BACKGROUND Contemporary patterns in management and outcomes of critical limb ischemia among United States veterans are unknown. METHODS We used Veterans Health Administration data to identify patients admitted for critical limb ischemia between 2005 and 2014. We examined temporal trends in incidence, management, and outcomes. RESULTS A total of 20 938 veterans with critical limb ischemia were hospitalized between 2005 and 2014. Mean age was 67.8 years. Incidence decreased from 0.3 to 0.24 per 1000 persons from 2005 to 2013, P<0.01. During the study period, there was a temporal increase in use of revascularization within 90 days of hospitalization-endovascular (11.2% in 2005 to 18.4% in 2014), surgical (23.8% in 2005 to 26.4% in 2014), and hybrid (6.2% in 2005 to 13.1% in 2014, P value for trend <0.01). Statin prescriptions increased from 47.4% in 2005 to 60.9% in 2014 (P value for trend <0.01). There was a significant decline in risk-adjusted mortality (11.8% in 2005 to 9.7% in 2014) and major amputation (19.8% in 2005 to 12.9% in 2014; P value for trend <0.01 for both) at 90 days. In adjusted analyses, revascularization was associated with a lower risk of mortality (RR, 0.45 [95% CI, 0.41-0.50]; P<0.001) and major amputation at 90 days (RR, 0.23 [95% CI, 0.21-0.26]; P<0.001). Nearly half of the patients who underwent amputation did not receive an invasive vascular procedure within the preceding 90 days. There was large site-level variation in the use of revascularization (median rate, 41.7% [interquartile range, 12.5%-53.2%]). Differences in patient case-mix explained only 8% of site-level variation in receipt of revascularization. CONCLUSIONS Over the past decade, use of revascularization increased among veterans with critical limb ischemia, which was accompanied by a reduction in mortality and major amputation. However, opportunities to further improve care in this high-risk population still remain.

中文翻译：

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患有严重肢体缺血的退伍军人住院、管理和临床结果的趋势。

背景 美国退伍军人严重肢体缺血的管理和结果的现代模式是未知的。方法 我们使用退伍军人健康管理局的数据来确定 2005 年至 2014 年期间因严重肢体缺血入院的患者。我们检查了发病率、管理和结果的时间趋势。结果 2005 年至 2014 年期间，共有 20 938 名患有严重肢体缺血的退伍军人住院治疗。平均年龄为 67.8 岁。从 2005 年到 2013 年，每 1000 人的发病率从 0.3 下降到 0.24，P<0.01。在研究期间，住院 90 天内血运重建术的使用在时间上有所增加 - 血管内（2005 年的 11.2% 至 2014 年的 18.4%）、手术（2005 年的 23.8% 至 2014 年的 26.4%）和混合（6.2%）从 2005 年的 % 到 2014 年的 13.1%，趋势的 P 值 <0.01）。他汀类药物的处方比例从 2005 年的 47.4% 增加到 2014 年的 60.9%（趋势 P 值<0.01）。90 天时风险调整死亡率（2005 年的 11.8% 至 2014 年的 9.7%）和大截肢（2005 年的 19.8% 至 2014 年的 12.9%；趋势 P 值均<0.01）显着下降。在调整后的分析中，血运重建与较低的死亡率（RR，0.45 [95% CI，0.41-0.50]；P<0.001）和 90 天大截肢（RR，0.23 [95% CI，0.21-0.26]）相关；P<0.001)。近一半接受截肢的患者在过去 90 天内没有接受过侵入性血管手术。血运重建的使用在不同部位存在很大差异（中位数率为 41.7% [四分位距，12.5%-53.2%]）。患者病例组合的差异仅解释了接受血运重建的部位水平差异的 8%。结论 在过去十年中，患有严重肢体缺血的退伍军人中血运重建的使用有所增加，同时死亡率和大截肢率也有所降低。然而，在这一高危人群中进一步改善护理的机会仍然存在。