Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

Abstract

Background-Epidemiology data for lower-extremity arterial thromboembolism (LET) are limited and may result from either acute limb ischemia or an acute exacerbation of critical limb ischemia. Given marked changes in both diagnosis and therapy over the last 2 decades, we hypothesized that this time period would have witnessed reductions in both the incidence and in-hospital mortality of LET. Methods and Results-Data from 1988 through 2007 from the National Hospital Discharge Survey were analyzed. All admissions for patients with LET were extracted, and the respective International Classification of Diseases, Ninth Revision, Clinical Modification codes were internally validated for both LET and acute limb ischemia. Descriptive statistics were used. The validity of the codes was good for identifying LET cases but poor for identifying acute limb ischemia cases because many of these acute presentations were attributable to critical limb ischemia. Over the 20-year span, there were 1.76 million cases of LET. The incidence of LET decreased significantly from 42.4 per 100 000 persons between 1988 and 1997 to 23.3 per 100 000 persons between 1998 and 2007. The in-hospital mortality for LET decreased significantly from 8.28% between 1988 and 1997 to 6.34% between 1998 and 2007, and male patients achieved greater mortality reduction compared with female patients. Treatments for acute limb ischemia showed decreasing use of surgical bypass and amputation and increasing rates of catheter-based thrombolysis. Conclusions-Over the 20-year study period, there have been significant reductions in both LET incidence and in-hospital mortality. Unfortunately, LET admissions extracted from an administrative database comprise a diverse group of individuals, including those with acute and chronic forms of limb ischemia and iatrogenic arterial injury, limiting the true assessment of ALI incidence. .).The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia

“…Yet, the risks of perioperative adverse events and postoperative death associated with operative revascularization performed in the setting of ALI remain high 5. With the advent of endovascular techniques and following the publication of randomized controlled trials in the 1990s suggesting that percutaneous thrombolysis is a less‐invasive yet comparable alternative to operative revascularization,6, 7, 8, 9, 10, 11, 12 ALI has been increasingly managed with endovascular peripheral vascular interventions (PVI) rather than open surgical approaches 13, 14…”

Clinical outcomes and cost-effectiveness of initial treatment strategies for nonembolic acute limb ischemia in real-life clinical settings

“…Administrative databases, such as the National Hospital Discharge Survey, have been used 6,7 but have significant limitations for the analysis of ALI outcomes and cost. A validation study showed low specificity and positive predictive value of the diagnostic codes typically used in ALI analyses.…”

“…A validation study showed low specificity and positive predictive value of the diagnostic codes typically used in ALI analyses. 7 However, diagnostic codes do not differentiate between ALI vs worsening of chronic limb ischemia or between embolic and nonembolic ALI, making estimations of incidence, in-hospital costs, and mortality unreliable. 7,8 Single-center studies of ALI have demonstrated that outcomes of interventions can differ significantly from those reported in RCTs.…”

“…7 However, diagnostic codes do not differentiate between ALI vs worsening of chronic limb ischemia or between embolic and nonembolic ALI, making estimations of incidence, in-hospital costs, and mortality unreliable. 7,8 Single-center studies of ALI have demonstrated that outcomes of interventions can differ significantly from those reported in RCTs. 6 Composition of the patient population is a contributing factor for such a difference.…”

Effective Use of Antiplatelets After Reconstructive Operations

“…По результатам недавно проведенного анализа 1,76 млн случаев госпитализаций пациентов с КИК и ОИК отме-чен положительный тренд по улучшению результатов лече-ния, однако уровень госпитальной летальности остается высоким -6%, а количество ампутаций достигает 7% [13].…”