Trends, complications, and mortality in peripheral vascular surgery

Area of Science:

• Vascular Surgery
• Health Services Research
• Public Health

Background:

• Outdated mortality statistics for vascular interventions necessitate current, generalizable data.
• Single-institution studies often lack representativeness for general practice outcomes.
• Analysis of national and state datasets (1979-2003) provides updated insights into peripheral vascular disease intervention trends.

Purpose of the Study:

• To analyze current mortality statistics and trends for peripheral vascular interventions.
• To compare outcomes of different intervention types, including open versus endovascular approaches.
• To assess shifts in the management of peripheral vascular disease.

Main Methods:

• Utilized Nationwide Inpatient Sample (1998-2003) and National Hospital Discharge Survey (1979-2003) data.
• Included four key procedures: abdominal aortic aneurysm repair, lower extremity revascularization, amputation, and carotid revascularization.
• Employed t-tests and chi2 tests for statistical analysis of continuous, dichotomous variables, and mortality trends.

Main Results:

• Amputation rates decreased significantly (13.2% overall, 21.2% major) from 1998-2003.
• Endovascular interventions increased by 40% since 1996, while open lower extremity revascularization declined.
• Endovascular abdominal aortic aneurysm repair usage rose to nearly 50%, with lower mortality than open repair; carotid endarterectomy showed higher mortality and stroke rates for endovascular procedures.

Conclusions:

• Peripheral vascular disease management has shifted dramatically, with an overall mortality decline.
• Endovascular interventions generally demonstrate a mortality advantage over open surgery, with notable exceptions.
• While vascular interventions are becoming safer, the choice between endovascular and open repair requires careful patient-specific consideration.