diseases, Vilnius, Lithuania
  • Vilnius City University Hospital, Vilnius, Lithuania
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Elvyra Stanevičiūtė
Published Online: 2012-07-20 | DOI: https://doi.org/10.2478/v10287-012-0002-4

The impact of endovascular intervention and open surgery on the incidence of lower extremity amputations

Objectives: The impact of endovascular surgery on the amputation rate is not clearly determined. The study aims at determining the relationship between the increasing number of endovascular procedures and the incidence of the lower limb amputations.

Patients and methods: Annual reports comprising 78,250 cases of peripheral arterial disease (PAD) obtained from 8 Lithuanian vascular surgery centers in 2001-2009 were overviewed and analyzed. There were 7,070 procedures of percutaneous transluminal angioplasty (PTA), 31,488 arterial reconstructive operations and 5,340 amputations of the lower limb.

Results: The number of amputations performed in 2009 increased by 7.4% compared to 2001. In this period the number of patients treated by vascular surgeons increased by 1,748 (22.3%). The number of reconstructive vascular operations remained relatively stable: 3,468 in 2003 compared to 3,376 in 2009. Endovascular procedures performed from 2001 to 2009 increased by 1,277 (309.2%). A strong correlation between the number of patients treated and the growing number of PTA in 2001-2009 was observed (r = 0.916, p = 0.001). An expansion of endovascular treatment resulted in decreasing number of amputations (r = -0.754, p < 0.01). The linear regression analysis showed that the increase in PTA by 1% resulted in decline of amputation number by 0.77% (p = 0.001).

Conclusions: Amputation rate is reliant on changes of admissions for critical limb ischemia. With the increasing number of endovascular procedures, amputation rate is decreasing.

Keywords: Peripheral artery atherosclerosis; endovascular surgery; reconstructive arterial surgery; amputation

  • Nehler MR, Wolford H. Amputation: An overview. In: Rutherford RB, editor. Vascular Surgery, 6th ed. Philadelphia (PA): Saunders; 2005: pp. 951-960.Google Scholar

  • Pernot HF, Winnubst GM, Cluitmans JJ, DeWitte LP. Amputees in Limburg: Incidence, morbidity and mortality, prosthetic supply, care utilisation and functional level after one year. Prosthet Orthot Int 2000; 24:90-96.PubMedCrossrefGoogle Scholar

  • Pohjolainen T, Alaranta H. Ten-year survival of Finnish lower limb amputees. Prosthet Orthot Int 1998; 22:10-16.PubMedGoogle Scholar

  • Rommers GM, Vos LD, Groothoff JW, Schuiling CH, Eisma WH. Epidemiology of lower limb amputees in the north of The Netherlands: Aetiology, discharge destination and prosthetic use. Prosthet Orthot Int 1997; 21:92-99.PubMedGoogle Scholar

  • Hynes N, Mahendran B, Manning B, Andrews E, Courtney D, Sultan S. The influence of subintimal angioplasty on level of amputation and limb salvage rates in lower limb critical ischaemia: A 15-year experience. Eur J Vasc Endovasc Surg 2005; 30:291-299.CrossrefGoogle Scholar

  • European Working Group on Critical Leg Ischemia. Second European consensus document (ECD) on definition of chronic critical leg ischemia. Eur J Vasc Surg 1992; 6:1-32.Google Scholar

  • DeFrang RD, Taylor LM, Porter JM. Basic data related to amputations. Ann Vasc Surg 1991; 5:202-207.CrossrefGoogle Scholar

  • Feinglass J, Brown JL, LoSasso A, Sohn MW, Manheim LM, Shah SJ et al. Rates of lower-extremity amputation and arterial reconstruction in the United States, 1979 to 1996. Am J Public Health 1999; 89:1222-1227.Google Scholar

  • Center for Disease Control and Prevention. Diabetes Data and Trends - Hospitalisations for Non-Traumatic Lower Extremity Amputation. Atlanta: Center for Disease Control and Prevention, 2010.Google Scholar

  • Trautner C. Reduced incidence of lower-limb amputations in the diabetic population of a German city, 1990-2005: Results of the Leverkusen Amputation Reduction Study (LARS). Diabetes Care 2007; 30:2633-2637.Web of ScienceGoogle Scholar

  • Chantelau E, Spraul M, Schmid M. Das Syndrom des diabetischen Fußes. Dtsch med Wschr 1989; 114:1034-1039.Google Scholar

  • Amin NV. Infected diabetic foot ulcers. AFP 1988; 37:283-292.Google Scholar

  • Hallett JW Jr, Byrne J, Gayari MM, Ilstrup DM, Jacobsen SJ, Gray DT. Impact of arterial surgery and balloon angioplasty on amputation: A population-based study of 1155 procedures between 1973 and 1992. J Vasc Surg 1997; 25:29-38.Google Scholar

  • Canavan RJ. Diabetes- and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care: Continuous longitudinal monitoring using a standard method. Diabetes Care 2008; 31:459-463.PubMedWeb of ScienceGoogle Scholar

  • The Global Lower Extremity Amputation Study Group. Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia. Br J Surg 2000; 87:328-337.Google Scholar

  • Rayman G. Are we underestimating diabetes-related lower-extremity amputation rates? Results and benefits of the first prospective study. Diabetes Care 2004; 27:1892-1896.CrossrefPubMedGoogle Scholar

  • Moxey PW. The burden of amputation - an epidemiological study of lower limb amputation in England between 2003 and 2008. Br J Surg 2009; 96:891-895.Google Scholar

  • Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet 2005; 366:1725-1735.Google Scholar

  • Burns P, Gough S, Bradbury AW. Management of peripheral arterial disease in primary care. BMJ 2003; 326:584-588.Google Scholar

  • McCaslin JE, Hafez HM, Stansby G. Lower-limb revas-cularization and major amputation rates in England. Br J Surg 2007; 94:835-839.Google Scholar

  • Sayers RD, Thompson MM, Hartshorne T, Budd JS, Bell PR. Treatment and outcome of severe lower-limb ischaemia. Br J Surg 1994; 81:521-523.Google Scholar

  • Anon P. Amputation or arterial reconstruction? Lancet 1992; 339:900-901.Google Scholar

  • Eickhoff JH, Hansen HJ, Lorentzen JE. The effect of arterial reconstruction on lower limb amputation rate. An epidemiological survey based on reports from Danish hospitals. Acta Chir Scand 1980; 502:181-187.Google Scholar

  • Christensen S. Lower extremity amputations in the county of Aalborg 1961-1971. Population study and follow-up. Acta Orthopaed Scand 1976; 47:329-334.Google Scholar

  • Liedberg E, Persson BM. Increased incidence of lower limb amputation for arterial occlusive disease. Acta Orthopaed Scand 1983; 54:230-234.CrossrefGoogle Scholar

  • Tunis SR, Bass EB, Steinberg EP. The use of angioplasty, bypass surgery, and amputation in the management of peripheral vascular disease. N Engl J Med 1991; 325:556-562.Google Scholar

  • Moxey PW, Gogalniceanu P, Hinchliffe RJ, Loftus IM, Jones KL, Thompson MM et al. Lower extremity amputations - a review of global variability in incidente. Diab Med. doi: 10.1111/j.1464-5491.2011.03279.xCrossrefGoogle Scholar

About the article

Published Online: 2012-07-20

Published in Print: 2012-01-01

Citation Information: Seminars in Cardiovascular Medicine, Volume 18, Issue 1, Pages 1–6, ISSN (Online) 1822-7767, DOI: https://doi.org/10.2478/v10287-012-0002-4.

Export Citation

This content is open access.

Comments (0)

Please log in or register to comment.
Log in