The comparative data for angioplasty and stenting for treatment of peripheral arterial
disease are largely limited to technical factors such as patency rates with sparse
data on clinical outcomes like mortality, postprocedural complications, and amputation.
The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide
Inpatient Sample database from 2006 to 2011. Peripheral endovascular interventions
were identified using appropriate International Classification of Diseases, Ninth Revision (ICD-9) Diagnostic and procedural codes. Two-level hierarchical multivariate mixed models
were created. The primary outcome includes inhospital mortality, and secondary outcome
was a composite of inhospital mortality and postprocedural complications. Amputation
was a separate outcome. Hospitalization costs were also assessed. Endovascular stenting
(odds ratio, 95% confidence interval, p value) was independently predictive of lower
composite end point of inhospital mortality and postprocedural complications compared
with angioplasty alone (0.96, 0.91 to 0.99, 0.025) and lower amputation rates (0.56,
0.53 to 0.60, <0.001) with no significant difference in terms of inhospital mortality
alone. Multivariate analysis also revealed stenting to be predictive of higher hospitalization
costs ($1,516, 95% confidence interval 1,082 to 1,950, p <0.001) compared with angioplasty.
In conclusion, endovascular stenting is associated with a lower rate of postprocedural
complications, lower amputation rates, and only minimal increase in hospitalization
costs compared with angioplasty alone.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- National health care costs of peripheral arterial disease in the Medicare population.Vasc Med. 2008; 13: 209-215
- Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000.Circulation. 2004; 110: 738-743
- Inter-society consensus for the management of peripheral arterial disease (TASC II).J Vasc Surg. 2007; 45: S5-S67
- Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial.Lancet. 2005; 366: 1925-1934
- Percutaneous treatment of peripheral artery disease: novel techniques.Circulation. 2012; 126: 2433-2440
- Femoral and popliteal arteries: reanalysis of results of balloon angioplasty.Radiology. 1992; 183: 767-771
- Randomized study to compare PTA alone versus PTA with Palmaz stent placement for femoropopliteal lesions.J Vasc Interv Radiol. 2001; 12: 935-942
- Balloon angioplasty combined with primary stenting versus balloon angioplasty alone in femoropopliteal obstructions: a comparative randomized study.Cardiovasc Intervent Radiol. 1997; 20: 420-425
- Sustained benefit at 2 years of primary femoropopliteal stenting compared with balloon angioplasty with optional stenting.Circulation. 2007; 115: 2745-2749
- Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST).Circulation. 2007; 116: 285-292
- Quality AfHRa. Healthcare Cost and Utilization Project (HCUP). July 2008. HCUP Databases, Rockville2008
- The healthcare cost and utilization project: an overview.Eff Clin Pract. 2002; 5: 143-151
- 2004 HCUP Nationwide Inpatient Sample (NIS) Comparison Report. HCUP Methods Series Report # 2007-03 Online.US Agency for Healthcare Research and Quality, Rockville, MD2007
- Coronary revascularization trends in the United States, 2001-2008.JAMA. 2011; 305: 1769-1776
- Peripheral arterial interventions: trends in market share and outcomes by specialty, 1998-2005.J Vasc Surg. 2009; 50: 1071-1078
- Effect of physician and hospital experience on patient outcomes for endovascular treatment of aortoiliac occlusive disease.Arch Surg. 2011; 146: 966-971
- Measures of patient safety based on hospital administrative data - the patient safety indicators.AHRQ Technical Reviews. 2002; 5 (Report No.: 02-0038)
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease. Dutch Iliac Stent Trial Study Group.Lancet. 1998; 351: 1153-1159
- Propensity score-matched analysis of open surgical and endovascular repair for type B aortic dissection.Int J Vasc Med. 2011; 2011: 364046
- Hospital variation in the use of noninvasive cardiac imaging and its association with downstream testing, interventions, and outcomes.JAMA Intern Med. 2014; 174: 546-553
- German multicenter real-world registry of stenting for superficial femoral artery disease: clinical results and predictive factors for revascularization.J Endovasc Ther. 2014; 21: 463-471
- Sustained safety and effectiveness of paclitaxel-eluting stents for femoropopliteal lesions: 2-year follow-up from the Zilver PTX randomized and single-arm clinical studies.J Am Coll Cardiol. 2013; 61: 2417-2427
- Angioplasty versus bare metal stenting for superficial femoral artery lesions.Cochrane Database Syst Rev. 2014; 6: CD006767
- Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC).J Vasc Surg. 2000; 31: S1-S296
- A novel self-expanding interwoven nitinol stent for complex femoropopliteal lesions: 24-month results of the SUPERA SFA registry.J Endovasc Ther. 2011; 18: 745-752
- Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: what are its implications?.Semin Vasc Surg. 2009; 22: 267-274
- Clinical outcomes and medical care costs among Medicare beneficiaries receiving therapy for peripheral arterial disease.Ann Vasc Surg. 2010; 24: 577-587
- The LEVANT I (Lutonix paclitaxel-coated balloon for the prevention of femoropopliteal restenosis) trial for femoropopliteal revascularization: first-in-human randomized trial of low-dose drug-coated balloon versus uncoated balloon angioplasty.JACC Cardiovasc interventions. 2014; 7: 10-19
- Results of ventricular septal myectomy and hypertrophic cardiomyopathy (from Nationwide Inpatient Sample [1998-2010]).Am J Cardiol. 2014; 114: 1390-1395
Article info
Publication history
Published online: May 28, 2015
Accepted:
May 7,
2015
Received in revised form:
May 7,
2015
Received:
March 19,
2015
Footnotes
Drs. Panaich, Arora, and Badheka share equal contribution to this report.
See page 640 for disclosure information.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
