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Home > Press Center > Press Releases from 2005 Annual Meeting > Mortality declines in peripheral vascular surgery

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Jill Goodwin
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Mortality and major complications related to peripheral vascular surgery have declined over the past 20 years, largely because the endovascular (within the vessel) approach is supplanting traditional open surgery and it tends to cause fewer complications, according to a study presented at the annual meeting of the Society for Vascular Surgery in Chicago. The study findings indicate that the overall safety of vascular interventions is improving.

Until now, information on patient mortality had not kept pace with the dramatic shifts that have occurred over the past two decades in managing peripheral vascular disease. New diagnostic procedures and surgical techniques, particularly endovascular strategies, have fundamentally changed treatment during that time. But “there has been little analysis of the impact of these technological changes on the volume of major vascular surgery, and even less is known about their effect on patient outcome,” said Dr. Roman Nowygrod of Columbia University in New York. So he and his associates analyzed several large data sets to update our understanding of patient survival after four major types of vascular surgery – lower extremity revascularization, abdominal aortic aneurysm repair, amputation, and carotid endarterectomy.
The researchers analyzed mortality data from the National Hospital Discharge Survey, which documents the outcomes of as many as 320,000 discharges from a national sample of 500 hospitals each year; the Nationwide Inpatient Sample, which monitors nearly 8 million inpatient stays each year at a national sample that represents 20 percent of all U.S. hospitals; and from the all the discharge records of four states that together account for 40 percent of the country’s hospital discharges (California, Florida, New Jersey, and New York).

They found that mortality related to lower extremity revascularization surgery has declined, in part because surgeons have been switching from the open surgical approach to the endovascular approach, which now accounts for almost half of all aneurysm procedures. Over the past five years LER endovascular procedures have increased by 30-40 percent and carotids have doubled in volume. Cardiac, stroke, respiratory, bleeding, and infectious complications all are significantly lower for the endovascular technique than for the open technique in this type of surgery. Similarly, for abdominal aortic aneurysms, the number of surgical repairs has remained stable but the percentage performed by the endovascular route rather than the open route has steadily increased. Mortality has remained stable for open repairs but has declined markedly for the endovascular route, and the complication rate also is much lower for endovascular repair. For amputations, both the number of procedures and the mortality related to them have declined, particularly among the highest-risk patients – those with diabetes, hypertension, and diseases impairing the kidneys, heart, or lungs. In contrast, mortality  related to carotid endarterectomy is lower for the open surgical approach (0.5 percent) than for the endovascular approach (1 percent-3 percent). In addition, the stroke complication rate is significantly higher for the endovascular approach. These rates are expected to improve as more practitioners gain experience with the endovascular technique and as the use of new tools, such as embolic protection devices, spreads.