Fighting amputations of the lower limbs (FALL)

Louise Skovgaard Londero, MD
Department of Cardiothoracic- and Vascular Surgery
University Hospital of Odense
Sdr. Boulevard 29
5000 Odense C
Fighting amputations of the lower limbs (FALL) – from epidemiological
risk identification to cost effective direct actions.
Symptomatic peripheral arterial disease (PAD) is associated with a significant morbidity and
mortality including high rates of major amputations of the lower limbs. Around 80% of all major
amputations of the lower limb have the etiology of symptomatic PAD and many of these patients
also have diabetes mellitus (DM). Patients with DM have a 12-24-fold higher risk of having a major
amputation compared with non-diabetics as well as a lower amputation-free survival after surgery
for critical limb ischemia. It has also been identified that later major amputation after primary
vascular reconstruction may be associated with generic types of medication. In Denmark the
incidence for major amputation is approximately 21/100.000 but with a difference between
The aim of this project is to identify “high risk” patients concerning modifiable end potentially
upcoming risk factors (socio-economic, co-morbidity incl. DM, use of secondary medical
prevention and whether the patients have received vascular evaluation/surgery prior to
amputation). We will also try to identify optimal cost effective vascular reconstruction intensities
to prevent major amputations in a cost effective way.
The project is epidemiologically based study gathering information from different national
databases. The results will be used to guide preventive actions in the Region of Southern
Denmark. The effect of this action will be monitored but is beyond the scope of this study.