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Sansosti AA, Munoz J, Lazar AN, Zenilman AL, Mehta A, Aljabban I, Chen P, Johnson AP, Siracuse J, Patel VI, Morrissey NJ. Practice patterns in utilization of atherectomy and embolic protection devices in inpatient and outpatient treatment settings. J Vasc Surg 2024:S0741-5214(24)01481-2. [PMID: 38944400 DOI: 10.1016/j.jvs.2024.06.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/12/2024] [Accepted: 06/22/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE The frequency of atherectomy in lower extremity arterial disease has increased substantially over the past several years, specifically in the office-based laboratory (OBL) setting, yet the efficacy compared with other interventions and the consequences of distal embolization remain unknown. Embolic protection devices (EPDs) have been used at varying rates depending on physician and practice setting. Previous studies have described lesion characteristics to consider when weighing the benefits and drawbacks associated with device use. Our study focuses on the use of atherectomy and EPDs in femoropopliteal arterial disease to better characterize resource use trends and postoperative outcomes in the inpatient and OBL interventional settings. METHODS We conducted a retrospective analysis on endovascular interventions performed for femoral-popliteal occlusive disease that were entered into the Vascular Quality Initiative data registry between 2017 and 2021. A one:one greedy match, adjusted analysis based on inpatient or OBL location of procedure was used to compare the groups. Hierarchical logistical regression with selective use of principal component analysis was used to further explore the differences in EPD use and immediate postoperative outcomes. A proportional hazard model was used to demonstrate differences in reintervention rates up to 2 years postoperatively between patients who underwent atherectomy in the inpatient vs OBL treatment setting. RESULTS Were included 2849 matched pairs in the final analysis. In our cohort, there was 22% EPD use overall, 40% in the hospital setting and 4.4% in the OBL setting (P < .001). Among the patients with available follow-up information, OBL intervention setting increased probability of reintervention by 18% at 2 years postoperatively compared with the inpatient setting; however, there was no difference associated with EPD placement and rate of reintervention. CONCLUSIONS Use of EPDs in the OBL setting compared with the hospital setting is dramatically decreased; however, no increased incidence of postoperative complications was seen compared with procedures performed in the hospital setting when controlling for patient and lesion characteristics. Patients with available follow-up data were more likely to undergo ipsilateral reintervention between 6 months and 2 years postoperatively if atherectomy was done in the OBL setting. Dedicated studies are encouraged to ensure patient safety, effective resource allocation, and long-term efficacy of OBL atherectomy as an ever-growing number of peripheral arterial procedures are transitioned to the OBL setting.
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Affiliation(s)
- Alexandra A Sansosti
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
| | - Jose Munoz
- Columbia University Vagelos College of Physicians & Surgeons, New York
| | - Andrew N Lazar
- Division of Vascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Ariela L Zenilman
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Ambar Mehta
- Department of General Surgery, Massachusetts General Hospital, Boston, MA
| | - Imad Aljabban
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Panpan Chen
- Division of Vascular Surgery, Cornell University, New York Presbyterian Hospital, New York, NY
| | - Adam P Johnson
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC
| | - Jeffrey Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA
| | - Virendra I Patel
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Nicholas J Morrissey
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
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Rondelet B, Dehanne F, Van Den Bulcke J, Martins D, Belhaj A, Libert B, Leclercq P, Pirson M. Daly/Cost comparison in the management of peripheral arterial disease at 17 Belgian hospitals. BMC Health Serv Res 2024; 24:109. [PMID: 38243251 PMCID: PMC10797854 DOI: 10.1186/s12913-023-10535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Peripheral arterial disease (PAD) is a manifestation of atherosclerosis that affects the lower extremities and afflicts more than 200 million people worldwide. Because of limited resources, the need to provide quality care associated with cost control is essential for health policies. Our study concerns an interhospital comparison among seventeen Belgian hospitals that integrates the weighting of quality indicators and the costs of care, from the hospital perspective, for a patient with this pathology in 2018. METHODS The disability-adjusted life years (DALYs) were calculated by adding the number of years of life lost due to premature death and the number of years of life lost due to disability for each in-hospital stay. The DALY impact was interpreted according to patient safety indicators. We compared the hospitals using the adjusted values of costs and DALYs for their case mix index, obtained by relating the observed value to the predicted value obtained by linear regression. RESULTS We studied 2,437 patients and recorded a total of 560.1 DALYs in hospitals. The in-hospital cost average [standard deviation (SD)] was €8,673 (€10,893). Our model identified the hospitals whose observed values were higher than predicted; six needed to reduce the costs and impacts of DALYs, six needed to improve one of the two factors, and four seemed to have good results. The average cost (SD) for the worst performing hospitals amounted to €27,803 (€28,358). CONCLUSIONS Studying the costs of treatment according to patient safety indicators permits us to evaluate the entire chain of care using a comparable unit of measurement.
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Affiliation(s)
- Benoît Rondelet
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Avenue G. Therasse, 1, 5530, Yvoir, Belgium.
- Chief Medical Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium.
| | - Fabian Dehanne
- Chief Executive Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- Health and Society Research Institute (IRSS) - UCLouvain, Louvain-La-Neuve, Belgium
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Van Den Bulcke
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitri Martins
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Asmae Belhaj
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Avenue G. Therasse, 1, 5530, Yvoir, Belgium
| | - Benoît Libert
- Chief Executive Officer Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium
| | - Pol Leclercq
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Department, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Kohata Y, Ohta M, Jin K, Anzai H. Effects of helical centerline stent vs. straight stent placement on blood flow velocity. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1196125. [PMID: 37333882 PMCID: PMC10272720 DOI: 10.3389/fmedt.2023.1196125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
As an approach to maintain patency in femoropopliteal stenting, a helical stent configuration was proposed, which showed improved patency in clinical trials. However, the effects of helical stent placement on the flow have not been quantitatively analyzed. The purpose of this study was to estimate flow velocities to quantify the influence of helical stent placement. Helical and straight stents were implanted in three healthy pigs, and the flow velocities were estimated using the time-intensity curve (TIC) in the angiography images. The angiographic images indicated thinning of the leading edge of the contrast medium through the helically deformed artery, which was not observed in the straight stent. The slower rise of the TIC peak in the helical stent indicated faster travel of this thinner edge. Arterial expansion due to stenting was observed in all cases, and the expansion rate varied according to location. All cases of helical stent implantation showed that velocity was maintained (55.0%-71.3% velocity retention), unlike for straight stent implantation (43.0%-68.0% velocity retention); however, no significant difference was observed.
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Affiliation(s)
- Yutaro Kohata
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Biomedical Flow Dynamics Laboratory, The Institute of Fluid Science, Tohoku University, Sendai, Japan
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, The Institute of Fluid Science, Tohoku University, Sendai, Japan
- ELyTMaXUMI 3757, CNRS – Université de Lyon – Tohoku University, International Joint Unit, Tohoku University, Sendai, Miyagi, Japan
| | - Kazuyoshi Jin
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
- Biomedical Flow Dynamics Laboratory, The Institute of Fluid Science, Tohoku University, Sendai, Japan
| | - Hitomi Anzai
- Biomedical Flow Dynamics Laboratory, The Institute of Fluid Science, Tohoku University, Sendai, Japan
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Follow the Data: It Is Time to Incentivize the Use of Drug-Eluting Stents and Balloons. J Vasc Interv Radiol 2022; 33:1159-1160. [PMID: 36182253 DOI: 10.1016/j.jvir.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
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