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Tsai TT, Rehring TF, Rogers RK, Shetterly SM, Wagner NM, Gupta R, Jazaeri O, Hedayati N, Jones WS, Patel MR, Ho PM, Go AS, Magid DJ. The Contemporary Safety and Effectiveness of Lower Extremity Bypass Surgery and Peripheral Endovascular Interventions in the Treatment of Symptomatic Peripheral Arterial Disease. Circulation 2015; 132:1999-2011. [PMID: 26362632 PMCID: PMC4652630 DOI: 10.1161/circulationaha.114.013440] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment for symptomatic peripheral artery disease includes lower extremity bypass surgery (LEB) and peripheral endovascular interventions (PVIs); however, limited comparative effectiveness data exist between the 2 therapies. We assessed the safety and effectiveness of LEB and PVI in patients with symptomatic claudication and critical limb ischemia. METHODS AND RESULTS In a community-based clinical registry at 2 large integrated healthcare delivery systems, we compared 883 patients undergoing PVI and 975 patients undergoing LEB between January 1, 2005 and December 31, 2011. Rates of target lesion revascularization were greater for PVI than for LEB in patients presenting with claudication (12.3±2.7% and 19.0±3.5% at 1 and 3 years versus 5.2±2.4% and 8.3±3.1%, log-rank P<0.001) and critical limb ischemia (19.1±4.8% and 31.6±6.3% at 1 and 3 years versus 10.8±2.5% and 16.0±3.2%, log-rank P<0.001). However, in comparison with PVI, LEB was associated with increased rates of complications up to 30 days following the procedure (37.1% versus 11.9%, P<0.001). There were no differences in amputation rates between the 2 groups. Findings remained consistent in sensitivity analyses by using propensity methods to account for treatment selection. CONCLUSIONS In patients with symptomatic peripheral artery disease, in comparison with LEB, PVI was associated with fewer 30-day procedural complications, higher revascularization rates at 1 and 3 years, and no difference in subsequent amputations.
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Affiliation(s)
- Thomas T Tsai
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
| | - Thomas F Rehring
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - R Kevin Rogers
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - Susan M Shetterly
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - Nicole M Wagner
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - Rajan Gupta
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - Omid Jazaeri
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - Nasim Hedayati
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - W Schuyler Jones
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - Manesh R Patel
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - P Michael Ho
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - Alan S Go
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
| | - David J Magid
- From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.)
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