Trends and Outcomes of Lower Limb Vascular Procedures in a Multiethnic Asian Population in Singapore: A 10 Year Study.

Abstract

The global burden of peripheral arterial disease (PAD) has increased, contributing to rising rates of lower limb vascular procedures (LLVPs), yet data from Asia remain limited. This retrospective, observational cohort study examined national trends in LLVPs and evaluated post-procedural outcomes, factors associated with these outcomes, and amputation free survival (AFS) following LLVPs. National administrative data were used to retrospectively analyse individuals aged 16 - 100 years from 2012 - 2021. Age-sex standardised LLVP rates were estimated overall, and among populations with diabetes mellitus (DM), end stage renal disease (ESRD), and cardiac disease (CD), including DM-ESRD and DM-CD subpopulations. Trends were assessed using joinpoint regression. Median times to repeat LLVP, minor and major amputation, and all cause mortality were estimated, and Cox regression identified factors associated with AFS and major AFS. A total of 20 597 LLVPs were performed in 10 703 unique individuals between 2012 and 2021, 88% of whom had DM. Overall, LLVP rates increased by 3.22% annually (p = .001). Risk attributable to DM increased from 85.8% to 92.4% (p = .004). In 2021, LLVP rates were highest among ESRD (6 072.68 per 100 000) population. Within the DM-ESRD population, ESRD increased LLVP risk by 19 fold. Post-LLVP all cause mortality was 111.86 per 1 000 person years, with a median survival of 22.7 months. AFS and major AFS were 42% and 52% at 3 years. Older age, lower socioeconomic status, poorer cardio-metabolic-renal profile, and higher comorbidity burden were associated with poor outcomes. LLVP rates increased nationally, reflecting a growing burden of PAD and were associated with high repeat intervention and mortality rates, particularly among patients with DM and ESRD. Marked ethnic and socioeconomic disparities further underscore the substantial burden of PAD and highlight the need for earlier prevention, improved risk factor control, and targeted strategies to improve long term outcomes.