PMID- 34902467
OWN - NLM
STAT- MEDLINE
DCOM- 20220510
LR  - 20221207
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 82
DP  - 2022 May
TI  - Rates of Intervention for Claudication versus Chronic Limb-Threatening Ischemia 
      in Canada and United States.
PG  - 131-143
LID - S0890-5096(21)00921-3 [pii]
LID - 10.1016/j.avsg.2021.10.068 [doi]
AB  - BACKGROUND: Previous studies have demonstrated important geographic variations in 
      peripheral artery disease (PAD) management despite existing guidelines. We 
      assessed differences in patient characteristics, procedural technique, and 
      outcomes for PAD interventions in Canada versus United States. METHODS: The 
      Vascular Quality Initiative (VQI) was used to identify all patients who underwent 
      endovascular intervention or surgical bypass for PAD between 2010 and 2019 in 
      Canada and United States. Independent t-test and chi-square test were performed 
      to assess differences between countries in terms of demographic, clinical, and 
      procedural characteristics. The primary outcome was the percentage of 
      interventions performed for claudication versus chronic limb-threatening ischemia 
      (CLTI). Perioperative outcomes were in-hospital mortality and index limb 
      amputation. The long-term outcome was 1-year amputation-free survival. 
      Univariate/multivariate logistic regression and Cox proportional hazards analysis 
      were performed to investigate associations between region and outcomes. RESULTS: 
      A total of 246,770 US patients and 3,467 Canadian patients underwent 
      revascularization for PAD during the study period. There was a higher proportion 
      of endovascular interventions in the US (75.9% vs. 69.2%, OR 1.41 [95% CI 
      1.31-1.51], P< 0.001). American patients were younger with more comorbidities, 
      including hypertension, diabetes, and coronary artery disease. The percentage of 
      interventions performed for claudication was significantly higher in the US 
      (42.3% vs. 35.7%, OR 1.31 [95% CI 1.22-1.44], P< 0.001). This persisted after 
      controlling for demographic, clinical, and procedural characteristics (adjusted 
      OR 1.05 [95% CI 1.01-1.10], P = 0.02). Perioperative outcomes were similar 
      between countries after adjustment for baseline differences: in-hospital 
      mortality (adjusted OR 1.07 [95% CI 0.69-1.62], P= 0.75) and index limb 
      amputation (adjusted OR 0.67 [95% CI 0.43-1.07], P= 0.09). However, 1-year 
      amputation-free survival was higher in the US (84.1% vs. 71.0%, HR 1.61 [95% CI 
      1.47-1.76], P< 0.001). Multivariable Cox proportional hazards analysis 
      demonstrated that the factor most strongly associated with index limb amputation 
      or death at 1-year was intervention for CLTI (HR 1.56 [95% CI 1.54-1.58], P< 
      0.001). CONCLUSIONS: There are significant variations in PAD management between 
      US and Canada. In particular, a higher proportion of interventions are performed 
      for claudication rather than CLTI in the US compared to Canada. This is an 
      important contributor to the higher 1-year amputation-free survival rate in US 
      patients. Reasons for these differences should be assessed by future studies and 
      evidence-based care may be standardized by targeted quality improvement projects.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Li, Ben
AU  - Li B
AD  - Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health 
      Network, University of Toronto, Toronto, Ontario, Canada.
FAU - Rizkallah, Philippe
AU  - Rizkallah P
AD  - Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health 
      Network, University of Toronto, Toronto, Ontario, Canada.
FAU - Eisenberg, Naomi
AU  - Eisenberg N
AD  - Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health 
      Network, University of Toronto, Toronto, Ontario, Canada.
FAU - Forbes, Thomas L
AU  - Forbes TL
AD  - Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health 
      Network, University of Toronto, Toronto, Ontario, Canada.
FAU - Roche-Nagle, Graham
AU  - Roche-Nagle G
AD  - Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health 
      Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: 
      graham.roche-nagle@uhn.ca.
LA  - eng
PT  - Journal Article
DEP - 20211210
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Amputation, Surgical
MH  - Canada
MH  - Chronic Limb-Threatening Ischemia
MH  - *Endovascular Procedures/adverse effects
MH  - Humans
MH  - Intermittent Claudication/diagnosis/surgery
MH  - Ischemia/diagnostic imaging/surgery
MH  - Limb Salvage
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States
EDAT- 2021/12/14 06:00
MHDA- 2022/05/11 06:00
CRDT- 2021/12/13 20:15
PHST- 2021/09/04 00:00 [received]
PHST- 2021/10/22 00:00 [revised]
PHST- 2021/10/24 00:00 [accepted]
PHST- 2021/12/14 06:00 [pubmed]
PHST- 2022/05/11 06:00 [medline]
PHST- 2021/12/13 20:15 [entrez]
AID - S0890-5096(21)00921-3 [pii]
AID - 10.1016/j.avsg.2021.10.068 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2022 May;82:131-143. doi: 10.1016/j.avsg.2021.10.068. Epub 2021 
      Dec 10.