More amputations, less revascularization among blacks with critical limb ischemia

Blacks had a lower rate of limb salvaging in proportion to other ethnic groups.

2009 Vascular Annual Meeting

Blacks with critical limb ischemia are disproportionately more likely to undergo limb amputation, according to a report presented at the Vascular Annual Meeting.

Researchers from the Howard University College of Medicine evaluated data from three groups of patients with critical limb ischemia who were enrolled in the National Inpatient Sample database. Three separate queries were made to the database, including requests for information on all patients presenting with critical limb ischemia, all patients undergoing an open endovascular lower extremity revascularization procedure and all patients who underwent a major lower extremity amputation between 1998 and 2005.

Of the 186,239 patients presenting with critical limb ischemia, 68.2% were white, 19.5% black, 9% Hispanic and 1.24% Asian. Of the 63,639 patients who underwent open revascularization for critical limb ischemia, 73.7% were white, 15.9% black, 7.4% Hispanic and 1.1% Asian. Of the 84,498 patients who underwent a major amputation of a lower extremity, 61% were white, 25.4% were black, 10.1% Hispanic and 1.1% Asian.

“There remains a significant ethnic disparity in limb salvage, with blacks comprising 25% of patients undergoing limb amputation along with 16% undergoing revascularization of limb salvage,” said Kakra Hughes, MD, a vascular surgeon at the Howard University College of Medicine, in a presentation. “The use of endovascular intervention for limb salvation has continued to increase, and arterial reconstruction remains a primary revascularization modality for limb salvage.” – by Eric Raible

Hughes K. PVSS16. Presented at: Vascular Annual Meeting; June 10-14, 2009; Denver.

Previous reports have documented that [black] patients have a higher rate of amputation and a lower incidence of vascular reconstruction. Most of these complications were published prior to the wide adoption of endovascular techniques, and perhaps this “endo first” approach is one that many will adopt. The researchers have attempted to determine if this remains true in contemporary practice using the NIS database from 1998 to 2005. It has provided mostly descriptive information, and has confirmed in aggregate that in a state year period, 20% of patients presenting with critical limb ischemia are black. Sixteen percent of revascularized patients are black, 25% of amputees are black. The total number of cases of limb salvation remains constant over the time period. Unfortunately, trying to draw conclusions from this descriptive data is one of the main limitations of the NIS, due to the inability to link the data to early determination of causality.

–Jason T. Lee, MD

Assistant Professor of Surgery
Stanford University