Impact of arterial surgery and balloon angioplasty on amputation: a population-based study of 1155 procedures between 1973 and 1992.
BACKGROUND
Limited population-based data are available on trends in the incidence of arterial surgery, balloon angioplasty, and amputation for arterial occlusive disease of the legs over the past two decades.


METHODS
We identified all elective and emergency arterial operations, balloon angioplasty procedures, and amputations performed for all residents of a defined community, Olmsted County, Minn., between 1973 and 1992. We focused on gender mix, type of procedure, and secular trends in utilization.


RESULTS
A total of 1155 procedures were performed, including 733 arterial surgical procedures, 59 balloon angioplasty procedures, and 363 amputations (288 major and 75 minor). Emergency procedures were performed in 12%. Suprainguinal inflow procedures were the most common arterial reconstruction (60%) compared with infrainguinal procedures (40%). The incidence of all revascularization procedures increased in the first decade but reached a plateau after 1985. Utilization rates of revascularization procedures from 1988 to 1992 were higher for men (141.9/100,000 person-years [p-yr]) than women (57.4/100,000 p-yr.). Angioplasty (17.0/100,000 p-yr) rates lagged behind surgery until 1985, but tripled in the past 10 years and have not yet reached a plateau. Although minor amputation rates remain unchanged in 20 years, major amputation rates have been reduced by 50% from 36.7/100,000 p-yr between 1973 and 1977 to 19.0/100,000 p-yr from 1988 to 1992.


CONCLUSIONS
From this long-term population-based analysis (1973 to 1992), we conclude that increased vascular surgery and balloon angioplasty rates have coincided with a significant reduction in major amputation rates in the past 10 years.
Hallett
J W
JW
Division of Vascular Surgery, Mayo Foundation, Rochester, MN 55905, USA.
Byrne
J
J
Gayari
M M
MM
Ilstrup
D M
DM
Jacobsen
S J
SJ
Gray
D T
DT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001157:Arterial Occlusive Diseases / Q000601:surgery / Q000628:therapy*; D002404:Catheterization / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011159:Population Surveillance; D012189:Retrospective Studies; D012720:Severity of Illness Index