What implications does the organisation of vascular services have for rates of amputation?

McIntosh H
Record ID 32013000473
Authors' recommendations: Summary The only secondary evidence source identified by the scoping literature search was an HTA published more than 10 years ago. Operational modelling using data from the 1990s showed that changes in the management of PVD in a devolved service to match the central hospital would be expected to reduce the number of major amputations and increase the proportion of more distal amputations, vascular reconstructions and angioplasties. Published observational studies dating from the 1980s and 1990s suggested an inverse association between the provision of vascular reconstruction and amputation rates. More recent observational studies from the USA suggest that there may be an association between increased use of endovascular treatment of PAD and lower rates of amputation. A UK RCT indicated that patients with severe leg ischaemia can reasonably be treated with either open bypass surgery first or balloon angioplasty first. There is evidence from case series that increased use of revascularisation procedures, including angioplasty, reduces rates of amputation. NICE guidelines recommend that inpatients with diabetic foot problems should be managed by a multidisciplinary foot care team. There is known variation in diabetic amputation rates in England. A reduction in diabetes-related amputations over time has been observed in at least one published UK study.
Project Status: Completed
Year Published: 2012
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Scotland, United Kingdom
MeSH Terms
  • Peripheral Vascular Diseases
  • Vascular Surgical Procedures
Organisation Name: Scottish Health Technologies Group
Contact Address: Scottish Health Technologies Group, Delta House, 50 West Nile Street, Glasgow, G1 2NP Tel: 0141 225 6998
Contact Name: his.shtg@nhs.scot
Contact Email: his.shtg@nhs.scot
Copyright: Healthcare Improvement Scotland
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.