IMPACT OF ARTERIAL-SURGERY AND BALLOON ANGIOPLASTY ON AMPUTATION - A POPULATION-BASED STUDY OF 1155 PROCEDURES BETWEEN 1973 AND 1992

Background: Limited population-based data are available on trends in t he incidence of arterial surgery, balloon angioplasty, and amputation for arterial occlusive disease of the legs over the past two decades. Methods: We identified all elective and emergency arterial operations, balloon angioplasty procedures, and amputations performed for all res idents of a defined community, Olmsted County, Mim., between 1973 and 1992. We focused on gender mix, type of procedure, and secular trends in utilization. Results: A total of 1155 procedures were performed, in cluding 733 arterial surgical procedures, 59 balloon angioplasty proce dures, and 363 amputations (288 major and 75 minor). Emergency procedu res were performed in 12%. Suprainguinal inflow procedures were the mo st common arterial reconstruction (60%) compared with infrainguinal pr ocedures (40%). The incidence of all revascularization procedures incr eased in the first decade but reached a plateau after 1985. Utilizatio n rates of revascularization procedures from 1988 to 1992 were higher for men (141.9/100,000 person-years [p-yr]) than women (57.4/100,000 p -yr.). Angioplasty (17.0/100,000 p-yr) rates lagged behind surgery unt il 1985, but tripled in the past 10 years and have not yet reached a p lateau. Although minor amputation rates remain unchanged in 20 years, major amputation rates have been reduced by 50% from 36.7/100,000 p-yr between 1973 and 1977 to 19.0/100,000 p-yr from 1988 to 1992. Conclus ions: From this long-term population-based analysis (1973 to 1992), we conclude that increased vascular surgery and balloon angioplasty rate s have coincided with a significant reduction in major amputation rate s in the past 10 years.