Rowe Vincent L, Lee William, Weaver Fred A, Etzioni David
CardioVascular Thoracic Institute, Division of Vascular and Endovascular Surgery, Los Angeles, Calif, USA.
J Vasc Surg. 2009 Apr;49(4):910-7. doi: 10.1016/j.jvs.2008.11.054.
Endovascular procedures are increasingly used in the treatment of peripheral arterial disease (PAD). Whether this new procedural approach translates to clinical outcomes equivalent or superior to open surgical revascularization is a subject of debate. We sought to analyze population-based rates of major amputations for PAD during a time period in which the use of endovascular surgical procedures increased dramatically.
We used the 1996-2005 Nationwide Inpatient Sample (NIS) to analyze rates of amputations and vascular interventions, and also to characterize the treatment of patients admitted acutely for PAD. Vascular interventions were designated based on International Classification of Diseases (ICD) procedure codes as open bypass, endovascular intervention, or major amputation (disarticulation at ankle or higher amputation). Population-based age-adjusted incidence rates of treatment were calculated by combining procedure rates with census data.
Our analysis included 97,000 acute admissions for PAD, 83,000 major amputations, 77,500 endovascular procedures, and 171,000 open vascular bypass operations. Between 1996 and 2005, population-based rates of acute admissions for PAD decreased by 4.3% per year, open procedures by 6.6% per year, and major amputations by 6.4% per year, whereas endovascular procedures increased by 4.8% per year. Of patients acutely admitted for PAD, the likelihood of undergoing an amputation decreased (30.2% to 21.8%), the likelihood of undergoing an open vascular procedure decreased (34.5% to 26.3%), and the likelihood of undergoing an endovascular operation increased (12.7% to 28.3%). All of these changes were statistically significant at P < .05.
The last decade has seen a significant increase in the use of endovascular procedures and a decrease in rates of major amputation. These trends are seen both for patients admitted with acute PAD, as well as in the population in general. While our study was not designed to demonstrate a causal relationship, our findings suggest an association between increased application of endovascular technology and reduced rates of amputation in patients with PAD.
血管内介入手术在周围动脉疾病（PAD）治疗中的应用日益增多。这种新的手术方法是否能带来等同于或优于开放性血管重建手术的临床效果，仍是一个有争议的话题。我们试图分析在血管内手术使用急剧增加的时期内，基于人群的PAD大截肢率。
我们使用1996 - 2005年全国住院患者样本（NIS）来分析截肢率和血管介入率，并对急性PAD入院患者的治疗情况进行描述。血管介入手术根据国际疾病分类（ICD）手术编码分为开放性旁路手术、血管内介入手术或大截肢手术（踝关节离断或更高位截肢）。通过将手术率与人口普查数据相结合，计算基于人群的年龄调整治疗发病率。
我们的分析包括97,000例急性PAD入院患者、83,000例大截肢手术、77,500例血管内手术和171,000例开放性血管旁路手术。在1996年至2005年期间，基于人群的急性PAD入院率每年下降4.3%，开放性手术每年下降6.6%，大截肢手术每年下降6.4%，而血管内手术每年增加4.8%。急性PAD入院患者中，接受截肢手术的可能性降低（从30.2%降至21.8%），接受开放性血管手术的可能性降低（从34.5%降至26.3%），而接受血管内手术的可能性增加（从12.7%增至28.3%）。所有这些变化在P < 0.05时具有统计学意义。
在过去十年中，血管内手术的使用显著增加，大截肢率下降。急性PAD入院患者以及总体人群中均出现了这些趋势。虽然我们的研究并非旨在证明因果关系，但我们的发现表明血管内技术应用增加与PAD患者截肢率降低之间存在关联。
