title: The Contemporary Safety and Effectiveness of Lower Extremity Bypass Surgery and Peripheral Endovascular Interventions in the Treatment of Symptomatic Peripheral Arterial Disease.
abstract: BACKGROUND
  Treatment for symptomatic peripheral artery disease includes lower extremity bypass surgery (LEB) and peripheral endovascular interventions (PVIs); however, limited comparative effectiveness data exist between the 2 therapies. We assessed the safety and effectiveness of LEB and PVI in patients with symptomatic claudication and critical limb ischemia.
  
  
  RESULTS
  In a community-based clinical registry at 2 large integrated healthcare delivery systems, we compared 883 patients undergoing PVI and 975 patients undergoing LEB between January 1, 2005 and December 31, 2011. Rates of target lesion revascularization were greater for PVI than for LEB in patients presenting with claudication (12.3±2.7% and 19.0±3.5% at 1 and 3 years versus 5.2±2.4% and 8.3±3.1%, log-rank P<0.001) and critical limb ischemia (19.1±4.8% and 31.6±6.3% at 1 and 3 years versus 10.8±2.5% and 16.0±3.2%, log-rank P<0.001). However, in comparison with PVI, LEB was associated with increased rates of complications up to 30 days following the procedure (37.1% versus 11.9%, P<0.001). There were no differences in amputation rates between the 2 groups. Findings remained consistent in sensitivity analyses by using propensity methods to account for treatment selection.
  
  
  CONCLUSIONS
  In patients with symptomatic peripheral artery disease, in comparison with LEB, PVI was associated with fewer 30-day procedural complications, higher revascularization rates at 1 and 3 years, and no difference in subsequent amputations.
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.). thomas.tsai@coloradooutcomes.org.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Rehring
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: R Kevin
authors.initials: RK
authors.lastname: Rogers
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shetterly
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Wagner
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: Rajan
authors.initials: R
authors.lastname: Gupta
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: Omid
authors.initials: O
authors.lastname: Jazaeri
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: Nasim
authors.initials: N
authors.lastname: Hedayati
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: W Schuyler
authors.initials: WS
authors.lastname: Jones
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: From Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T., T.F.R., S.M.S., N.M.W., P.M.H., D.J.M.); University of Colorado, Denver (T.T.T., T.F.R., R.K.R., R.G., O.J., P.M.H., D.J.M.); UC Davis Health System, Davis, CA (N.H.); Duke Clinical Research Institute, Durham, NC (W.S.J., M.R.P.); Denver VA Medical Center, Denver, CO (P.M.H.); and Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D003120:Colorado / Q000453:epidemiology; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007383:Intermittent Claudication / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D007511:Ischemia / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*
keywords: comparative effectiveness research; lower extremity bypass surgery; peripheral arterial disease