Trends in lower extremity surgical and endovascular revascularization in Germany

Background: We analyzed trends in lower extremity endovascular and open surgical procedures in hospitalized patients in Germany. Patients and methods: We used national statistics (DRG statistics) published by the Federal Statistical Office including data from almost all hospitals in Germany to calculate annual procedure rates of lower extremity endovascular and open surgical procedures in the years 2005 to 2008. Detailed lists of the OPS-codes 8 - 836, 5 - 381, 5 - 393 separated by the 6th number of the code were analyzed regarding procedures representing revascularization of peripheral arteries including the aorta. Results: Between 2005 and 2008 the total number of endovascular procedures increased from 73,584 to 98,664 and the number of surgical procedures from 74,789 to 86,172 a year. Age-adjusted incidence rates of endovascular procedures in people >= 65 years increased from 325 to 432 per 100,000 while the incidence rates of all open surgical procedures increased from 315 to 351 per 100.000. Looking only at bypass surgery the incidence remained unchanged with 177 and 176 per 100,000 in the same period. Endovascular procedures other than balloon angioplasty including percutaneous atherectomy, laser recanalization or usage of cutting balloon, account for less than 1 % in Germany. Conclusions: The numbers of endovascular procedures overweigh the numbers of open surgical procedures for treatment of lower extremity PAD in Germany today. In contrast to data from the USA we could not demonstrate a decrease of open surgical procedures in Germany in recent years.