New Study Suggests Higher Amputation Rates in Less Invasive Vascular Treatments

Sarasota, FL (WorkersCompensation.com) – Adequate blood flow is an important factor to healing, and critical for a good outcome in limb injury cases. Any time a patient has a compromised vascular system, the risk for complication, including amputation and death, increases greatly. Around 2 million people in the U.S. have had an amputation, of those around 45 percent were caused by trauma. 

Peripheral artery disease is a condition in which arteries in the limbs are narrowed, reducing the blood flow to the arms or legs. More than 230 million worldwide are affected by Peripheral artery disease, with around 11 percent developing critical limb ischemia (CLI), which is a severe blockage of blood flow. Risk factors for CLI include a sedentary lifestyle, obesity, high cholesterol, high cholesterol, smoking, and age. CLI can be caused by trauma, embolisms, blood clots, and any injury to a muscle that severely limits blood flow. CLI is associated with a 50 percent mortality rate at 5 years, and a 40 percent amputation rate at 1 year, and around 60 percent are readmitted within 6 months.

Complication rates for CLI patients are often high due to comorbidities. Studies have shown around 23.5 percent have infections, and 22.2 percent will have recurrent manifestations of peripheral artery disease. Some estimates of CLI hospitalizations have been as high as $4.2 billion annually. Given that approximately 1 in 5 CLI patients are readmitted within 30 days, the additional readmission costs have been estimated at $624 million.

While surgical revascularization has been the usual course of treatment, the option is more expensive than less invasive treatments. Endovascular treatments such as drug-eluting stents, drug-coated balloons, pedal arch reconstruction, venous arterialization, and atherectomy devices are increasingly recommended as treatments for CLI. These options usually involve less down time, requires less medical resources, and are a cost effective alternative.

Researchers from the Cardiovascular department at the University of Kansas Medical Center in Kansas City asked the question of whether there was a difference of outcomes when comparing endovascular treatment methods and surgical revascularization. In a study published this month in JAMA Network Open, researchers compared in-hospital safety, 6-month amputation rates, and mortality in CLI patients for the two treatment routes.

The researchers found that the endovascular methods were safer, without any differences in mortality rates. Endovascular treatment had a 17 percent less risk of acute kidney injury, major bleeding, or vascular complication.

Endovascular treatment was also associated with 25 percent shorter length of stay, and 10 percent lower hospital cost. However, the less expensive endovascular methods were associated with an increased risk of major amputation in comparison to surgical treatment. In fact, the endovascular treatments were associated with 18 percent higher risk of amputation at 6 months. On the other hand, when performed at high-volume facilities, the risk of major amputation was similar between the two methods.

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