Revascularization Beats Amputation for Limb Ischemia

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Long-term survival and costs are similar for endovascular and surgical revascularization techniques in critical limb ischemia.
Long-term survival and costs are similar for endovascular and surgical revascularization techniques in critical limb ischemia.

HealthDay News — For patients with critical limb ischemia, long-term survival and costs are similar for endovascular and surgical revascularization techniques, with longer survival and lower costs versus major amputation, according to a study published in the Aug. 21 issue of the Journal of the American Heart Association.

Jihad A. Mustapha, M.D., from the Advanced Cardiac & Vascular Amputation Prevention Centers in Grand Rapids, Mich., and colleagues obtained administrative claims on 72,199 Medicare beneficiaries with initial critical limb ischemia diagnosis in 2011. Over four years, clinical outcomes and health care costs were estimated among all patients and by first treatment in unmatched and propensity-score-matched samples.

The researchers found that survival was 46 percent and freedom from major amputation was 87 percent. Among 9,942 propensity-score-matched patients, survival was 38, 40, and 23 percent with endovascular revascularization, surgical revascularization, and major amputation, respectively (median survival, 2.7, 2.9, and 1.3 years, respectively). The corresponding major amputation rates were 6.5, 9.6, and 10.6 percent. During follow-up, the cost per patient year was $49,700, $49,200, and $55,700, respectively.

"Long-term survival and cost in critical limb ischemia management is comparable between revascularization techniques, with lower major amputation rates following endovascular revascularization," the authors write. "Primary major amputation results in shorter survival, higher risk of subsequent major amputation, and higher health care costs versus revascularization."

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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