Patterns of treatment for peripheral arterial disease in the United States: 1996-2005

Abstract

The last decade has seen a significant increase in the use of endovascular procedures and a decrease in rates of major amputation. These trends are seen both for patients admitted with acute PAD, as well as in the population in general. While our study was not designed to demonstrate a causal relationship, our findings suggest an association between increased application of endovascular technology and reduced rates of amputation in patients with PAD.

Beta-blocker Treatment Does Not Worsen Critical Limb Ischemia in Patients Receiving Endovascular Therapy

“…Consequently, the results were similar for the endpoints of AFS, limb salvage, overall survival, CV death and MALE. The outcomes of EVT have recently improved, and this method has become common as a result of technical developments and improvements in devices [11][12][13] . Providing general anesthesia is difficult in many CLI patients with severe CAD, HF or LV dysfunction, although the number of high-risk patients who receive EVT is likely to increase.…”

Critical Limb Ischemia: Current Trends and Future Directions

“…Prognosis with respect to limb salvage and survival in CLI patients, and the PAD population as a whole, has improved over the years 24, 25, 26, 27, 28, 29, 30, 31. In a large population‐based study in a heterogeneous PAD population >65 years of age, the adjusted odds ratio of lower extremity amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95–0.95, P <0.001) 31.…”

“…To date no other randomized studies have compared bypass surgery with endovascular therapy in CLI. However, a tendency to an endovascular‐first strategy has evolved over the past 2 decades, fueled by results of nonrandomized comparisons, reports in milder and selected PAD populations, and a perceived short‐term favorable balance of an endovascular‐first approach in the high‐risk CLI population 24, 28, 29, 65…”

http://www.esciencecentral.org/journals/update-on-management-of-aneurysms-of-the-abdominal-aorta-its-branchvessels-and-the-lower-extremities-2329-9495-1000e109.php?aid=41201

“…Yet for patients with critical limb ischemia, life is characterized by vicissitudes of morbid sequelae including amputation, disability and death [5][6][7][8]. Once the purview of vascular specialists, the timely, accurate diagnosis of critical limb ischemia is now a responsibility that is shared amongst all medicaland surgical specialists and given the multifaceted nature of critical limb ischemia, effective treatment and improved amputation free survival requires an aggressive interdisciplinary approach to care [9,10].…”