Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
Ann R Coll Surg Engl. 2021 May;103(5):360-366. doi: 10.1308/rcsann.2020.7090. Epub 2021 Apr 14.
The increasing prevalence of diabetes mellitus and advances in endovascular therapies continue to have an impact on the epidemiology and management of lower extremity arterial disease. This study describes trends in lower extremity revascularisation and major lower limb amputation in NHS England over the past two decades (2000-2019).
Numbers of lower extremity endovascular interventions, open surgical procedures and major lower limb amputations performed in NHS England between 2000 and 2019 were extracted from publicly available hospital admitted patient care activity reports. Trends in intervention were assessed with linear regression models and chi-square tests for trend.
Over this period, 527,131 revascularisations and 92,053 amputations were performed. The mean age of patients was 67.5 years (standard deviation 1.6 years) and 65.3% were male. The number of lower limb revascularisation procedures increased by 402.4 units/year (95% confidence interval, CI, 290.1-514.6, < 0.001). The number of endovascular interventions rose by 43.5% (10,912 in 2000 vs 15,657 in 2019; β = 359.5.0, 95% CI 279.3-439.8, < 0.001) compared with no significant increase in the number of open surgical procedures (8,483 in 2000 vs 7,872 in 2019; β = 42.8, 95% CI -8.3 to 94.0, = 0.095). The number of major lower limb amputations has decreased by 9.4% (5,418 in 2000 vs 4,907 in 2019; β = -31.0; 95% CI -49.6 to -12.5, R = 0.42, = 0.003).
There has been a significant increase in the rate of lower limb revascularisation procedures associated with decreased numbers of major lower limb amputations over the past two decades. These changes in overall trends may affect both service provision and vascular surgery training planning.
糖尿病患病率的上升和腔内治疗技术的进步继续对下肢动脉疾病的流行病学和管理产生影响。本研究描述了在过去二十年（2000-2019 年）英国国家医疗服务体系（NHS England）中下肢血运重建和主要下肢截肢的趋势。
从公开的医院入院患者护理活动报告中提取了 2000 年至 2019 年期间在英国 NHS 进行的下肢腔内介入、开放手术和主要下肢截肢的数量。通过线性回归模型和卡方趋势检验评估干预措施的趋势。
在此期间，进行了 527131 次血运重建和 92053 次截肢。患者的平均年龄为 67.5 岁（标准差 1.6 岁），65.3%为男性。下肢血运重建手术数量每年增加 402.4 个单位（95%置信区间，290.1-514.6， < 0.001）。腔内介入数量增加了 43.5%（2000 年为 10912 次，2019 年为 15657 次；β = 359.5，95%CI 279.3-439.8， < 0.001），而开放手术数量无明显增加（2000 年为 8483 次，2019 年为 7872 次；β = 42.8，95%CI -8.3 至 94.0， = 0.095）。主要下肢截肢数量减少了 9.4%（2000 年为 5418 次，2019 年为 4907 次；β = -31.0；95%CI -49.6 至 -12.5，R = 0.42， = 0.003）。
在过去的二十年中，下肢血运重建手术的比例显著增加，同时主要下肢截肢的数量减少。这些总体趋势的变化可能会影响服务提供和血管外科学培训计划。
