Objective

Patients with peripheral artery disease (PAD) have an increased risk of lower limb amputation. Given the international wide variance in major amputations, the high mortality rates and follow up costs as well as the significantly reduced quality of life of patients with amputations, vascular diagnostics and vascular surgery treatments are of great importance for lower limb preservation in patients with PAD. This study examines these guideline based procedures in patients before a first lower limb amputation and PAD.

Methods

This was a retrospective longitudinal study. Data from a large German statutory health insurance scheme were examined on patients with first amputation of lower extremities and PAD between 2013 and 2015 (incidence). Pre-defined vascular diagnostic and vascular surgical procedures were considered, as specified by guidelines within inpatient and outpatient care in a defined time before lower limb amputation.

Results

The overall estimated incidence of lower extremity amputations in the total population was 0.12% from 2013 to 2015. Of these, 51.7% had PAD; 81.8% of patients received at least one vascular diagnostic measure and 61.0% a vascular surgery procedure before the lower extremity amputation. There were only minor variations in the use of diagnostic or surgical treatments between patients with major and minor amputation. In total, 63.9% of patients had vascular surgery before the incident major amputation compared with 60.0% of patients with a minor amputation. Noticeable regional differences were found ranging from 91% (Berlin) to 67% (Bremen) regarding diagnostic procedures provided before amputation, and from 83% (Hamburg) to 55% (Saxony-Anhalt) regarding vascular surgery before amputations.

Conclusion

Of patients with PAD, 18.2% did not receive a vascular diagnostic examination before amputation as specified in the guidelines, which reflects an underuse of health services. In one third of patients who did not receive vascular surgery, major amputation probably could have been avoided.

中文翻译：

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动脉血管疾病患者下肢截肢前的血管诊断和手术治疗：德国 2013 年至 2015 年基于人群的研究

客观的

外周动脉疾病 (PAD) 患者下肢截肢的风险增加。鉴于国际上大截肢的差异很大，高死亡率和随访费用以及截肢患者的生活质量显着降低，血管诊断和血管手术治疗对于 PAD 患者的下肢保存具有重要意义。本研究在第一次下肢截肢和 PAD 之前检查了这些基于指南的程序。

方法

这是一项回顾性纵向研究。对 2013 年至 2015 年间首次下肢截肢和 PAD 患者（发生率）的德国大型法定健康保险计划的数据进行了检查。在下肢截肢前的规定时间内，根据住院和门诊护理指南的规定，考虑了预先确定的血管诊断和血管外科手术。

结果

从 2013 年到 2015 年，总人口中下肢截肢的总体估计发生率为 0.12%。其中，51.7% 患有 PAD；81.8% 的患者在下肢截肢前接受了至少一项血管诊断措施，61.0% 的患者接受了血管外科手术。大截肢和小截肢患者在诊断或手术治疗的使用上只有很小的差异。总共有 63.9% 的患者在发生大截肢前接受了血管手术，而小截肢患者的这一比例为 60.0%。在截肢前提供的诊断程序方面，发现显着的区域差异从 91%（柏林）到 67%（不来梅），关于截肢前血管手术从 83%（汉堡）到 55%（萨克森-安哈尔特州）。

结论

在 PAD 患者中，18.2% 的患者在截肢前没有接受指南中规定的血管诊断检查，这反映了卫生服务的使用不足。在三分之一未接受血管手术的患者中，可能可以避免大截肢。