Temporal Trends and In Hospital Outcomes after Revascularisation for Peripheral Arterial Disease: Analysis from the Hungarian Vascular Registry (2011 -2019).

Abstract

Peripheral arterial disease (PAD) is rising globally, impacting healthcare systems. However, in Hungary, and indeed in the Central Eastern European region, which represents an important historical and socioeconomic block, little is known about recent evolution of this disease and the accompanying therapeutic interventions. This study investigated trends over the past decade among patients with PAD in Hungary, focusing on patients with intermittent claudication (IC) and chronic limb threatening ischaemia (CLTI) undergoing revascularisation. Data from patients undergoing revascularisation for IC or CLTI were extracted from the Hungarian Vascular Registry (HUNVASC) from 2011 to 2019 and analysed. Patients were grouped into three time periods: period one (2011 - 2013), period two (2014 - 2016), period three (2017 - 2019) for comparison of characteristics, interventions, and clinical outcomes. In hospital death was the primary outcome of interest. Among 28 587 patients with PAD undergoing revascularisation, IC accounted for 16 908 and CLTI for 11 679 cases. From period one to period three, the proportion of revascularised IC patients increased from 55.2% to 61.6%, while CLTI decreased from 44.8% to 38.4%. There was a general increase in disease burden over time, and patients with CLTI presented with more comorbidities than those with IC. Endovascular procedures were more common in IC. Open interventions declined from 77.6% to 60.0%, with a concomitant rise in endovascular and hybrid methods. The in hospital mortality rate remained consistent at 1.4% and did not change with time. Predictors of death included CLTI, ischaemic heart disease, chronic kidney disease, chronic pulmonary disease, older age, and open revascularisation. This study showed that patients with CLTI had a higher comorbidity burden and higher rates of open interventions and post-operative complications compared with patients with IC. Although open procedures are declining, they remain the primary method of revascularisation irrespective of the disease cohort. Despite increasing patient comorbidities over time, post-operative mortality rates have not changed significantly.