Peripheral Arterial Disease - Trends in Morbidity and Mortality

Abstract

The prevalence of peripheral artery disease (PAD) is increasing worldwide. Patients with PAD not only have a reduced quality of life, they are at high risk for cardiovascular events such as stroke, myocardial infarction and death. Recent nationwide studies in Germany demonstrate an increase of PAD burden, particularly of the advanced stages of PAD, i.e. of the subset with critical limb ischemia (CLI).Despite the awareness campaigns and the advances in medical and technical management of the disease in the last decades, the total number of ischemic limb amputations in Germany remains high (> 50 000/year). The total number and the rate of minor amputation are increasing. However, the rate of major amputation is continuously decreasing (- 31% from 2005 to 2014). In contrast to the trend in major amputation, cardiovascular and overall mortality remains at high rates and almost unchanged compared to historical data. Limb amputation and mortality in patients with PAD strongly depends on disease severity: the risk of limb amputation at 4-years follow-up in patients at Rutherford categories 1 - 3, 4, 5 and 6 has been shown to be 4.6 %, 12.1 %, 35.3 % and 67.3 %, respectively, while the projected 4-years-mortality was 18.9 %, 37.7 %, 52.2 % and 63.5 %, respectively.The causes for the lack of improvement of prognosis in PAD patients are unclear. However, the increase in comorbidity burden as well as the lack of adherence to evidence-based guidelines-recommended therapies, such as revascularization for CLI and secondary preventive measures, may play a pivotal role in the persistence of the poor prognosis of patients with PAD.