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Vascular Health and Risk Management Volume 20, 2024 - Issue
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ORIGINAL RESEARCH

Trends in Lower Extremity Artery Disease Repair Incidence, Comorbidity, and Mortality: A Danish Nationwide Cohort Study, 1996–2018

Anders Møller1 Department of Anesthesia and Intensive Care, Næstved-Slagelse-Ringsted, Slagelse Hospital, Slagelse, Denmark;2 Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, DenmarkCorrespondence[email protected]
ORCID Iconhttps://orcid.org/0000-0002-1288-6326View further author information
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Nikolaj Eldrup3 Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark;4 Danish Vascular Registry, Aarhus, Denmark;5 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DenmarkView further author information
,
Jørn Wetterslev6 Private Office, Tuborg Sundpark, Hellerup, 2900, DenmarkORCID Iconhttps://orcid.org/0000-0001-7778-1771View further author information
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Dorthe Hellemann1 Department of Anesthesia and Intensive Care, Næstved-Slagelse-Ringsted, Slagelse Hospital, Slagelse, Denmark;5 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DenmarkView further author information
,
Henning Bay Nielsen7 Department of Anesthesia and Intensive Care, Zealand University Hospital Roskilde, Roskilde, Denmark;8 Department of Nutrition, Exercise and Sport, Faculty of Science, University of Copenhagen, Copenhagen, DenmarkView further author information
,
Klaus Rostgaard9 Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark;10 Department of Epidemiology Research, Statens Serum Institut, Copenhagen, DenmarkORCID Iconhttps://orcid.org/0000-0001-6220-9414View further author information
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Henrik Hjalgrim5 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;9 Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark;10 Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark;11 Department of Hematology, Copenhagen University Hospital, Copenhagen, DenmarkView further author information
&
Ole Birger Pedersen5 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;10 Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark;12 Department of Clinical Immunology, Zealand University Hospital, Køge, DenmarkORCID Iconhttps://orcid.org/0000-0003-2312-5976View further author information
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Pages 125-140 | Received 11 Aug 2023, Accepted 23 Jan 2024, Published online: 15 Mar 2024

Figures & data

Figure 1 Standardized incidence rate by technique (A) and Sankey plot visualizing the distribution of techniques used for vascular repair between 90 days and 5 years following primary revascularization (B).

Notes: (A) Incidence rate standardized to the age and sex distribution of the Danish population aged above 40 and below 100 years in 2000. Note, the 2019 data are exclusively used graphically in this plot and not in any tables or the result section, as we did not have Danish National Patient Registry (DNPR) data for 2019. (B) The size of each node (box) corresponds to the number of patients having vascular repair for occlusive lower extremity artery disease (LEAD) for that technique. The three nodes in the far left of the figure represents any first-time “primary” LEAD repair (grey line in panel A above). First-time peripheral vascular surgery is represented by the three blue colored nodes (blue line in panel A). Correspondingly, PTA is colored green, and aorto-iliac surgery is colored light orange. Please refer to baseline under “Vascular Surgical history” for details on LEAD repair history by each group. As patients could not be reported in the same group twice, the third column of nodes (the smallest nodes to the right of the middle and to the left of the censoring and death nodes) are patient that had undergone all three LEAD repair techniques. Exclusive to the Sankey plot visualization, we censored patients 5 years following LEAD repair since the most frequent technique changed over time.
Figure 1 Standardized incidence rate by technique (A) and Sankey plot visualizing the distribution of techniques used for vascular repair between 90 days and 5 years following primary revascularization (B).

Figure 2 Incidence rate of primary vascular repair for lower extremity artery disease.

Notes: Shows the crude incidence rate (IR) and adjusted incidence rate ratio (IRR) with Forest plot of primary repair for lower extremity artery disease (LEAD). The IRRs were computed by a multivariable Poisson regression model adjusted for calendar year, age group, sex, and Charlson’s comorbidity index (CCI) score. The CCI score was based on records concluded before the date of surgery, which meant that LEAD diagnosed on the day of repair, or in ongoing outpatient records, could not contribute to the CCI score. Thus, some patients were characterized with normal CCI.
Abbreviations: CCI, Charlson’s comorbidity index; CI, confidence interval; IR, incidence rate; IRR, incidence rate ratio; LEAD, lower extremity artery disease.
Figure 2 Incidence rate of primary vascular repair for lower extremity artery disease.

Figure 3 Sex specific incidence rate in repair for lower extremity artery disease.

Notes: Sex-specific trends in the incidence rate of LEAD repair, standardized to the age distribution of the Danish population in 2000.
Figure 3 Sex specific incidence rate in repair for lower extremity artery disease.

Figure 4 Indication specific standardized incidence rate in repair for lower extremity artery.

Notes: Incidence rate of revascularization for occlusive lower extremity artery disease by technique and indication, standardized to the age- and sex-composition of the Danish population in the year 2000.
Abbreviation: PTA, percutaneous transluminal angioplasty.
Figure 4 Indication specific standardized incidence rate in repair for lower extremity artery.

Table 1 Baseline Characteristics of Patients Undergoing Surgery for Lower Extremity Artery Disease in Denmark 1996–2018

Figure 5 Age trend in Charlson’s comorbidity index score relative to age group 71–75 by population.

Notes: Age trend in Charlson’s comorbidity index (CCI) score presented as ratios standardized to the calendar year and sex distribution of persons aged 71–75 years within each population. The bars indicate the 95% confidence intervals and were computed by Poisson regression including the covariates calendar year, age, sex and CCI score.
Abbreviations: DK, The Danish population; PTA, percutaneous transluminal angioplasty.
Figure 5 Age trend in Charlson’s comorbidity index score relative to age group 71–75 by population.

Table 2 Five-Year Mortality Following LEAD Surgery in Denmark 1996–2018

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