Revascularization for Femoropopliteal Disease

Hunink, Myriam; Wong, Jb; Mc, Donaldson; Meyerovitz, MF; Devries, J. P.; Harrington, DP

doi:10.1001/jama.1995.03530020083037

Cited by 208 publications

(21 citation statements)

References 45 publications

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“…Our findings build on the analysis by Hunink and colleagues, who compared endovascular therapy and surgical bypass using a Markov model and literature-based estimates [5]. Compared to the findings by Hunink and colleagues, we found a smaller difference in QALMs between endovascular therapy and surgical bypass.…”

Section: Discussionsupporting

confidence: 80%

“…In these cases, the patient could choose to repeat the initial procedure or to undergo one of the remaining three therapies, which were constructed as “clones” of the initial branch on the tree diagram. We assumed each patient would undergo each procedure a maximum of two times [5]. Additionally, we assumed that patients who initially chose medical management would not later opt for a surgical procedure.…”

Section: Methodsmentioning

confidence: 99%

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Decision-Making in Critical Limb Ischemia: A Markov Simulation

Deutsch

Jain

Blumenthal

et al. 2017

Annals of Vascular Surgery

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Background Critical limb ischemia (CLI) is a feared complication of peripheral vascular disease that often requires surgical management and may require amputation of the affected limb. Objective To use a decision model to inform clinical management for a 63-year-old woman with CLI and multiple medical comorbidities, including advanced heart failure and diabetes. Methods Markov decision model evaluating four strategies: amputation, surgical bypass, endovascular therapy (e.g. stent or revascularization), and medical management. We measured the impact of parameter uncertainty using 1-way, 2-way, and multi-way sensitivity analyses. Results In the base case, endovascular therapy yielded similar discounted quality-adjusted life-months (26.50 QALMs) compared to surgical bypass (26.34 QALMs). Both endovascular and surgical therapies were superior to amputation (18.83 QALMs), and medical management (11.08 QALMs). This finding was robust to a wide range of peri-procedural mortality weights, and was most sensitive to long-term mortality associated with endovascular and surgical therapies. Limitations Utility weights were not stratified by patient comorbidities; nonetheless, our conclusion was robust to a range of utility weight values. Conclusions For a patient with CLI, endovascular therapy and surgical bypass provided comparable clinical outcomes. However, this finding was sensitive to long-term mortality rates associated with each procedure. Both endovascular and surgical therapies were superior to amputation or medical management in a range of scenarios.

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Section: Discussionsupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Decision-Making in Critical Limb Ischemia: A Markov Simulation

Deutsch

Jain

Blumenthal

et al. 2017

Annals of Vascular Surgery

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“…Similarly critical leg ischemia (PAD stages III–IV) is on average $4478 more expensive than the treatment of intermittent claudication (PAD stage II disease) [8,9]. This also holds true for the costs of a specific therapeutic/invasive procedure; for example, the costs for percutaneous transluminal angioplasty (PTA) are much greater for patients with critical ischemia and tissue necrosis than for patients with disabling claudication secondary to higher complication rates and longer hospital stays [10]. Another consideration is that amputation has been shown to be about twice as expensive as a limb salvage strategy with either interventional or surgical methods and for both acute and chronic limb threatening ischemia [11].…”

Section: Factors That Impact the Costs Of Peripheral Vascular Disementioning

confidence: 99%

“…Initial angioplasty increased quality-adjusted life expectancy by 2 to 13 months in patients with disabling claudication and by 1 to 4 months in patients with chronic critical ischemia and resulted in decreased lifetime expenditures compared with bypass surgery in both groups. A Markov model economic estimation based on this study using a maximum threshold cost of US$50,000 per QALY showed that PTA was cost effective when compared with vein bypass for lesions that could be treated with a better than 30% 5-year patency [10]. …”

Section: Cost Effectiveness Of Percutaneous Transluminal Angioplasmentioning

confidence: 99%

Cost-effectiveness of medical, endovascular and surgical management of peripheral vascular disease

Fanari

Weintraub

2015

Cardiovascular Revascularization Medicine

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Peripheral arterial disease (PAD) is responsible for 20% of all US hospital admissions. Management of PAD has evolved over time to include many medical and transcatheter interventions in addition to the traditional surgical approach. Non-invasive interventions including supervised exercise programs and antiplatelets use are economically attractive therapies that should be considered in all patients at risk. While surgery offers so far a clinically and economically appropriate option, the improvement of percutaneous transluminal angioplasty (PTA) technique with the addition of drug-coated balloons offers a reasonably clinically and economically attractive alternative that will continue to evolve in the future.

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“…Similarly, a cost-effectiveness analysis compared PTA and bypass surgery with exercise therapy for treatment of claudication and demonstrated that the cost-effectiveness for PTA was $38,000 per quality-adjusted life year compared to $311,000 per quality-adjusted life year for bypass surgery [88]. In regards to cost-effectiveness, PTA is preferable to surgery as long as the expected 5-year patency rate for the treated vessel exceeds 30% [89]. In addition, PTA is preferred over surgery, when possible, in patients younger than 50 years old, because they have a higher risk of graft failure after surgical therapy than do older patients [1].…”

Section: Managementmentioning

confidence: 99%

Current Approach to the Diagnosis and Treatment of Femoral-Popliteal Arterial Disease. A Systematic Review

Kasapis

Gurm²

2009

Current Cardiology Reviews

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Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and surgical management of SFPA disease.

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Revascularization for Femoropopliteal Disease

Cited by 208 publications

References 45 publications

Decision-Making in Critical Limb Ischemia: A Markov Simulation

Decision-Making in Critical Limb Ischemia: A Markov Simulation

Cost-effectiveness of medical, endovascular and surgical management of peripheral vascular disease

Current Approach to the Diagnosis and Treatment of Femoral-Popliteal Arterial Disease. A Systematic Review

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