A recent research revealed that the number of hospitalized veterans who required amputations or died because of critical blockage in leg arteries has declined between 2005 and 2015.
The findings of the research are published in the journal of Circulation- Cardiovascular Interventions.
Critical tightening of leg arteries, known as critical limb ischemia (CLI), is an advanced state of disorder in arteries which can lead to severe pain in legs even at rest, wounds which don’t deal and poor life quality. It can lead to amputation without any proper treatment. It severely impacts the life quality and decreases the mobility for living. Such patients are also at higher risk of having a stroke or heart attack.
The improvements in the outcomes of patients paralleled to an increasing number of veterans living with CLI who have undergone surgeries or procedures to restore normal blood flow. The revascularization procedures either surgical bypass or endovascular procedure for inserting a stent to keep the artery open can be effective in relieving pain, avoiding amputations and improving the healing of wounds.
In this retrospective study, researchers observe overall positive trends among the veterans who were treated for CLI at Veterans Affairs medical centers, yet there were areas that need improvement. Many of the veterans were not taking the recommended statin medications, almost half of the veterans who underwent amputation didn’t previously receive any procedure for restoring the normal flow of blood to the impacted limb.
An assistant professor at the University of Iowa Carver College of Medicine and the senior author of the study, Saket Girotra said that all the patients with critical limb ischemia should be strictly evaluated to check if they could get benefit from a procedure to restore normal blood flow and should be aggressively treated with medications including statins and blood pressure medicines in case of hypertension and drugs to reduce the stickiness of platelets in order to avoid heart attack and stroke.
The researchers examined data nationwide from all VA facilities for almost 21,000 patients who were hospitalized between 2005 and 2014 to identify the trends in treatments and their outcomes.
- The mortality rate decreased from 12% to 10% (after adjusting for other risk factors)
- Amputation cases decreased from 20% to 10% (after adjusting for other risk factors)
- Patients who underwent a different procedure to restore the flow of blood were 77% less likely to have an amputation and 55% less likely to counter death.
- Sharp differences among the Veteran Affinity hospitals in the proportion of patients undergoing revascularization procedures, ranging from 13 to 53% with little variation.
- Although having information about other medical conditions of the patients, researchers don’t have information about the extent of disease in the arteries.
Girotra said that some patients have the advance disease, stenting and surgery was not feasible in their case, therefore, the only option they had was an amputation to limit the further spread of the infection and gangrene. A more detailed study is required to know if revascularization was not given to some patients who may have benefited.
The results of this study may not be generalized to female veterans or non-VA healthcare settings because the study was conducted in the male veteran population.