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Leg amputations for artery disease on the decline

By Frederik Joelving

NEW YORK (Reuters Health) - Leg amputations in older people whose arteries are clogged by cholesterol buildups have gone down over the past decade, according to a new U.S. study.

But thousands of people with diseased blood vessels in their legs still lose a leg or part of one every year - a number researchers say is higher than it should be.

"Our real goal is to highlight the fact that there are still a lot of amputations occurring around the country," said Dr. W. Schuyler Jones, a cardiologist at Duke University Medical Center in Durham, North Carolina.

"In our practice, and probably in practices all over the country, patients who get amputations have poor outcomes, so we think there should be a big push to save patients' limbs," he told Reuters Health.

In so-called peripheral artery disease, or PAD, blood vessels in the limbs grow increasingly narrow due to cholesterol buildups. This reduces blood flow and may cause leg pain while walking, hard-to-heal ulcers and eventually gangrene.

Jones said treatments that allow patients to avoid amputation have improved significantly over the past ten years, particularly procedures in which the buildups are broken up or removed. But it hasn't been clear if that development has been followed by a drop in amputations.

To answer that question, the researchers tapped into data from Medicare, the federal health insurance for people over 65. They identified nearly 3 million patients hospitalized for PAD between 2000 and 2008.

More than 186,000 of the patients had a leg or part of it amputated. Most of the amputees were over 75 and they were more likely to be black and have diabetes and kidney disease than were patients who kept their limbs.

Amputation rates varied widely across the country, but dipped over the study from more than seven percent to less than six percent overall.

"There was a significant decline over time, so that is definitely encouraging," said Jones.

The study, published in the Journal of the American College of Cardiology, couldn't say why the rates are dropping. But Jones ventured that improvement in procedures to open up blocked arteries, known as revascularization, may be part of the answer.

"The big thing you have to do now is connect the dots," said Jones, who performs the procedures himself. "So you connect the increase in revascularization to the decrease in amputation and prove it is cause and effect."

His team is currently working on research to that effect, he added, in hopes of finding a way to drive down amputation rates even further.

SOURCE: http://bit.ly/XZJQEV Journal of the American College of Cardiology, online October 24, 2012.

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