title: Longitudinal outcomes after tibioperoneal angioplasty alone compared to tibial stenting and atherectomy for critical limb ischemia.
abstract: OBJECTIVE
  There are limited data available evaluating longitudinal outcomes after tibioperoneal angioplasty (TA) alone compared to adjunctive tibial procedures including stenting and atherectomy.
  
  
  METHODS
  Using the Centers for Medicare & Medicaid Services inpatient claims (2005-2007), patients evaluated TA only, TA plus stent placement (TA + S), and TA plus atherectomy (TA + A).
  
  
  RESULTS
  A total of 2080 patients with critical limb ischemia underwent percutaneous tibioperoneal intervention for the indication of ulceration. Procedures included TA (56.3%), TA + S (16.2%), and TA + A (27.5%). Rates of amputation were not statistically different between the groups at 30, 90, and 365 days after the intervention. Mean total hospital charges were TA ($35,867), TA + A ($41,698; P = .0004), and TA + S ($51,040; P < .0001).
  
  
  CONCLUSIONS
  Patients undergoing TA alone compared to concomitant stenting or atherectomy for ulceration demonstrated no improvement in limb salvage. Future analysis of adjunctive tibioperoneal interventions is essential to temper cost, as they fail to improve long-term limb salvage.
authors.affiliation: 1Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, MO, USA.
authors.forename: Shaun
authors.initials: S
authors.lastname: Reynolds
authors.forename: Edgar Luis
authors.initials: EL
authors.lastname: Galiñanes
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D017073:Atherectomy; D014487:Centers for Medicare and Medicaid Services, U.S.; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000628:therapy*; D007871:Leg Ulcer / Q000175:diagnosis / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: PAD; interventions; lower extremity; outcomes