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

URL for published report: http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/earlier_scoping_reports/technologies_scoping_report_1.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland, United Kingdom

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