PMID- 38070783
OWN - NLM
STAT- MEDLINE
DCOM- 20240325
LR  - 20240325
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 79
IP  - 4
DP  - 2024 Apr
TI  - Comparison of endovascular therapies for chronic limb-threatening ischemia and 
      claudication.
PG  - 875-886.e8
LID - S0741-5214(23)02325-X [pii]
LID - 10.1016/j.jvs.2023.12.001 [doi]
AB  - OBJECTIVE: Analysis of regional data from the Vascular Quality Initiative (VQI) 
      suggested improved survival for patients undergoing stent placement compared with 
      balloon angioplasty and atherectomy. Using national data from the VQI linked to 
      Medicare claims data through the Vascular Implant Surveillance and Interventional 
      Outcomes Network program, this study aimed to compare the rates of mortality, 
      reintervention, and amputation after endovascular interventions (atherectomy, 
      stenting, and balloon angioplasty) for two separate cohorts: patients with 
      chronic limb-threatening ischemia (CLTI) and patients with claudication. METHODS: 
      This was a secondary data analysis of Society for Vascular Surgery National VQI 
      data linked to Medicare claims, between October 2016 and December 2019. Patients 
      aged >/=65 years with symptoms of claudication or CLTI and a diagnosis of occlusive 
      disease were included. Urgent or emergent interventions or those with concurrent 
      procedures (endarterectomy, bypass, or bilateral intervention) were excluded. 
      Interventions were grouped into (1) balloon angioplasty only; (2) stent (with or 
      without balloon angioplasty); or (3) atherectomy (alone, with or without stent, 
      with or without balloon angioplasty). Propensity score-matched cohorts were 
      constructed to conduct pairwise intervention comparisons of mortality, 
      reintervention, and amputation rates. Multivariable logistic regression was used 
      to derive propensity scores for each patient. Kaplan-Meier estimates and Cox 
      proportional hazards ratios (HRs) (95% confidence interval [CI]) analyses were 
      performed. RESULTS: A total of 9785 (2665 claudication, 7120 CLTI) eligible 
      patients were identified. After propensity score matching for the CLTI group, 
      2826, 3608, and 2796 pairs of cases were used to compare balloon angioplasty vs 
      atherectomy, balloon angioplasty vs stent, and stent vs atherectomy, 
      respectively. No statistically significant difference in mortality was observed 
      among all interventions. However, atherectomy was associated with a significant 
      increase in reintervention rate compared with balloon angioplasty (HR, 1.22; 95% 
      CI, 1.06-1.39; P = .01) and compared with stenting (HR, 1.27; 95% CI, 1.10-1.46; 
      P < .01) within the first year after the index procedure. Of note, both 
      atherectomy (HR, 0.82; 95% CI, 0.68-0.98; P < .05) and stenting (HR, 0.76; 95% 
      CI, 0.64-0.90; P < .01) showed lower rates of major amputation when compared with 
      balloon angioplasty within 1 year after the index procedure. In the claudication 
      group, there were no significant differences observed among interventions for 
      peripheral arterial disease for mortality, reintervention, or amputation rates. 
      CONCLUSIONS: Further studies are needed to identify appropriate indications for 
      atherectomy, because there may be a subset of patients with CLTI who benefit from 
      this therapy with respect to amputation rates. Until then, caution should be 
      exercised when using atherectomy because it is also associated with higher 
      reintervention rates.
CI  - Copyright (c) 2023 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Chu, David
AU  - Chu D
AD  - Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA.
FAU - Zheng, Xinyan
AU  - Zheng X
AD  - Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.
FAU - Mao, Jialin
AU  - Mao J
AD  - Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.
FAU - Ramsey, Lolita
AU  - Ramsey L
AD  - Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA.
FAU - Mukherjee, Dipankar
AU  - Mukherjee D
AD  - Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA. Electronic 
      address: dipankar.mukherjee@inova.org.
LA  - eng
PT  - Journal Article
DEP - 20231207
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Humans
MH  - Aged
MH  - United States
MH  - Chronic Limb-Threatening Ischemia
MH  - Medicare
MH  - Risk Factors
MH  - Ischemia/diagnostic imaging/surgery
MH  - Treatment Outcome
MH  - Intermittent Claudication/diagnostic imaging/surgery
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - *Angioplasty, Balloon/adverse effects
MH  - Retrospective Studies
MH  - Limb Salvage
OTO - NOTNLM
OT  - Atherectomy
OT  - Balloon angioplasty
OT  - Chronic limb-threatening ischemia
OT  - Claudication
OT  - Stenting
COIS- Disclosures None.
EDAT- 2023/12/10 06:43
MHDA- 2024/03/25 06:43
CRDT- 2023/12/09 19:28
PHST- 2023/09/22 00:00 [received]
PHST- 2023/11/30 00:00 [revised]
PHST- 2023/12/01 00:00 [accepted]
PHST- 2024/03/25 06:43 [medline]
PHST- 2023/12/10 06:43 [pubmed]
PHST- 2023/12/09 19:28 [entrez]
AID - S0741-5214(23)02325-X [pii]
AID - 10.1016/j.jvs.2023.12.001 [doi]
PST - ppublish
SO  - J Vasc Surg. 2024 Apr;79(4):875-886.e8. doi: 10.1016/j.jvs.2023.12.001. Epub 2023 
      Dec 7.