Trends in arterial reconstruction, angioplasty and amputation.

Data from operating theatre and X-ray department ledgers, and other sources, for two periods (1983-87 and 1988-91) were compared retrospectively to determine the trend in leg amputation in the defined population of a District Health Authority, following an increase in arterial reconstruction and percutaneous transluminal angioplasty for peripheral arterial disease. There was an eleven-fold increase in arterial reconstructions, and a thirteen-fold increase in angioplasty, in 1988-1991 compared with 1983-1987. A significant reduction occurred in the age- and sex-adjusted mean annual rate for major leg amputation, from 47.5 (95% confidence intervals 41.5-53.6) in 1983-87 to 32 (95% confidence intervals 26.5-37.6) in 1988-91 (Wilcoxon rank sum test, p < 0.05). There was no increase in the ratio of above-knee to below-knee amputations. The introduction of peripheral arterial reconstruction and percutaneous transluminal angioplasty was associated with a reduction in major amputations for peripheral arterial disease of 3.8 per 100,000 population per year.