Failure of surgical and endovascular infrainguinal and iliac procedures in the management of peripheral arterial disease using data from electronic medical records.
OBJECTIVE
To understand rates of procedure failure among patients undergoing revascularization for peripheral arterial disease (PAD) in clinical practice.


METHODS
This retrospective analysis of patients with PAD who underwent a PAD-related procedure used claims and electronic medical record data from 2005 to 2009. Procedures were grouped by type (endovascular [ie, angioplasty with/without stent, atherectomy] or surgical [ie, bypass surgery, endarterectomy, thrombectomy]) and site (ie, iliac, infrainguinal). The study assessed antiplatelet and anticoagulant agent use; procedure failure, defined as a subsequent procedure or amputation; and predictors of time to procedure failure.


RESULTS
A sample of 248 patients with PAD who underwent a PAD-related procedure was identified. The population was 59% male, had a mean age of 73 years, and had a mean follow-up of 23 months. Endovascular procedures alone were performed in 37% of patients, with the remainder receiving surgery only or surgery with an endovascular procedure, and 79% of patients had an infrainguinal intervention. Antiplatelet and anticoagulant use rates after the procedure were 90% and 25%, respectively. After their initial procedure, 20% of patients required a second procedure or amputation, with an average failure time of 228 days. Patients treated with infrainguinal procedures had a significantly higher failure rate versus those treated with iliac procedures (23% vs 8%; P = .011). In multivariate analysis, patients without anticoagulant use before the procedure were at significantly lower failure risk (P = .022).


CONCLUSIONS
Repeated intervention and/or major amputation after revascularization of PAD was common. Further investigation of the factors associated with procedure failure is warranted.
Boston Health Economics, Waltham, MA 02451, USA.
Matthew
M
Sussman
Rajiv
R
Mallick
Mark
M
Friedman
Victoria
V
Federico
Leon
L
Josephs
Paul
P
Vaitkus
Joseph
J
Menzin
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000925:Anticoagulants / Q000627:therapeutic use; D057286:Electronic Health Records; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000601:surgery / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors