Norwegian trends in numbers of lower extremity revascularisations and amputations including regional trends in endovascular treatments for peripheral arterial disease: a retrospective cross-sectional registry study from 2001 to 2014

Abstract

ObjectiveThe numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important.MethodsThis retrospective cross-sectional study from 2001 to 2014 used data from the Norwegian Patient Registry. The revascularisation treatments were categorised in multilevel, aortoiliac, femoral to popliteal and popliteal to foot levels and sorted as open, endovascular and hybrid. The sessions in amputations were divided in major (thigh and below knee) and minor (ankle, foot or digit). Incidence rates were assessed per 100 000 for patients in the age group >60 years. The diabetic prevalence was calculated and the endovascular numbers at the South-Eastern, Western, Central and Northern Norway Regional Health Authority were compared.ResultsThe overall revascularisation rates increased from 308.7 to 366.8 (p=0.02). Open revascularisations decreased from 158.9 to 98.7 (p<0.01) while endovascular revascularisations increased from 142.2 to 243.4 (p<0.01). Hybrid revascularisations increased from 7.4 to 24.8 (p<0.01). Major amputation rates decreased from 87.8 to 48.7 (p<0.01) while minor amputations increased from 12.3 to 19.6 (p=0.01). The diabetic percentages increased from 12.2 to 22.3 (p<0.01) in revascularisations, from 26.5 to 30.8 (p=0.02) in major amputations and from 43.0 to 49.3 (p=0.13) in minor. (p values refer to average annual changes.) The regional trends in endovascular treatments varied within and between the vascular groups.ConclusionFrom 2001 to 2014, the revascularisation rates increased due to the rise in endovascular procedures. Open revascularisations and major amputation rates decreased, minor increased. The regional variances in endovascular treatments indicate that the availability of this technology differed between the health regions of Norway. The increase in patients with diabetes requires continued awareness of diabetes and its complications.

Urban-rural disparity in lower extremities amputation in patients with diabetes after nearly two decades of universal health Insurance in Taiwan

“…This seemingly conflicting finding was also consistent with Unwin's study, which was based on ten medical centers around the world and concluded that the differences in overall LEA prevalence could not be accounted for by differences in the prevalence of DM, but a more important factor leading to LEA was peripheral vascular disease [31]. One cross-sectional study also demonstrated regional variations in the availability of endovascular treatments that could increase revascularization rates and in turn decrease LEA [32]. Moreover, Troisi et al's study also supported the aforementioned finding and found significant reductions in LEA after just a 1 year program organized by a multidisciplinary surgical team to provide care for foot ulcers in patients with diabetes in an urban area, including earlier and more frequent use of revascularization procedures [25].…”

Population-based secular trends in lower-extremity amputation for diabetes and peripheral artery disease

“…Few studies have examined temporal trends of amputations exclusively related to peripheral artery disease. [31][32][33][34][35][36] Data from these studies suggest a decline in major amputations related to peripheral artery disease, and an increase in minor amputations related to peripheral artery disease over the last decade. This could be explained by advancements in cardiovascular risk-reduction therapies, 37 greater uptake of endovascular interventions, 36 and an increased focus on limb-preservation strategies that may result in a minor amputation to prevent a major one.…”

Trends in Lower Limb Amputation in Patients with Diabetic Foot Based on Vascular Intervention of Peripheral Arterial Disease in Korea: a Population-based Nationwide Study

“…For example, from 1996 to 2011, the rate of endovascular interventions increased by 165%, while the rate of lower limb amputations decreased by 45% in the United States 9. Along with increased revascularization rates, major amputation rates decreased from 87.8 to 48.7 while minor amputations increased from 12.3 to 19.6 from 2001 to 2014 in Norway 13. Such results suggest an increase in the rate of endovascular interventions followed by changes in types of amputation, consistent with findings of the current study.…”