Dear P&O colleagues,
This months Amputee Coalition of America PUBMED compilation summarizes this
very interesting article published in the Journal of Vascular Surgery.
Medicare Part B claims between 1996 and 2006 were reviewed and major
amputation rates declined 25%. A local Level 1 Trauma hospital just
reviewed their rehab unit intake rate and also showed a significant decline
in admittance of people with amputations.
Comments / Observations?
Thank you,
Al
Al Ingersoll, Certified Prosthetist
Winkley Orthotics & Prosthetics
740 Douglas Drive North
Golden Valley MN 55422 USA
Ph. 763-546-1177 Fax 763-847-9508
1-800-Winkley Direct to VM 763-252-1128
[email protected]
www.Winkley.com
1: J
2009 Jul;50(1):54-60. Epub 2009 May 28.
National trends in lower extremity bypass surgery, endovascular
interventions, and major amputations.
Dartmouth-Hitchcock Medical Center, Lebanon, NH 03765, USA.
[email protected]
INTRODUCTION: Advances in endovascular interventions have expanded the
options available for the invasive treatment of lower extremity peripheral
arterial disease (PAD). Whether endovascular interventions substitute for
conventional bypass surgery or are simply additive has not been
investigated, and their effect on amputation rates is unknown. METHODS: We
sought to analyze trends in lower extremity endovascular interventions
(angioplasty and atherectomy), lower extremity bypass surgery, and major
amputation (above and below-knee) in Medicare beneficiaries between 1996 and
2006. We used 100% samples of Medicare Part B claims to calculate annual
procedure rates of lower extremity bypass surgery, endovascular
interventions (angioplasty and atherectomy), and major amputation between
1996 and 2006. Using physician specialty identifiers, we also examined
trends in the specialty performing the primary procedure. RESULTS: Between
1996 and 2006, the rate of major lower extremity amputation declined
significantly (263 to 188 per 100,000; risk ratio [RR] 0.71, 95% confidence
interval [CI] 0.6-0.8). Endovascular interventions increased more than
threefold (from 138 to 455 per 100,000; RR =.30; 95% CI: 2.9-3.7) while
bypass surgery decreased by 42% (219 to 126 per 100,000; RR =.58; 95% CI:
0.5-0.7). The increase in endovascular interventions consisted both of a
growth in peripheral angioplasty (from 135 to 337 procedures per 100,000; RR
=.49; 95% CI: 2.2-2.8) and the advent of percutaneous atherectomy (from 3
to 118 per 100,000; RR =3.12; 95% CI: 34.8-52.0). While radiologists
performed the majority of endovascular interventions in 1996, more than 80%
were performed by cardiologists and vascular surgeons by 2006. Overall, the
total number of all lower extremity vascular procedures almost doubled over
the decade (from 357 to 581 per 100,000; RR =.63; 95% CI: 1.5-1.8).
CONCLUSION: Endovascular interventions are now performed much more commonly
than bypass surgery in the treatment of lower extremity PAD. These changes
far exceed simple substitution, as more than three additional endovascular
interventions were performed for every one procedure declined in lower
extremity bypass surgery. During this same time period, major lower
extremity amputation rates have fallen by more than 25%. However, further
study is needed before any causal link can be established between lower
extremity vascular procedures and improved rates of limb salvage in patients
with PAD.
PMID: 19481407 [PubMed – indexed for MEDLINE]
