Vascular diagnostic and surgical treatments before lower lim
Patients with peripheral artery disease (PAD) have an increased risk of lower limb amputation. Given the international wide variance in major amputations, the high mortality rates and follow-up costs as well as the significantly reduced quality of life of patients with amputations, vascular diagnostics, and vascular surgery treatments are of great importance for lower limb preservation in patients with PAD.

This study examines these guideline-based procedures in patients before a first lower limb amputation and PAD.

This was a retrospective longitudinal study. Data from a large German statutory health insurance scheme were examined on patients with the first amputation of lower extremities and PAD. Pre-defined vascular diagnostic and vascular surgical procedures were considered, as specified by guidelines within inpatient and outpatient care in a defined time before lower limb amputation.

- The overall estimated incidence of lower extremity amputations in the total population was 0.12% from 2013 to 2015. Of these, 51.7% had PAD; 81.8% of patients received at least one vascular diagnostic measure, and 61.0% a vascular surgery procedure before the lower extremity amputation.

- There were only minor variations in the use of diagnostic or surgical treatments between patients with major and minor amputation.

- In total, 63.9% of patients had vascular surgery before the incident major amputation compared with 60.0% of patients with a minor amputation.

- Noticeable regional differences were found ranging from 91% (Berlin) to 67% (Bremen) regarding diagnostic procedures provided before amputation, and from 83% (Hamburg) to 55% (Saxony-Anhalt) regarding vascular surgery before amputations.

Of patients with PAD, 18.2% did not receive a vascular diagnostic examination before amputation as specified in the guidelines, which reflects the underuse of health services. In one-third of patients who did not receive vascular surgery, major amputation probably could have been avoided.

European Journal of Vascular and Endovascular Surgery