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Use of Revascularization Up for Critical Limb Ischemia in Veterans

In veterans, revascularization linked to lower risks for mortality, major amputation at 90 days

THURSDAY, Feb. 13, 2020 (HealthDay News) -- For veterans, the incidence of critical limb ischemia decreased from 2005 to 2013, while use of revascularization increased from 2005 to 2014, according to a study published online Feb. 13 in Circulation: Cardiovascular Interventions.

Amgad Mentias, M.D., from the University of Iowa Carver College of Medicine in Iowa City, and colleagues examined temporal trends in incidence, management, and outcomes for 20,938 veterans (mean age, 67.8 years) with critical limb ischemia who were hospitalized between 2005 and 2014.

The researchers found that from 2005 to 2013, there was a decrease in incidence from 0.3 to 0.24 per 1,000 persons. A temporal increase in use of revascularization within 90 days of hospitalization was seen from 2005 to 2014 (endovascular, 11.2 to 18.4 percent; surgical, 23.8 to 26.4 percent; and hybrid, 6.2 to 13.1 percent). During the study period, statin prescriptions increased from 47.4 to 60.9 percent. A significant decrease was seen in risk-adjusted mortality (11.8 to 9.7 percent) and in major amputation (19.8 to 12.9 percent) at 90 days. Revascularization was associated with lower risks for mortality and major amputation at 90 days in adjusted analyses (RR, 0.45 and 0.23, respectively). The use of revascularization varied considerably between sites (median rate, 41.7 percent; interquartile range, 12.5 to 53.2 percent).

"Further studies are needed to examine the reason of low utilization of endovascular revascularization in VA hospitals compared with surgical revascularization," the authors write.

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