Abstract
The aim of this study was to evaluate the contemporary population based incidence of acute lower limb ischaemia (ALI) and factors associated with major amputation/death at one year.In this retrospective observational study, in hospital, operation, radiological, and autopsy registries were scrutinised to capture 161 citizens of Malmö, Sweden, with ALI between 2015 and 2018. Age and sex specific incidence rates were calculated in the population of Malmö between 2015 and 2018, expressed as number of patients per 100 000 person years (PY). Independent risk factors for major amputation/death at one year were identified by multivariable logistic regression analysis and expressed as odds ratios (ORs) with 95% confidence intervals (CIs).One hundred and sixty-one patients with ALI gave an overall incidence of 12.2/100 000 PY (95% CI 10.3 - 14.1), with no sex related differences. Embolism (42.2%) was the most common cause of ALI. Among 52 patients with atrial fibrillation, 38.5% were on anticoagulant medication. Endovascular or open vascular revascularisation was performed in 54.7% of patients. The total cause specific mortality ratio was 2.63 (95% CI 1.66 - 3.61)/1 000 deaths, without no sex related differences. The combined major amputation/mortality rate at one year for the whole cohort was 46.6%. Rutherford ≥ IIb ALI (OR 4.19, 95% CI 1.94 - 9.02; p < .001), age (OR 1.03/year, 95% CI 1.00 - 1.06; p = .036), female sex (OR 2.37, 95% 1.07 - 5.26; p = .034), and anaemia (OR 2.46, 95% CI 1.08 - 5.62; p = .033) were associated with an increased risk of major amputation/death at one year. The major amputation/mortality rate at one year was 100% (n = 14/14) for patients living in a nursing home on admission.The incidence of ALI appears to be unchanged, and major amputation and mortality at one year remain high. It is necessary to include the substantial proportion of patients with ALI that do not undergo revascularisation in epidemiological studies. There is room for improvement in anticoagulation therapy in patients with atrial fibrillation to prevent ALI due to embolism. Research on gender inequalities in patients with ALI is warranted.
Highlights
Acute lower limb ischaemia (ALI) is caused by a rapid onset of decreased arterial perfusion of the limb, requiring urgent recognition and management as it threatens the survival of the limb and life.[1]The most common causes of non-traumatic ALI include embolism, thrombosis in both native and reconstructed arteries, and arterial aneurysm with thromboembolism
One hundred and sixty-one patients with ALI gave an overall incidence of 12.2/100 000 person years (PY), with no sex related differences
Rutherford IIb ALI, age, female sex, and anaemia were associated with an increased risk of major amputation/death at one year
Summary
The most common causes of non-traumatic ALI include embolism, thrombosis in both native and reconstructed arteries, and arterial aneurysm with thromboembolism. Nationwide large scale epidemiological studies rely on administrative hospital claims data with their inherent drawbacks such as miscoding between ALI and chronic limb threatening ischaemia, and uncertainty regarding aetiology, embolism, or in situ thrombosis.[3] Vascular registries will probably be more reliable in terms of capturing patients with ALI, aetiology and revascularisation techniques[4] but does not include the unknown proportion managed nonoperatively. Population based studies that included non-operated patients for accurate estimates of the overall incidence of ALI are outdated;[5,6] there are no contemporary epidemiological reports.[7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
