Distal arterial reconstruction in Scotland 1989–1998

Methods: A retrospective analysis of national hospital discharge data (Scottish Morbidity Record 1) from 1989 to 1998 was undertaken. Results: The population of Scotland has remained constant at 5·1 million. A total of 975 distal arterial grafts were performed in 10 years. The overall rate of distal reconstruction increased from 0·9 per 100 000 population in 1989, peaked at 2·6 per 100 000 in 1994, and has since declined steadily to 1·8 per 100 000 in 1998 ( Table ). There were huge interregional variations in the rate of reconstruction, with up to a 17‐fold variation in annual rates between the 12 mainland health boards. The variations in distal reconstruction between the health boards were not reflected in reduced amputation rates, nor was the decline in distal reconstruction easily explained by increased non‐femoral angioplasty.Distal arterial reconstruction in Scotland 1989–1998, R. J. Holdsworth and H. M. Paterson1989 1990 1991 1992 1993 1994 1995 1996 1997 1998Total grafts 47 57 102 126 102 133 105 118 94 91 Rate per 100 000 per year 0·92 1·18 2·00 2·47 1·97 2·59 2·04 2·30 1·83 1·75 No. of non‐femoral angioplasties 245 173 124 158 180 139 226 193 186 237 No. of amputations 823 834 813 836 944 852 922 815 849 775Conclusion: Rates of distal arterial reconstruction in Scotland fall well below those of comparable European countries. It is likely that insufficient distal operations are undertaken to impact on amputation rates. The authors recommend an increased provision of specialist vascular surgical expertise in Scotland. © 2001 British Journal of Surgery Society Ltd