Lower extremity angioplasty for claudication: a population-level analysis of 30-day outcomes.
OBJECTIVE
With the increased availability of lower extremity percutaneous transluminal angioplasty (PTA), the conventional, non-interventional management of claudication may be evolving. This study evaluated changes in the use and short-term outcomes of PTA among patients with claudication and other manifestations of peripheral arterial disease (PAD).


METHODS
A retrospective cohort study was conducted using the linked Washington State hospital discharge database (CHARS). Cases included all patients undergoing inpatient lower extremity PTA from 1997 to 2004. Patients with claudication were compared with those having PTA for other lower extremity diagnoses. The main outcome measures were readmission, reintervention (angiography, angioplasty/stent, surgical revascularization, or amputation), and death </=30 days.


RESULTS
A total of 1718 patients (mean age 69.7 +/- 11.2, 52.4% male) underwent PTA for claudication (51.9%), rest pain (12.1%), ulceration (23.2%), or not otherwise specified (12.9%). Yearly PTA use nearly doubled between 1997 and 2004, from 182 to 360, with a more dramatic increase in PTA among patients with claudication. Patients undergoing PTA for claudication were younger (67.9 +/- 10.3 vs 71.7 +/- 11.7 years, P < .01), more likely male (58.2% vs 46.2%, P < .01), and had a lower comorbidity index (0.7 vs 1.1, P < .01) compared with all others. A total of 65.3% were Medicare eligible. Among 555 patients aged <65 years, the indication for PTA was claudication more often when they had private insurance compared with uninsured or Medicaid beneficiaries (70.3% vs 49.1%, P < .01). Patients with claudication had shorter hospitalizations (2.4 +/- 2.3 vs 5.2 +/- 5.8 days, P < .01), lower rates of in-hospital death (0.8% vs 3.3%, P < .01), 30-day mortality (1.2% vs 4.7%, P < .01), and 30-day readmission (10% vs 23.1%, P < .05). Reintervention was required in 28.1% of readmitted patients with claudication, but none underwent amputation </=30 days.


CONCLUSIONS
The use of PTA for claudication dramatically increased during the 8-year study period. Claudication was more often the diagnosis for PTA in patients who were younger, healthier, and privately insured. PTA for claudication had a higher-than-expected morbidity, 30-day readmission, and rate of reintervention. Future studies should focus on the factors motivating the use of PTA, its associated outcomes, and global impact on patients and the health care system.
Vogel
Todd R
TR
Department of Surgery, Surgical Outcomes Research Center, Division of Vascular Surgery, Harborview Medical Center, Seattle, WA 98104, USA. trvogel@u.washington.edu <trvogel@u.washington.edu>
Su
Leonard T
LT
Symons
Rebecca G
RG
Flum
David R
DR
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D007871:Leg Ulcer / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000401:mortality / Q000628:therapy; D011159:Population Surveillance; D012086:Reoperation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology