Is the Lower Extremities Amputation Rate on Decrease?

Czech version

Authors: J. Spáčil; J. Táborský ^*
Authors‘ workplace: III. interní klinika VFN, Praha, přednosta prof. MUDr. Š. Svačina ; II. chirurgická klinika VFN, přednosta doc. MUDr. J. Tošovský ^*
Published in: Rozhl. Chir., 2008, roč. 87, č. 10, s. 531-535.
Category: Monothematic special - Original

Overview

In the past few years, rates of the lower extremity amputations for ischemia have been decreasing in some countries and many world regions. Surely, growing numbers of revascularization procedures contribute to the situation. In the Czech Republic, the amputation and large amputation rates are similar to those in the developed countries (45, resp. 24/100 000) (according to hospital data), as well as the numbers of surgical revascularizations. However, in our country, foot amputations are on increase, while numbers of major amputations do not decrease, probably as a result of the human age prolongation and fast increase of diabetes mellitus rates. The following prerequisites are required to improve the situation: primary prevention of atherosclerosis, building a network of vascular centres which are able to provide all modern revascularization methods. In cooperation with general practitioners, angiologists, diabetologists and other medical specialists, it is necessary to prevent most patients from developing critical extremity ischemia. If it develops, it should be diagnosed immediately and the revascularization procedure should be considered.

Key words:
lower extremity ischemia – amputation – revascularization

Sources

1. Tunis, S. R., Bass, E. B., Steinberg, E. P. The use of angioplasty, bypass surgery, and amputation in the management of peripheral vascular disease. N. Engl. J.Med., 1991; 325: 556–562.

2. Feinglass, J., Brown, J. L., LoSasso, A., et al. Rates of lower-extremity amputation and arterial reconstruction in the United Stattes, 1979 to 1996. Am. J. Public Health, 1999; 89: 1222–1227.

3. Al-Omran, M., Tu, J. V., Johnston, K. W., et al. Use of interventional procedures for peripheral artrerial occlusive disease in Ontario between 1991 and 1998: a population based study. J. Vasc. Surg., 2003; 38: 289–295.

4. Ebskov, L. B., Schroeder, T. V., Holstein, P. E. Epidemiology of leg amputation: the influence of vascular surgery. Brit. J. Surg. 1994; 81: 1600–1603.

5. Pell, J. P., Fowkes, F. G. R., Ruckley, C.V., et al. Declining incidence of amputation for arterial disease in Scotland. Eur. J. Vasc. Surg., 1994; 8: 602–606.

6. Larsson, J., Apelqvist, J., Agardh, C. C, Stenström, V. Decreasing incidence of major amputation in diabetic patiens: a consequence of a multidisciplinary foot care team approach? Diabet. Med., 1995; 9: 770–776.

7. Morfia, A. D., McAlpine, R., Steine, D., et al. Diabetes and lower limb amputation in the community. Diabetes Care, 1998; 21: 738–743.

8. Holstein, P., Ellitsgaard, N., Olsen, B. B., Ellitsgaard, V. Decreasing incidence of major amputations in people with diabetes. Diabetologia, 2000; 43: 844–847.

9. vanHoutum, W. H., Rauwerda, J. A., Ruwaarda, J. A., et al. Reduction in diabetes-related lower-extremity amputations in the Netherlands: 1991–2000. Diabetes Care, 2004; 27: 1042–1046.

10. Eskelinen, E., Eskleline, A., Albäck, A., Lepäntalo, M. Major amputation incidence decreases both in non-diabetic and in diabetic patiens in Helsinki. Scand. J. Surg., 2006; 95: 185–189.

11. Trautner, C., Haastert, B., Mauckner, P., et al. Reduced incidence of lower-limb amputations in the diabetic population of a german city, 1990–2005. Diabetes Care, 2007; 30: 2633–2637.

12. Krishnan, S., Nash, F., Baker, N., et al. Reduction in diabetic amputations over 11 years in a defined U.K. population: Benefits of multidisciplinary team working and prospective audit. Diabetes Care, 2008; 31: 99–101.

13. Nowygrod, R., Egorova, N., Greco, G., et al. Trends, compliactions, and mortality in peripheral vascular surgery. J. Vasc. Surg., 2006; 43: 205–216.

14. McCaslin, J. E., Hafez, H. M., Stansby, G. Lower-limb revascularization and major amputation rates in England. British J. Surg., 2007; 94: 835–839.

15. www.uzis.cz

16. www.cskvch.cz/vysledky/registr_cevni.html

17. Norgen, L., Hiatt, W. R, et al. TASC II Dokument on the management of peripheral arterial disease. Eur. J. Vas. Endovasc. Surg. 2007;33: S1–S75.

18. Táborský, J., Vaněk, I., Firt, P. Výsledky ankety o stavu cévní chirurgie v ČSR. Rozhl. Chir. 1989; 68: 444–449.

19. Zdravotnická ročenka ČR 1992 a 2006, ÚZIS Praha, www. uzis.cz

20. Miniňo, A. M., Heron, P. H., Murény, S. L., et al. Death: Final data for 2004. National Vital Statistics Reports, 2007; 55: 1–120. (www.cdc.gov/nchs/data/nvsr55_19.pdf )

21. Kožnar, B., Peregrin, J. H. Factors influencing clinical result of the infrapopliteal arteries PTA. CEVJ., 2008; 7: 16.

22. Staffa, R., Leopold, J., Kříž, Z. Význam pedálního bypassu pro záchranu končetiny. Rozhl. Chir., 2004; 83: 24–30.

23. Staffa, R., Kriz, Z., Gregor, Z., et al. Pedal bypase grafting on arteriographically invisible foot arteries detected by duplex ultrasound for limb salvage. Minerva Chir., 2007; 62: 115–124.