Swedish Study Compares Outcomes of Revascularized Patients With Intermittent Claudication or CLI
August 16, 2017—E. Baubeta Fridh, MD, et al published findings from a Swedish population-based study that sought to describe mid- to long-term amputation risk, cumulative incidence of death or amputation, and differences in preoperative comorbidities in patients who underwent revascularization for peripheral artery disease (PAD). The study is available online ahead of print in the European Journal of Vascular and Endovascular Surgery (EJVES).
This observational cohort study combined data from the Swedish National Quality Registry for Vascular Surgery (Swedvasc) with mandatory national health care registries and patient medical records. All patients aged ≥ 50 years who underwent revascularization for intermittent claudication (IC) or critical limb ischemia (CLI) in Sweden between May 2008 and May 2013 were identified through the Swedvasc database. Data on comorbidities, mortality, and major amputations were obtained from mandatory national health care registries and medical records.
As summarized in EJVES, data from a total of 16,889 patients with PAD were evaluated (IC, n = 6272; CLI, n = 10,617). The incidence of amputations in IC patients was 0.4% (range, 0.3%–0.5%) per year. Among CLI patients, the amputation rate during the first 6 months after revascularization was 12% (95% confidence interval (CI), 11.3%–12.6%); thereafter, the incidence declined to approximately 2% per year.
Three years after revascularization, the cumulative combined incidence of death or amputation was 12.9% (95% CI, 12.0%–13.9%) in IC patients and 48.8% (95% CI, 47.7%–49.8%) in CLI patients. As compared with IC patients, the prevalence of diabetes, ischemic stroke, heart failure, and atrial fibrillation was approximately doubled and renal failure was nearly tripled in CLI patients, even after age standardization.
The investigators concluded that CLI patients have a higher risk of amputation during the first 6 months after revascularization, whereas IC patients have a benign course in terms of limb loss, and there is a substantial risk of mortality in both IC and CLI patients. Revascularized CLI patients have different comorbidities from IC patients, noted the investigators in EJVES.