Late outcomes of balloon angioplasty and angioplasty with selective stenting for superficial femoral-popliteal disease are equivalent

Nguyen, Bao Ngoc; Conrad, Mark F.; Guest, Julie; Hackney, Lauren A.; Patel, Viendra I.; Kwolek, Christopher J.; Cambria, Richard P.

doi:10.1016/j.jvs.2011.03.283

Cited by 29 publications

(18 citation statements)

References 32 publications

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“…This means that lower limb revascularization and salvation, even for a limited amputation-free survival period, should be recognized as a worthwhile and cost-effective procedure, which is supported by other authors [5,[9][10][11][12][13]. The resource expenditure linked with endovascular procedures might be further decreased by the selective use of stents and other expensive devices [9,14]. The other potential way to reduce resource utilization in patients with lower limb ischemia is the recommendation of appropriate pharmacotherapy in accordance with the requirements for the prevention of secondary cardiovascular disorders and supervised exercise training in patients with intermittent claudication (not with CLI), which appear to be more cost-effective in such disease advancement than endovascular revascularization [15].…”

Section: Discussionmentioning

confidence: 82%

Koszty szpitalnego leczenia z powodu krytycznego niedokrwienia kończyn dolnych u pacjentów, u których ostatecznie przeprowadzono amputację kończyny. Obserwacje z jednego ośrodka

Budzyński¹,

Wnęk

Banaś

et al. 2017

MBS

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S u m m a r y B a c k g r o u n d . Currently, the average amputation free survival in patients with critical limb ischemia (CLI) amounts to 76% after one year of follow-up. Such poor prognosis raises the question: is revascularization in patients with CLI cost-effective? The aim of this study was to conduct a cost analysis of vascular care in patients with CLI.The aim of this study was to conduct a cost analysis of vascular care in patients with CLI. P a t i e n t s a n d m e t h o d s . A retrospective cost analysis of in-hospital endovascular treatment in 37 patients with CLI who underwent secondary leg amputation between January 2012 and June 2015.R e s u l t s . The average length of time between the first endovascular procedure due to CLI and leg amputation amounted to 214 days (range 8-1088 days). The total cost of hospitalizations before leg amputation amounted to 687 603.13 PLN, which is, on average, 18 583.87 PLN per patient, and 86.84 PLN per person per day for living with the preserved lower limb. The total costs associated with the patients who had undergone leg amputation amounted to 404 883.24 PLN, which is an average of 10 942.79 PLN per patient. Previous endovascular procedures accounted for 58.9% of this sum and 37.1% to total management costs for the patients.C o n c l u s i o n s . The cost per day of endovascular treatment that makes it possible to live with two lower limbs did not exceed the established cost-effectiveness threshold. Lower limb amputation increases the costs of in-hospital patient care by 59%, represents financial wastage for the hospital, and incurs other costs not easily measured.S t r e s z c z e n i e W s t ę p . Obecnie około 76% pacjentów z krytycznym niedokrwieniem kończyn dolnych (KNKD) poddanych rewaskularyzacji przeżywa kolejny rok z zachowaną kończyną.Powstaje więc pytanie, czy zabiegi rewaskularyzacyjne u tych pacjentów są efektywne kosztowo, skoro 24% chorych nie korzysta z ich efektów dłużej niż przez rok? Celem niniejszej pracy była analiza kosztów opieki naczyniowej u pacjentów z KNKD.P a c j e n c i i m e t o d y . Retrospektywna analiza kosztów szpitalnego leczenia angiologicznego KNKD u 37 pacjentów poddanych wtórnej amputacji kończyny w okresie 01.2012 -06.2015. W y n i k i . Średni okres między pierwszym zabiegiem rewaskularyzacyjnym a amputacją tej kończyny wynosił 214 dni (przedział 8-1088dni). Całkowite koszty hospitalizacji związanych z zabiegami wewnątrznaczyniowymi przed amputacją kończyny wyniosły 687 603,13PLN, co średnio na pacjenta daje 18 583,87 PLN, 86,84 PLN za jeden dzień i 18 578,5 PLN za potencjalny rok życia z kończyną. Na koszty te składały się koszty stałe oraz zmienne, związane DOI: http://dx.doi.org/10.12775/MBS.2016.029 Jacek Budzyński et al. 14 głównie z liczbą implantowanych stentów (n=59) i leczeniem trombolitycznym (n=6). Natomiast całkowity koszt hospitalizacji związanych z amputacją kończyny dolnej wynosił w badanej grupie 404 883.24 PLN, co daje średnio 10 942,79 PLN na pacjenta. Suma ta stanowiła 58,9% kosztów wcześniejszych...

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Section: Discussionmentioning

confidence: 82%

Koszty szpitalnego leczenia z powodu krytycznego niedokrwienia kończyn dolnych u pacjentów, u których ostatecznie przeprowadzono amputację kończyny. Obserwacje z jednego ośrodka

Budzyński¹,

Wnęk

Banaś

et al. 2017

MBS

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“…10 Stenting is appropriate for complex lesions and as a 'bailout' procedure after complications of balloon angioplasty, or recoil after balloon dilatation, and the outcome with stenting is superior to balloon angioplasty alone. 6,7,11 We did not give preference to any specific stent, and a single stent was preferred in order to cover the entire lesion; multiple stents were however deployed if necessary.…”

Section: Discussionmentioning

confidence: 99%

“…4 Vascular surgeons have become more experienced with catheter-based technology and due to the minimal invasiveness of the procedure, both patients and vascular surgeons are increasingly attracted to endovascular procedures. Mwipatayi et al 5 and Nguyen et al 6 found stenting resulted in equivalent outcomes when compared to balloon angioplasty alone, but Laird et al 7 found that self-expanding nitinol stents were associated with better angiographic results and improved patency compared with balloon angioplasty alone.…”

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confidence: 99%

Comparison between superficial femoral artery stenting and bypass surgery in severe lower-limb ischaemia : a retrospective study : cardiovascular topic

Islam

Robbs

2015

CVJA

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Background: Symptomatic femoro-popliteal disease is treated by bypass surgery or angioplasty with or without stenting. The aim of this study was to compare the results of stenting and bypass surgery with regard to limb salvage in patients with severe leg ischaemia. Methods: A total of 213 patients with femoro-popliteal disease presenting with severe claudication or critical limb ischaemia between January 2009 and December 2013 were evaluated; 118 patients (139 limbs) had stents placed and 95 patients (104 limbs) had bypass surgery. Most (60%) presented with critical limb ischaemia (rest pain 40%, tissue necrosis 20%), and the remainder with severe claudication. The treatment groups had matching risk factors. Results: The average age was 66 years and 73% were male. Tissue necrosis was found in 26% of the stent group and 12% of the bypass group (p = 0.009). In the stent group 26% had adjunctive procedures, compared to 16% in the bypass group (p = 0.138). During the one-year follow up, there were 30 stent occlusions (22%) and 18 graft occlusions (17%) (p = 0.42). There were 14 major amputations (10%) in the stent group, and 13 (13%) in the bypass group (p = 0.68). Limb salvage rate was 90% in the stent group, and 88% in the bypass group (p = 0.68). There were no peri-operative deaths in the stent group, but one in the bypass group (1%). One-year mortality rate was equal (8%) in both groups (p = 1.00). Conclusion: One-year outcome was comparable in both groups with regard to mortality, stent or graft patency and limb salvage rates.

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“…Long segment and more extensive peripheral arterial disease demonstrate poorer outcome following PTA with a restenosis rate above 70% in the first year [4]. There are improved clinical outcomes and patency with bare nitinol (NiTi) stent (BNS) placement in comparison to balloon PTA alone [5][6][7][8][9][10][11]. However, intimal hyperplasia particularly on either end of the stent graft represents a pathological challenge to this treatment which eventually leads to disease recurrence (restenosis) [12].…”

Section: Introductionmentioning

confidence: 99%

Heparin-Bonded Viabahn and Drug-Eluting Bare Metal Zilver (PTX) Sandwich Stents in Femoral Chronic Total Occlusion: A Retrospective Review of Mid-Term and Long-Term Outcomes

Awwad

Al-Obaydi

Yong

et al. 2015

Journal of Angiology

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Articles describe a retrospective cohort study to assess the feasibility of reducing neointimal hyperplasia following interventions in chronic total occlusive peripheral vascular disease. The "sandwich" technique implemented is a novel modified angioplasty technique that combines heparin-bonded (Viabahn) stents with drug-eluting stents (Zilver PTX) deployed during arterial recanalisation. A review of 46 cases underwent this procedure at our institution as a limb saving procedure is conducted to determine mid-long-term patency outcomes and identify any subsequent interventions. Followup demonstrates favourable midlong-term patency in 50% of TASC-C cases. No documented postprocedural complications were noted with unrelated observed mortality rates in either TASC-C or TASC-D subgroups. An observed advantage could be gained by using this new stenting technique via the subintimal recanalisation route. Albeit not statistically significant, type II diabetics and patients on aspiring had better sustained patency angioplasties. The sandwich technique has been shown to effectively offer symptoms relief and reduce total duration of hospital stay. Study findings support the need to evaluate the long-term efficacy through a larger longitudinal prospective study. However, to overcome the encountered study limitations, a well-structured methodology for comparison with conventional angioplasty techniques is essential to assess the synergetic potential of the sandwich technique.

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Late outcomes of balloon angioplasty and angioplasty with selective stenting for superficial femoral-popliteal disease are equivalent

Cited by 29 publications

References 32 publications

Koszty szpitalnego leczenia z powodu krytycznego niedokrwienia kończyn dolnych u pacjentów, u których ostatecznie przeprowadzono amputację kończyny. Obserwacje z jednego ośrodka

Koszty szpitalnego leczenia z powodu krytycznego niedokrwienia kończyn dolnych u pacjentów, u których ostatecznie przeprowadzono amputację kończyny. Obserwacje z jednego ośrodka

Comparison between superficial femoral artery stenting and bypass surgery in severe lower-limb ischaemia : a retrospective study : cardiovascular topic

Heparin-Bonded Viabahn and Drug-Eluting Bare Metal Zilver (PTX) Sandwich Stents in Femoral Chronic Total Occlusion: A Retrospective Review of Mid-Term and Long-Term Outcomes

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