Despite mild reductions in rates of lower extremity amputation over the past decade, few data exist on the use of arterial testing in patients before amputation.
Methods and results:
Using Medicare claims from 2000 through 2010, we examined rates of preamputation arterial testing between 0 to 12 and 0 to 24 months before amputation. We used multivariable, modified Poisson regression models to identify patient and clinical predictors of preamputation arterial testing. The main outcome measures were rates of preamputation arterial testing. Among 17 463 patients undergoing nontraumatic amputation, 68.4% underwent some type of arterial testing. Of these patients, 47.5% underwent ankle-brachial index measurement, 38.7% duplex ultrasound, 31.1% invasive angiography, 6.7% computed tomographic angiography, and 5.6% magnetic resonance angiography. Temporal analysis revealed an increase in testing from 65.7% in 2002 to 69.2% in 2010 (P<0.001). The use of preamputation arterial testing varied significantly by location of amputation and was lowest for foot amputation (62.5%), followed by above-knee amputation (69.0%) and below-knee amputation (76.7%; P<0.001). After multivariable adjustment, older age, male sex, black race, renal disease, diabetes mellitus, known peripheral arterial disease, evaluation by a vascular specialist, and living in the East North Central region were associated with greater rates of preamputation arterial testing.
Rates of evaluation for peripheral arterial disease before amputation were low, and testing varied by patient, provider, and regional characteristics.
"Of these patients, 47.5% underwent ankle–brachial index measurement, 38.7% duplex ultrasound, 31.1% invasive angiography, 6.7% computed tomographic angiography, and 5.6% magnetic resonance angiography.24 Women, younger patients, and patients living in rural areas were all less likely to receive preamputation arterial testing.24 "
[Show abstract][Hide abstract] ABSTRACT: Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies.
Vascular Health and Risk Management 07/2014; 10:417-424. DOI:10.2147/VHRM.S50588
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