National trends in lower extremity bypass surgery, endovascular interventions, and major amputations

摘要: Introduction Advances in endovascular interventions have expanded the options available for invasive treatment of lower extremity peripheral arterial disease (PAD). Whether substitute conventional bypass surgery or are simply additive has not been investigated, and their effect on amputation rates is unknown. Methods We sought to analyze trends (angioplasty atherectomy), surgery, major (above below-knee) Medicare beneficiaries between 1996 2006. used 100% samples Part B claims calculate annual procedure Using physician specialty identifiers, we also examined performing primary procedure. Results Between 2006, rate declined significantly (263 188 per 100,000; risk ratio [RR] 0.71, 95% confidence interval [CI] 0.6-0.8). Endovascular increased more than threefold (from 138 455 RR=3.30; CI: 2.9-3.7) while decreased by 42% (219 126 RR=0.58; 0.5-0.7). The increase consisted both a growth angioplasty 135 337 procedures RR=2.49; 2.2-2.8) advent percutaneous atherectomy 3 118 RR=43.12; 34.8-52.0). While radiologists performed majority 1996, 80% were cardiologists vascular surgeons Overall, total number all almost doubled over decade 357 581 RR=1.63; 1.5-1.8). Conclusion now much commonly PAD. These changes far exceed simple substitution, as three additional every one surgery. During this same time period, fallen 25%. However, further study needed before any causal link can be established improved limb salvage patients with