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. 2021 May;55(4):325-331.
doi: 10.1177/1538574420975588. Epub 2020 Nov 24.

Utilization Rates of Diagnostic and Therapeutic Vascular Procedures Among Patients Undergoing Lower Extremity Amputations in a Rural Community Hospital: A Clinicopathological Correlation

Joji J Varghese  1 , Bailey Ann Estes  1 , Brad J Martinsen  2 , Zsuzsanna Igyarto  2 , Jihad Mustapha  3 , Fadi Saab  3 , Srihari S Naidu  4
Affiliations

Utilization Rates of Diagnostic and Therapeutic Vascular Procedures Among Patients Undergoing Lower Extremity Amputations in a Rural Community Hospital: A Clinicopathological Correlation

Joji J Varghese et al. Vasc Endovascular Surg. 2021 May.

Abstract

Background: Significant geographical variations exist in amputation rates and utilization of diagnostic and therapeutic vascular procedures before lower extremity amputations in the United States. The purpose of this study was to evaluate the rates of diagnostic and therapeutic vascular procedures in the year prior to amputation in a contemporary population and correlate with pathological findings of the amputation specimens.

Methods: A retrospective analysis was conducted of non-traumatic amputations from 2011 to 2017 at a rural community hospital. We reviewed the proportion of patients undergoing diagnostic (ankle brachial index with duplex ultrasound, computerized tomography angiogram and invasive angiogram) and therapeutic (endovascular and surgical revascularization) vascular procedures in the year prior to amputation. Prevalence of tissue viability and osteomyelitis were evaluated in all amputated specimens and atherosclerotic vascular disease (ASVD) was evaluated in major amputations. We also analyzed primary amputation rates among different subgroups.

Results: 698 patients were included with 248 (36%) major amputations and 450 (64%) minor amputations. Any diagnostic procedure was performed in 59% of the major amputations and 49% of the minor amputations (P = 0.01). Any therapeutic revascularization procedure was performed in 34% of the major amputations and 28% of the minor amputations (P = 0.08). The pathology of major amputation specimens revealed severe ASVD in 57% and mild-moderate ASVD in 27% of specimens. Tissue viability was significantly higher in major amputations (90% vs 30%, P = 0.04) and osteomyelitis was significantly higher in minor amputations (50% vs 14%, P = 0.03). Primary amputations were performed in 66% of major amputations, 72% of minor amputations, 81% with mild to moderate ASVD and 54% with severe ASVD.

Conclusion: Diagnostic and therapeutic vascular procedures appear under-utilized for patients undergoing lower extremity amputations at a rural community hospital. ASVD rates and tissue viability imply that revascularization could be of significant benefit to avoid major amputation.

Keywords: amputation; critical limb ischemia; endovascular revascularization; peripheral artery disease; surgical revascularization.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Brad J Martinsen—Employed by and owns stock in Cardiovascular Systems, Inc.; Zsuzsanna Igyarto—Employed by and owns stock in Cardiovascular Systems, Inc.; Jihad Mustapha—Consulting agreements with Boston Scientific (BSc), Cardiovascular Systems, Inc (CSI), Bard Peripheral Vascular (BPV), Terumo Medical, and Philips; Fadi Saab—Consulting agreements with Boston Scientific (BSc), Cardiovascular Systems, Inc (CSI), Bard Peripheral Vascular (BPV), Terumo Medical, and Philips.

Figures

Figure 1.
Figure 1.
Flow diagram of study selection.
Figure 2.
Figure 2.
Bar graph demonstrating the rates of diagnostic vascular procedures prior to major or minor amputation.
Figure 3.
Figure 3.
Bar graph demonstrating the rates of therapeutic vascular interventions prior to major or minor amputations.
Figure 4.
Figure 4.
Primary and secondary amputation rates based on the subgroups of major amputation, minor amputation, and degree of atherosclerotic vascular disease (ASVD).
See this image and copyright information in PMC

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