Comparative Analysis of Outcomes in Patients Undergoing Femoral Endarterectomy plus Endovascular (Hybrid) or Bypass for Femoropopliteal Occlusive Disease

DeCarlo, Charles; Boitano, Laura T.; Sumpio, Brandon J.; Latz, Christopher A.; Feldman, Zach M.; Pendleton, Anna A.; Chou, Elizabeth L.; Stern, Jordan R.; Dua, Anahita

doi:10.1016/j.avsg.2020.08.143

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…These findings are in line with a recent study by Fereydooni et al that reported an increasing use of hybrid revascularizations between 2010 and 2017 in the Vascular Quality Initiative database [16]. Compared to other recent studies that analyzed hybrid revascularization approaches, we additionally divided this group into subgroups (hybrid or two-step) according to whether these interventions were performed as a real hybrid revascularization in one setting or if both an endovascular and surgical revascularizations were performed in one hospitalization [16][17][18]. In addition to lower costs and shorter stay, we also found lower endovascular procedural codes in the true hybrid group.…”

Section: Discussionsupporting

confidence: 71%

“…Although several studies reported a cost benefit of endovascular revascularizations compared to surgical approaches, the healthcare costs for the treatment of PAD are still high and continue to rise, especially in patients with higher comorbidity [4,5,9,14,15]. Additionally, hybrid revascularization procedures have also recently been shown to increase in number and provide perioperative advantages to open surgical revascularization [16][17][18]. Overall, robust large-scale data to understand how the surge in resulting costs can be explained and what the role of different revascularization approaches (such as hybrid interventions) is, are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 Million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018

Decker

Helmer

Bette

et al. 2022

Cardiovasc Intervent Radiol

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Objective To analyze trends and differences of endovascular, surgical and hybrid revascularization approaches and the impact of comorbidity on characteristics, costs, and outcome of in-patients with peripheral artery disease (PAD) of the lower extremity. Methods Analyzing data provided by the Research Data Center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine IIb (Rutherford 2–3) or higher in Germany between 2009–2011 and 2016–2018. According to the individually performed procedures encoded by the Operation and Procedure Classification System, we divided hospitalizations by revascularization procedures into sole endovascular, sole surgical, hybrid, two-step and no revascularization. Patient’s comorbidity was assessed using the linear van Walraven comorbidity score (vWs). Results 1,067,671 hospitalizations (mean age 71.3 ± 11.1 years; 60.1% male) were analyzed. Between 2009–2011 and 2016–2018, reimbursement costs rose by 28.0% from €2.72 billion (€5,350/case) to €3.49 billion (€6,238/case). The share of hospitalizations with any revascularization increased by 8.9% (67.7–73.7%) driven by an increase in two-step (+ 63.3%), hybrid (+ 58.2%) and sole endovascular revascularizations (+ 32.6%), while sole surgical approaches declined (− 18.2%). Hospitalizations of more comorbid patients (vWs ≥ 20) rose by 46.8% (21,444–31,478 cases), showed an overproportionate increase in costs of 124.6% (+ €1,750/case) and were associated with more individual procedures (+ 90.6%). Conclusions In-patient treatment of PAD patients shows increasing numbers of hybrid and sole endovascular revascularizations and more patients with higher comorbidity, while sole surgical interventions and in-hospital mortality decrease. Consequently, associated costs are surging especially in more comorbid patients due to an increasing number of performed procedures and escalation of therapy.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 Million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018

Decker

Helmer

Bette

et al. 2022

Cardiovasc Intervent Radiol

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“…2,3,13,14,36–40 Hybrid revascularization techniques can also be used for revascularization of PAD, especially for patient anatomy including aortoiliac disease, and the use of hybrid revascularization procedures is supported by observational studies. 5,6,9–11,41–45 In the aortoiliac segment, less invasive hybrid procedures have similar primary patency and limb salvage rates when compared with open surgical reconstruction, 4,5,45 especially when using covered stent grafts. 4,6,7,45 Similarly, hybrid infrainguinal interventions have similar patency and limb salvage rates to open bypass in selected patients.…”

Section: Management Of Cltimentioning

confidence: 99%

2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Gornik,

Aronow,

Goodney

et al. 2024

Circulation

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AIM: The “2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease” provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS: A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE: Recommendations from the “2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.

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“… Lower morbidity and mortality rates were seen after performing endarterectomy compared to bypass procedures. 11 DeCarlo et al [ 63 ] USA (n=4,478) Overall complications were much higher in patients with vein or prosthetic graft compared to patients who had a hybrid revascularization (OR = 1.45; 95% CI: 1.04-2.02; P = 0.028) Patients with ICD underwent more complications post open bypass as opposed to patients who sought a hybrid approach to their treatment. 12 Kuma et al [ 64 ] Japan Retrospective study (n=111) 75 patients (n=111) with ICD were compared to 43 patients with CLI.…”

Section: Tablementioning

confidence: 99%

“…While preventative measures and routine care of the extremities serve as effective methods to limit disease progression, a holistic approach must be considered depending on the patient profile. We looked at over 12 primary research articles and recognized that endovascular interventions are necessary to provide comprehensive treatment for PAD [53][54][55][56][57][58][59][60][61][62][63][64]. The findings are summarized in Table 2.…”

Section: Tablementioning

confidence: 99%

Peripheral Arterial Disease: A Narrative Review

Parwani¹,

Ahmed²,

Mahawar³

et al. 2023

Cureus

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Peripheral arterial disease (PAD) describes the partial or complete occlusion of blood flow in the distal arteries of the body. A decreased arterial patency may occur due to a reduction in the elasticity or diameter of the vessel. The goal of interventions is to decrease incidence and reduce complications by identifying and minimizing the primary causes. This paper discusses PAD affecting the aortoiliac, common femoral, and femoropopliteal arteries. In a significant portion of the population, PAD may lack usual symptoms such as limb pain, claudication, and diminished pulses. Imaging techniques become crucial to ensuring timely diagnosis, monitoring treatment effectiveness, and preventing recurrence. Duplex ultrasound (DUS) is a cheap and non-invasive preliminary technique to detect atherosclerotic plaques and grade arterial stenosis. Magnetic resonance angiography (MRA) provides the added advantage of minimizing artifacts. Digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis but is only employed second-line to DUS or MRA due to the high dose of nephrotoxic contrast. Computed tomography angiography (CTA) is able to overcome the anatomical limitations of DUS and MRA and proves to be a suitable alternative to DSA in patients with renal disease. Preventative measures involve monitoring blood pressure, cholesterol levels, and tobacco usage. First-line treatment options include endovascular procedures as well as surgical interventions in cases of significant arterial involvement. Endovascular treatments involve the use of balloon angioplasty, drug-coated balloons, and drug-coated stents, to name a few, that serve as minimally invasive techniques to manage PAD. Surgical procedures, although more complex, are considered gold-standard treatment options for long and intricate lesions. Endovascular methods are generally preferred over surgical options as the complication risk is severely reduced and the rates of reintervention are comparable to surgical options.

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Comparative Analysis of Outcomes in Patients Undergoing Femoral Endarterectomy plus Endovascular (Hybrid) or Bypass for Femoropopliteal Occlusive Disease

Cited by 6 publications

References 17 publications

Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 Million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018

Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 Million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018

2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Peripheral Arterial Disease: A Narrative Review

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