CHICAGO -New research from Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA, compares the benefit of angioplasty vs. bypass graft as treatments of claudication and limb threatening (limb threat) ischemia. The study was designed to determine national estimates for the costs, utilization and outcomes for treatment for each procedure. The findings have been published in the October 2011 issue of the Journal of Vascular Surgery®, the official publication of the Society for Vascular Surgery®.
Through the use of the Nationwide Inpatient Sample, researchers found 563,143 patients who underwent intervention for well-defined level of artherosclerotic disease with claudication or limb threat between 1999 and 2007. Of these patients, 38 percent had percutaneous transluminal angioplasty (PTA); 50 percent received peripheral bypass graft (BPG); and 6 percent had aortofemoral bypass (ABF).
“We compared demographics, costs and comorbidities, as well as multivariable adjusted outcomes of in-hospital mortality and major amputation,” said Marc Schermerhorn, MD, chief of vascular and endovascular surgery within the Stephen R. Weiner Department of Surgery at BIDMC. “Additionally, we used the New Jersey State Inpatient and Ambulatory databases in order to better understand the influence of outpatient procedures on current volume and trends.”
Average costs for PTA increased over 60 percent for claudication between 2001and 2007 ($8,670 to $14,084) and limb threat ($13,903 to $23,196). For BPG, average costs increased 36 percent for both claudication ($9,322 to $12,681) and limb threat was ($16,795 to $22,910). In 2007, the average cost per procedure of PTA was higher than BPG for both claudication ($13,903 vs. $12,681) and limb threat ($23,196 vs. $22,910.
During the study, the number of patients per year undergoing PTA increased threefold (15,903 to 46,138) for claudication and limb threat (6,752 to 19,468). For BPG, procedures per year decreased approximately 40 percent for both claudication (13,625 to 9,108) and limb threatening ischemia (25,575 to 13,762). In-hospital mortality was similar for PTA and BPG groups for claudication (0.1 percent vs. 0.2 percent) and limb threat (2.1 percent vs. 2.6 percent). In-hospital amputation rates were significantly higher for patients who had PTA (7 percent) than BPG (3.9 percent) or patients who underwent ABF.
“PTA has altered the treatment paradigm for lower limb ischemia with an increase in costs and procedures,” added Dr. Schermerhorn. “It is unclear if this represents an increase in patients or number of treatments per patient. Although mortality is slightly lower with PTA for all indications, amputation rates for limb-threat patients appear higher, as does the average cost. The mortality benefit with PTA may be ultimately lost, and average costs elevated, if multiple interventions are performed on the same patients.”
Dr. Schermerhorn believes that with claudication and limb-threat patients that longitudinal studies are needed to determine the appropriateness of PTA and that there should be an increased use of prospective registries in order to provide consensus on treatment options.
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Journal of Vascular Surgery® provides vascular, cardiothoracic and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography and endovascular management. Special issues publish papers presented at the annual meeting of the Journal's sponsoring society, the Society for Vascular Surgery®. Visit the Journal Web site at http:www.jvascsurg.org/. About the Society for Vascular Surgery
The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 3,370 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease. Visit its Web site at www.VascularWeb.org
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