Brothers T E, Rios G A, Robison J G, Elliot B M
Department of Surgery, Medical University of South Carolina and Ralph Henry Johnson Department of Veterans Affairs Medical Center, Charleston 29425, USA.
Cardiovasc Surg. 1999 Jan;7(1):62-9. doi: 10.1016/s0967-2109(98)00037-4.
Intervention for vascular occlusive disease of the distal lower extremity in elderly patients will inevitably be scrutinized as medical resources decline. The authors applied surgical decision analysis to three treatment options: revascularization, amputation and expectant management. The appropriate outcome probabilities were derived from our experience with revascularization to the tibial and pedal vessels, and utility scores were obtained by formalized patient assessment. Revascularization was predicted to improve patient outcome by 1.10 quality-adjusted life-years compared with primary amputation and by 1.16 quality-adjusted life-years compared with expectant management. To gain one additional quality-adjusted life-years, revascularization would cost $5280 more than expectant management, but $33,900 less than primary amputation. Sensitivity analysis predicted revascularization to be the least costly treatment per quality-adjusted life-years as long as 1-month patency exceeds 11%. Revascularization for limb-threatening ischemia of the distal lower extremity is justified and can be performed at a reasonable cost.
随着医疗资源的减少，老年患者下肢远端血管闭塞性疾病的干预措施必然会受到严格审查。作者对三种治疗方案进行了手术决策分析：血管重建、截肢和保守治疗。合适的结果概率来自我们对胫动脉和足背动脉血管重建的经验，效用评分通过正式的患者评估获得。与一期截肢相比，血管重建预计可使患者的预后改善1.10个质量调整生命年；与保守治疗相比，可改善1.16个质量调整生命年。为了多获得一个质量调整生命年，血管重建比保守治疗的成本高出5280美元，但比一期截肢少33900美元。敏感性分析预测，只要1个月通畅率超过11%，血管重建就是每质量调整生命年成本最低的治疗方法。对下肢远端威胁肢体的缺血进行血管重建是合理的，并且可以以合理的成本进行。
