Peripheral Bypass Surgery and Amputation

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Abstract
DESPITE REDUCTIONS in the prevalence of cardiovascular risk factors, such as smoking, hypertension, and ischemic heart disease, the rate of nontraumatic major lower-extremity amputation has not fallen in the United States.1 In part, this lack of progress is related to the steady population prevalence of diabetes. Although accounting for between 40% and 60% of all thigh, calf, and foot amputations, patients with diabetes have 20 times the relative risk of undergoing amputation as patients without diabetes.2,3 There have been a number of studies documenting the often dramatic reduction in amputation rates that can be achieved through improved access to preventive primary care4-7 and limb-preserving arterial bypass or angioplasty procedures.8-11 Thus, from a public health standpoint, recent reports documenting continuing differences in per capita rates of amputation for patients with and without diabetes by race,12-14 income,15 and sex3,13 raise potentially disturbing questions about health care access and effectiveness.16,17