PMID- 35177249 OWN - NLM STAT- MEDLINE DCOM- 20220509 LR - 20240216 IS - 1942-5546 (Electronic) IS - 0025-6196 (Print) IS - 0025-6196 (Linking) VI - 97 IP - 5 DP - 2022 May TI - Population-Based Trends in Amputations and Revascularizations for Peripheral Artery Disease From 1990 to 2009. PG - 919-930 LID - S0025-6196(21)00805-3 [pii] LID - 10.1016/j.mayocp.2021.10.021 [doi] AB - OBJECTIVE: To determine trends in amputations and revascularizations for peripheral artery disease (PAD) in a well-defined population. METHODS: A population-based cohort study of Olmsted County, Minnesota, residents with PAD undergoing amputation or revascularization was conducted between January 1, 1990, and December 31, 2009. Population-level 5-year incidence trends for endovascular, open surgical, and hybrid revascularizations and major and minor amputations were determined. Limb-specific outcomes after revascularization, including major adverse limb events and amputation-free survival, were compared between initial surgical and endovascular or hybrid revascularization groups using Kaplan-Meier analysis. RESULTS: We identified 773 residents who underwent 1906 limb-procedures, including 689 open revascularizations, 685 endovascular or hybrid revascularizations, and 220 major amputations. During the 20-year study period, the incidence of endovascular and hybrid revascularizations increased, whereas the incidence of open surgical revascularizations and major amputations decreased. Incidence of revascularizations for chronic limb-threatening ischemia (CLTI) did not change. Among residents with CLTI undergoing their first revascularization on a limb, endovascular revascularization was associated with more major adverse limb events and major amputations compared with surgical revascularization during the ensuing 15 years. CONCLUSION: The rising incidence of endovascular and hybrid revascularizations and the decreasing incidence of open surgical revascularizations for PAD were associated with a decreasing incidence of major amputations in this population between 1990 and 2009, despite a stable incidence of revascularizations for CLTI. With more major adverse limb events and major amputations after endovascular revascularization, these trends suggest that additional emphasis should be placed on improving limb salvage efforts beyond just mode of revascularization. CI - Copyright (c) 2021 Mayo Foundation for Medical Education and Research. All rights reserved. FAU - Nienaber, Jeffrey J AU - Nienaber JJ AD - Division of Vascular and Endovascular Surgery. FAU - Smith, Carin Y AU - Smith CY AD - Division of Biomedical Statistics, Mayo Clinic, Rochester, MN. J.J.N. is currently at the Charles George VA Medical Center, Asheville, NC. M.C. is currently at Instituto Vascular, Passo Fundo, Brazil. P.G.R. is currently in the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN. FAU - Cha, Stephen AU - Cha S AD - Division of Biomedical Statistics, Mayo Clinic, Rochester, MN. J.J.N. is currently at the Charles George VA Medical Center, Asheville, NC. M.C. is currently at Instituto Vascular, Passo Fundo, Brazil. P.G.R. is currently in the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN. FAU - Correa, Mateus AU - Correa M AD - Division of Vascular and Endovascular Surgery. FAU - Rowse, Phillip G AU - Rowse PG AD - Division of Vascular and Endovascular Surgery. FAU - Bailey, Kent R AU - Bailey KR AD - Division of Biomedical Statistics, Mayo Clinic, Rochester, MN. J.J.N. is currently at the Charles George VA Medical Center, Asheville, NC. M.C. is currently at Instituto Vascular, Passo Fundo, Brazil. P.G.R. is currently in the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN. FAU - Kalra, Manju AU - Kalra M AD - Division of Vascular and Endovascular Surgery. Electronic address: kalra.manju@mayo.edu. LA - eng GR - R01 AG034676/AG/NIA NIH HHS/United States GR - R33 AG058738/AG/NIA NIH HHS/United States GR - UL1 TR000135/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20220215 PL - England TA - Mayo Clin Proc JT - Mayo Clinic proceedings JID - 0405543 SB - IM MH - Amputation, Surgical/adverse effects MH - Cohort Studies MH - *Endovascular Procedures/adverse effects MH - Humans MH - Ischemia MH - Lower Extremity/blood supply MH - *Peripheral Arterial Disease/epidemiology/surgery MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome PMC - PMC9081231 MID - NIHMS1780666 COIS- Conflcts of Interest Disclosures: None reported EDAT- 2022/02/19 06:00 MHDA- 2022/05/10 06:00 PMCR- 2023/05/01 CRDT- 2022/02/18 05:35 PHST- 2021/01/13 00:00 [received] PHST- 2021/09/23 00:00 [revised] PHST- 2021/10/14 00:00 [accepted] PHST- 2022/02/19 06:00 [pubmed] PHST- 2022/05/10 06:00 [medline] PHST- 2022/02/18 05:35 [entrez] PHST- 2023/05/01 00:00 [pmc-release] AID - S0025-6196(21)00805-3 [pii] AID - 10.1016/j.mayocp.2021.10.021 [doi] PST - ppublish SO - Mayo Clin Proc. 2022 May;97(5):919-930. doi: 10.1016/j.mayocp.2021.10.021. Epub 2022 Feb 15.