Trends in provision of distal arterial reconstruction in Scotland 1989-1999

Objectives: to establish if access to distal arterial reconstructive surger y is equally distributed within the health boards of Scotland and to establ ish if any variations in practice are reflected in lower limb amputation. Methods: a retrospective, descriptive study using hospital discharge data ( Scottish Morbidity Record-1) from 1989 to 1999. Results: the rate of distal arterial reconstruction in Scotland increased f rom 0.9 per 100 000 population in 1989, peaked at 2.6 per 100 000 in 1994 a nd has since declined steadily to 1.6 per 100 000 in 1999. There was lip to 17-fold variation in annual rates of distal reconstruction between the 12 mainland health boards. The variations in distal reconstruction between the health boards were not reflected in variations in amputation rate nor is t he decline in distal reconstruction easily explained by increased angioplas ty. Conclusions: rates of distal arterial reconstruction in Scotland fall well below those in other European countires. It is likely that insufficient dis tal operations are undertaken to sufficiently impact on amputation rates. T he study recommends an increased provision of specialist vascular surgical expertise in Scotland.