Epidemiologie und Behandlung der PAVK und der akuten Extremitä tenischämie in deutschen Krankenhäusern von 2005 bis 2012

Background: Due to the demographic changes an increase in peripheral arterial occlusive disease (PAOD) and acute ischemia of the extremities can be assumed. Simultaneously, the options for revascularization have been extended with the chance of a decreasing rate of amputation. It is unclear whether these developments can also be realized at a national level in Germany. Material and methods: An analysis of the thoroughly categorized diagnosis data of hospital patients and the diagnosis-related groups (DRG) statistics of the Statistisches Bundesamt (StBA, Federal Statistical Office) from the years 2005 to 2012) was carried out. The numbers of cases, the incidence and mortality of chronic ischemia of the extremities and the main diagnoses (HD) 170 (atherosclerosis), E10.5-E14.5 (diabetes mellitus with peripheral vascular complications) and acute ischemia of the extremities (HD I74, arterial embolism and thrombosis) were analysed. All open and endovascular treatment modalities and major and minor amputations were assessed based on the DRG statistics of the StBA. Results: The inhospital incidence of chronic and acute ischemia of the extremities increased from 199 to 241 and from 22 to 27 HDs per 100,000 inhabitants, respectively. The incidence of all cases of ischemia of the extremities showed a clear increase after the age of 70 years. The mortality associated with HD 170 has decreased since 2005 from 3.6∈% to 2.7∈%. The mortality over the age of 80 years is 5-10∈%. The corresponding mortality associated with HD 174 was 9.7 % with an increase to 10-20 % in both sexes above 80 years old. The total number of all cases of peripheral balloon angioplasty increased from 73,000 in 2005 to approximately 130,000 in 2012. The number of peripheral bypass operations decreased from approximately 43,000 to 39,500 (-8.4 %). The number of cases of embolectomy and thrombectomy increased from approximately 38,000 to 60,000 and endovascular therapy of acute ischemia of the extremities increased from approximately 12,000 to 21,000. The number of major amputations could be reduced by 32 % since 2005. Conclusion: The incidence of acute and chronic ischemia of the extremities is increasing. The mortality risk increases with age and is particularly high for acute ischemia of the extremities. Despite the increase in hospitalized cases with the threat of amputation due to ischemia, the number of major amputations has clearly decreased.