Amputations in PAD patients drop 45% over 15 years

The rate of lower limb amputations in Medicare patients with peripheral artery disease (PAD) took a nosedive over the past 15 years while endovascular interventions rose, according to a study published in the January issue of JAMA Surgery.

Philip P. Goodney, MD, MS, of the vascular surgery section of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and colleagues analyzed Medicare claims data between 1996 and 2011 to calculate lower limb amputation rates. They also reviewed Medicare surveys and Behavioral Risk Factor Surveillance System data to study smoking and diabetes trends.

Goodney et al determined that the lower limb amputation rate fell 45 percent in the 15-year period, from 196 to 119 procedures per 100,000 patients. Above-the-knee and below-the knee amputations declined by 48 percent and 39 percent, respectively.

The drop in amputations coincided with increases in the rates of most peripheral endovascular interventions. The rate of therapeutic endovascular interventions changed from 138 to 584 interventions per 100,000 patients, for instance. Those interventions included angioplasty, stenting and atherectomy. Diagnostic lower extremity angiographic procedures rose from 451 to 1,124 procedures per 100,000 patients.

Surgical bypass procedures dropped from 201 to 83 procedures per 100,000 patients, though.

The prevalence of diabetes increased from 16 to 26 cases per 100 patients over 15 years and smoking stayed the same, at 14 smokers per 100 patients.

“[W]e recognize that our study presents no direct causative experimental evidence to explain the decrease in amputation risk,” Goodney et al wrote. “However, it is evident that the increasing use of vascular and preventive care, especially among patients with diabetes, has been temporally associated with lower rates of major amputation.”