Long-term Survival in Medicare Patients Undergoing Interventions for Peripheral Arterial Disease Is Poor
Scott R. Levin, MD, MSc1, Alik Farber, MD, MBA1, Philip P. Goodney, MD, MS2, Elizabeth G. King, MD1, Mohammad H. Eslami, MD, MPH3, Mahmoud B. Malas, MD, MHS4, Virendra I. Patel, MD, MPH5, Sharon C. Kiang, MD6, Jeffrey J. Siracuse, MD, MBA1
1Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA; 2Division of Vascular and Endovascular Surgery, Dartmouth Medical School, Lebanon, NH; 3Division of Vascular and Endovascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; 4Division of Vascular and Endovascular Surgery, University of California, San Diego, CA; 5Division of Vascular and Endovascular Interventions, Columbia University College of Physicians and Surgeons, New York, NY; 6Division of Vascular and Endovascular Surgery, Loma Linda University, School of Medicine, VA Loma Linda Medical Center, Loma Linda, CA
Background: Interventions for peripheral arterial disease (PAD) balance invasiveness with durability and clinical benefit. This balance is particularly important for determining whether and how to intervene for intermittent claudication (IC) and can help guide chronic limb-threatening ischemia (CLTI) treatment. Our goal was to assess survival after interventions for IC and CLTI.
Methods: Vascular Quality Initiative Medicare-linked data (2010-2021) were queried for long-term survival after peripheral vascular interventions (PVI), infrainguinal bypasses (IIB), and suprainguinal bypasses (SIB) for IC and CLTI. Multivariable analysis identified factors associated with long-term mortality.
Results: There were 31,457 PVI (44.7% IC, 55.3% CLTI), 7,978 IIB (26.9% IC, 73.1% CLTI), and 2,149 SIB (50.1% IC, 49.9% CLTI). Among PVI, IIB, and SIB cohorts, mean ages were 75, 73, and 72 years, respectively. Respective 5-year mortality after PVI for IC and CLTI was 37.2% and 71.1%; after IIB for IC and CLTI was 37.8% and 60%; and after SIB for IC and CLTI was 33.8% and 53.8%. Across all procedures, ESRD, CLTI, CHF, anemia, COPD, and prior amputation were independently associated with increased mortality. Pre-admission home-living and pre-operative statin and aspirin use were associated with decreased mortality.
Conclusion: Long-term survival in patients undergoing interventions for PAD is poor, particularly among patients with CLTI of whom two-thirds were not alive at 5 years. Survival among patients with IC undergoing elective, lifestyle-benefitting intervention is also poor. These data can help guide discussions and expectations with patients about the benefits of any intervention for IC and the appropriate intervention type for CLTI.
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