REVIEW   Free access

International Angiology 2017 April;36(2):107-15

DOI: 10.23736/S0392-9590.16.03673-7

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

”No more amputations“: a complex scientific problem and a challenge for effective preventive strategy implementation on vascular field

Endre KOLOSSVÁRY ¹, Katalin FARKAS ¹, Mary P. COLGAN ², Michael EDMONDS ³, Hannah P. FITZGERALD ⁴, Martin FOX ⁵, Zsolt PÉCSVÁRADY ⁶, Jean C. WAUTRECHT ⁷, Mariella CATALANO ⁸ ✉

¹ Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary; ² James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland; ³ Diabetic Foot Clinic, King’s College Hospital, London, UK; ⁴ Non Invasive Vascular Unit, Beaumont Hospital, Dublin, Ireland; ⁵ The College of Podiatry, Society of Chiropodists and Podiatrists, London, UK; ⁶ Second Department of Internal Medicine, Vascular Center, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary; ⁷ Service de Pathologie Vasculaire, Clin. Univ. Hop. Erasme, Bruxelles, Belgium; ⁸ Angiology Unit, Research Center on Vascular Diseases, University of Milan, Sacco Hospital, Milan, Italy

Lower limb vascular amputations represent serious problem in the vascular care. As a consequence of critical limb ischemia, often associated with diabetes, it is highly critical to health care service aiming at prevention of limb loss. Understanding of the nature and complexity of amputation scenario is paramount for the effective preventive strategy planning and implementation. Amputation incidence and data of the trends show high variability in the international reports. Variability is also remarkable in a more granular, regional comparison. Different calculation methods for incidence fraction, varying epidemiological, demographic features of the populations, different socio-economic, cultural backgrounds and disparity in vascular care are the main factors contributing to this variability in reports. Lower limb amputations can be considered as a valuable healthcare quality indicator with some limitations. One of these limitations is the lower actionability that corresponds to the reduced ability of health care providers to intervene influencing the burden of amputations. Lower limb vascular amputations represent a lifetime risk, therefore not only the effective revascularization is to be achieved but the importance of the early recognition of peripheral arterial disease, no delay in referral to special vascular care, effective vascular risk prevention and collaboration in multidisciplinary teams should be also emphasized.

KEY WORDS: Peripheral arterial disease - Ischemia - Diabetic foot - Amputation