Mustapha JA, Katzen BT, Neville RF, Lookstein RA, Zeller T, Miller LE, Jaff MR, et al.
Journal of the American Heart Association. Date of publication 2018 Aug 21;volume 7(16):e009724.
1. J Am Heart Assoc. 2018 Aug 21;7(16):e009724. doi: 10.1161/JAHA.118.009724.
Determinants of Long-Term Outcomes and Costs in the Management of Critical Limb
Ischemia: A Population-Based Cohort Study.
Mustapha JA(1), Katzen BT(2), Neville RF(3), Lookstein RA(4), Zeller T(5), Miller
LE(6), Jaff MR(7).
Author information:
(1)1 Advanced Cardiac & Vascular Amputation Prevention Centers Grand Rapids MI.
(2)2 Division of Interventional Radiology Miami Cardiac and Vascular Institute
Miami FL.
(3)3 Division of Vascular Surgery Department of Surgery Inova Heart and Vascular
Institute Inova Fairfax Medical Campus Falls Church VA.
(4)4 Department of Radiology Icahn School of Medicine at Mount Sinai New York NY.
(5)5 Department of Angiology Universitäts-Herzzentrum Freiburg-Bad Krozingen Bad
Krozingen Germany.
(6)6 Miller Scientific Consulting Asheville NC.
(7)7 Newton-Wellesley Hospital Newton MA.
Comment in
J Am Heart Assoc. 2018 Aug 21;7(16):e010093.
Background The optimal treatment for critical limb ischemia remains controversial
owing to conflicting conclusions from previous studies. Methods and Results We
obtained administrative claims on Medicare beneficiaries with initial critical
limb ischemia diagnosis in 2011. Clinical outcomes and healthcare costs over
4 years were estimated among all patients and by first treatment (endovascular
revascularization, surgical revascularization, or major amputation) in unmatched
and propensity-score-matched samples. Among 72 199 patients with initial primary
critical limb ischemia diagnosis in 2011, survival was 46% (median survival,
3.5 years) and freedom from major amputation was 87%. Among 9942
propensity-score-matched patients (8% rest pain, 26% ulcer, and 66% gangrene),
survival was 38% with endovascular revascularization (median survival,
2.7 years), 40% with surgical revascularization (median survival, 2.9 years), and
23% with major amputation (median survival, 1.3 years; P<0.001 for each
revascularization procedure versus major amputation). Corresponding major
amputation rates were 6.5%, 9.6%, and 10.6%, respectively ( P<0.001 for all
pair-wise comparisons). The cost per patient year during follow-up was $49 700,
$49 200, and $55 700, respectively ( P<0.001 for each revascularization procedure
versus major amputation). Conclusions Long-term survival and cost in critical
limb ischemia management is comparable between revascularization techniques, with
lower major amputation rates following endovascular revascularization. Primary
major amputation results in shorter survival, higher risk of subsequent major
amputation, and higher healthcare costs versus revascularization. Results from
this observational research may be susceptible to bias because of the influence
of unmeasured confounders.
DOI: 10.1161/JAHA.118.009724
PMCID: PMC6201392
PMID: 30369325 [Indexed for MEDLINE]
