Lower Extremity Amputation Prevention Programme (LEAP) — The Singapore Experience

Local patients present with claudication or critical ischaemia; 80% of all patients with claudication are managed conservatively; 20% progress into critical ischaemia. Angioplasty is very useful for limb salvage for critical limb ischaemia. They have a high peri-procedure mortality rate which may be due to a selection bias (patients who are unfit for open bypass undergo angioplasty). There is a low peri-operative mortality trend for patients undergoing open revascularisation surgery (bias towards selecting “fit” patients to undergo bypass procedure). Peri-operative mortality for primary amputation and vascular reconstruction is almost similar. LEAP programme should be introduced to primary care physicians so that patients “at risk” are offered diabeticfoot screening early.