Impact of travel distance to revascularization services on amputations in patients with Peripheral Arterial Disease (PAD): a 10-year analysis of the Public Healthcare System in Brazil Data

BackgroundPeripheral Artery Disease (PAD) is a progressive condition that can lead to major amputation if not properly managed. Geographic barriers may influence access to vascular care and outcomes. ObjectiveTo assess the impact of geographic distance on amputation rates and to evaluate mortality and hospitalization length among PAD patients treated in Brazils public healthcare system. MethodsA nationwide, retrospective, population-based analysis was conducted using DATASUS data from 2015-2024, including 335,716 PAD hospitalizations and 70,602 amputations. Logistic regression models evaluated factors associated with amputation and death. ResultsAmputation risk increased among patients treated outside their municipality and in state-managed hospitals. Male sex and older age were associated with higher odds of amputation, whereas women, though less frequently amputated, had greater mortality and longer hospital stays when amputation occurred. Mortality following amputation remained elevated nationwide. Regional variations reflected disparities in access to specialized vascular services. ConclusionGeographic and structural inequalities increased PAD-related amputations and mortality in Brazils public system. Greater distance to care and treatment outside the municipality were key predictors of poor outcomes.