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.