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. 2024 Mar 14:20:125-140.
doi: 10.2147/VHRM.S427211. eCollection 2024.

Trends in Lower Extremity Artery Disease Repair Incidence, Comorbidity, and Mortality: A Danish Nationwide Cohort Study, 1996-2018

Anders Møller  1   2 , Nikolaj Eldrup  3   4   5 , Jørn Wetterslev  6 , Dorthe Hellemann  1   5 , Henning Bay Nielsen  7   8 , Klaus Rostgaard  9   10 , Henrik Hjalgrim #  5   9   10   11 , Ole Birger Pedersen #  5   10   12
Affiliations

Trends in Lower Extremity Artery Disease Repair Incidence, Comorbidity, and Mortality: A Danish Nationwide Cohort Study, 1996-2018

Anders Møller et al. Vasc Health Risk Manag. .

Abstract

Background: The prevalence of occlusive lower extremity artery disease (LEAD) is rising worldwide while European epidemiology data are scarce. We report incidence and mortality of LEAD repair in Denmark from 1996 through 2018, stratified on open aorto-iliac, open peripheral, and endovascular repair.

Methods: A nationwide cohort study of prospective data from population-based Danish registers covering 1996 to 2018. Comorbidity was assessed by Charlson's Comorbidity Index (CCI). Incidence rate (IR) ratios and mortality rate ratios (MRR) were estimated by multivariable Poisson and Cox regression, respectively.

Results: We identified 41,438 unique patients undergoing 46,236 incident first-time LEAD repairs by either aorto-iliac- (n=5213), peripheral surgery (n=18,665) or percutaneous transluminal angioplasty (PTA, n=22,358). From 1996 to 2018, the age- and sex-standardized IR for primary revascularization declined from 71.8 to 50.2 per 100,000 person-years (IRR, 0.70; 95% CI, 0.66-0.75). Following a 2.5-fold IR increase of PTA from 1996 to 2010, all three repair techniques showed a declining trend after 2010. The declining IR was driven by decreasing LEAD repair due to claudication, and by persons aged below 80 years, while the IR increased in persons aged above 80 years (p interaction<0.001). LEAD repair was more frequent in men (IRRfemale vs male, 0.78; 95% CI, 0.77-0.80), which was consistent over calendar time (p interaction=0.41). Crude mortality decreased following open/surgical repair, and increased following PTA, but all three techniques trended towards lower adjusted mortality comparing the start and the end of the study period (MRRaorto-iliac, 0.71; 95% CI, 0.54-0.93 vs MRRperipheral, 0.76; 95% CI, 0.69-0.83 vs MRRPTA, 0.96; 95% CI, 0.86-1.07). Increasing age and CCI, male sex, smoking, and care dependency associated with increased mortality.

Conclusion: The incidence rate of LEAD repair decreased in Denmark from 1996 to 2018, especially in persons younger than 80 years, and primarily due to reduced revascularization for claudication. Adjusted mortality rates decreased following open surgery, but seemed unaltered following PTA.

Keywords: Danish National Patient Registry; Danish Vascular Registry; claudication; critical limb ischemia; registers; vascular surgery.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Standardized incidence rate by technique (A) and Sankey plot visualizing the distribution of techniques used for vascular repair between 90 days and 5 years following primary revascularization (B).
Figure 2
Figure 2
Incidence rate of primary vascular repair for lower extremity artery disease.
Figure 3
Figure 3
Sex specific incidence rate in repair for lower extremity artery disease.
Figure 4
Figure 4
Indication specific standardized incidence rate in repair for lower extremity artery.
Figure 5
Figure 5
Age trend in Charlson’s comorbidity index score relative to age group 71–75 by population.
See this image and copyright information in PMC

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