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Home > Vascular Annual Meeting > dryjski_endovascular_intervention

Endovascular Intervention (EVI) for Lower Extremity Ischemia in New York State

Maciej L. Dryjski, Monica S. O'Brien-Irr, Hasan Dosluoglu, Gregory Cherr, Linda M. Harris.
University at Buffalo, Buffalo, N.Y.

OBJECTIVES: EVI has dramatically changed management of peripheral vascular disease (PVD). We evaluated the practice of hospital admission for management of PVD in New York State to determine whether EVI has impacted inpatient treatment or outcomes.

METHODS: HANYS data obtained for the years 2001-2006 are listed in Table 1.

Analysis was by Student T- test for paired samples using EXCEL. Significance was reported at the 0.05 level.

RESULTS: Hospitalization for DRG 478 and 479 rose 45%. While primary diagnosis of CLI decreased 3%, claudication rose 76% (p=0.07) comprising 23% of all PVD admissions in 2001 and 35% in 2006. Total number of revascularizations rose 42%. A substantial shift from open procedure towards EVI occurred and doubling of EVI volume (p=0.04) was noted. Reductions in open procedures and major amputation occurred but were not statistically significant.


 

CONCLUSIONS: In-patient EVI doubled despite literature supporting efficacy and cost effectiveness as an ambulatory procedure. Amputation and open procedures did not significantly decline as revascularization transitioned towards EVI. Over 1/3 of PVD admissions occurred for treatment of non-limb threatening ischemia an elective condition whose outcome criteria has yet to be clearly delineated. While early diagnosis and treatment of claudication may improve quality of life, the associated increased economic burden may negatively impact health care delivery. These data enumerate the need for the development of distinct indications, standards of practice and outcome measures. Vascular surgeons must be proactive in defining these criteria and educating other specialists.

AUTHOR DISCLOSURES: M.L. Dryjski, None; M.S. O'Brien- Irr, None; H. Dosluoglu, None; G. Cherr, None; L.M. Harris, None.