A Systematic Review of Cost-Utility Analyses in Chronic Limb-Threatening Ischemia

Shan, Leonard; Wang, Jennifer; Westcott, Mark J.; Tew, Michelle; Davies, Alun H.; Choong, Peter

doi:10.1016/j.avsg.2022.04.036

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…Close collaboration among surgeons, clinicians and biomedical engineers is crucial to tailor the treatment for each patient [40,41], similarly to the lessons of the Heart Team in cardiology. In this scenario, patient-reported outcomes play a pivotal role in evaluating the cost-effectiveness of each treatment [2,5,42] as well as circulating biomarkers to promptly detect complications even before clinical events [43].…”

Section: Discussionmentioning

confidence: 99%

“…Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life, and its optimal treatment remains debated [1][2][3][4][5][6]. As recently reported in the Global Vascular Guidelines, vein bypass should be preferred for patients with advanced limb threat and high-complexity disease in cases of low-intermediate surgical risk [1]; however, the optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery [1].…”

Section: Introductionmentioning

confidence: 99%

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External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

Montelione,

Catanese,

Nenna

et al. 2024

JCM

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Background: The surgical treatment of chronic limb-threatening ischemia and optimal conduit choice are extensively debated. The presence of suboptimal autologous material, such as varicosities or venous aneurysms, might impair long-term outcomes. Therefore, kink-resistant external supports have been advocated in the recent literature to improve the conduit quality and outcomes. This study analyzes the FRAME external support in venous ectasic grafts in patients with chronic limb-threatening ischemia. Methods: From September 2017 to September 2023, a total of sixteen patients underwent CLTI surgery with FRAME external support for venous grafts. The inclusion criteria for FRAME applications were varicose or ectasic autologous material with a diameter ≥ 4.5 and ≤ 8 mm in an isolated segment or in the entire vein and a higher risk of bypass extrinsic compression (e.g., extra-anatomical venous bypass course). Results: Technical success and intraoperative patency were achieved in all cases. At 30 days, the limb salvage and survival rates were 100%. The primary bypass patency was 93.7% due to an early graft occlusion. No graft infection was registered. In one case, dehiscence of the surgical wound was treated by surgical debridement and antibiotic therapy. Minor amputation was required in four patients. Over a median follow-up of 32 months, two occlusions were observed; one was treated with reoperation and the other with major amputation. The primary patency was 68.7% and the assisted primary patency was 75%. Limb salvage rates observed during the entire follow-up period were 87.5%. No graft infections or dilatation of the reinforced veins were registered. Conclusions: For patients with CLTI undergoing infrainguinal bypass, satisfactory results in terms of patency and limb salvage rates were achieved using the autologous venous material, even if ectasic or varicose, with the vascular external support FRAME.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

Montelione,

Catanese,

Nenna

et al. 2024

JCM

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“…1 The themes we developed allow the development of a CLTI-specific QOL instrument that is based on patient and consumer co-design. Our group's work highlights how this instrument forms the foundation for QOL measurement 3 and downstream clinical applications such as QOL outcomes, 2 cost-utility, 4 and prognostication and risk stratification. 5 There was a significant benefit to incorporating PPI into this study.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 It is an outcome that matters to patients and is vital within a value-based healthcare system. 4,5 Our recent review demonstrated that whilst revascularisation in CLTI may lead to modest QOL benefits, amputation and conservative management may also maintain QOL. 2 However, interpretation of QOL outcomes is hampered by the lack of a CLTI-specific QOL instrument and significant weaknesses of best alternatives such as VascuQoL.…”

Section: Introductionmentioning

confidence: 99%

“…Quality of life (QOL) is an established outcome measure 1 that is frequently used to evaluate and compare treatments for chronic limb‐threatening ischemia (CLTI) 2,3 . It is an outcome that matters to patients and is vital within a value‐based healthcare system 4,5 . Our recent review demonstrated that whilst revascularisation in CLTI may lead to modest QOL benefits, amputation and conservative management may also maintain QOL 2 .…”

Section: Introductionmentioning

confidence: 99%

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Patient perspectives of quality of life in chronic limb‐threatening ischemia: a qualitative study

Shan,

Telianidis,

Westcott

et al. 2023

ANZ Journal of Surgery

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BackgroundQuality of life (QOL) is an outcome that matters to patients with chronic limb‐threatening ischemia (CLTI). However, we identified the lack of and need for a CLTI‐specific QOL instrument. Our group is developing this instrument which requires a deep understanding of patient perspectives of QOL in CLTI.MethodsQualitative inquiry with patient and public involvement was performed in accordance with the Standards for Reporting Qualitative Research. Reflexive thematic analysis of semi‐structured interviews was conducted within a constructivist‐interpretivist research paradigm. Data were organized and managed in NVivo. Techniques to enhance trustworthiness included maintaining an audit trail, member checking, mentoring, and peer‐debriefing. Patient and the public were consulted for feedback on codes, themes, and thematic maps.ResultsThirteen participants (median age: 74 years, range: 43–90 years) with a variety of patient demographics were interviewed. Four themes were developed on QOL in CLTI: (i) ‘independence as key to life satisfaction’, (ii) ‘change in identity when continuity is needed’, (iii) ‘coping with intractable disease’, and (iv) ‘not wanting to be alone’. Member checking with patient and public involvement confirmed the relevance and centrality of these themes to the lived experiences of patients with CLTI.ConclusionsThe thematic outputs contribute important insights into what QOL truly means to patients with CLTI and what matters for their QOL. The content validity of the new CLTI‐specific QOL instrument is improved by giving patients voice. This study highlights the value of qualitative inquiry and patient and public involvement in vascular surgical research.

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Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study

Saratzis,

Torsello,

Cardona-Gloria

et al. 2024

European Journal of Vascular and Endovascular Surgery

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A Systematic Review of Cost-Utility Analyses in Chronic Limb-Threatening Ischemia

Cited by 6 publications

References 37 publications

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

External Scaffold for Venous Graft to Treat Chronic Limb-Threatening Ischemia: Results of the FRAME Vascular Support

Patient perspectives of quality of life in chronic limb‐threatening ischemia: a qualitative study

Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study

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