Department of Cardiovascular Surgery, Faculty of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey.
Vascular. 2024 Jun;32(3):653-660. doi: 10.1177/17085381231156216. Epub 2023 Feb 7.
With the initial utilization of endovascular treatment options in 1970s, the number of procedures performed for lower extremity artery disease (LEAD) both with open surgical (OS) and endovascular (EV) treatment increased, but this did not result in a decrease in the number of amputations. The burden of LEAD still constitutes a huge proportion among the health care costs over the world.
The patients who admitted to our clinic between October 2014 and December 2019 with LEAD and required revascularization were enrolled. The total hospitalization costs related to LEAD were registered and divided into two groups as care costs and medical supplies costs.
181 procedures were performed to 133 patients. Mean age was 63.98 ± 11.65 and 115 (86.5%) patients were male. Mean follow-up period was 31.19 ± 17.99 months (95% CI). The most frequent comorbidities were diabetes mellitus (DM) ( = 86, 66.2%) and active smoking ( = 59, 44.4%). Total costs and medical supplies costs were increased in EV group when compared with OS group ($4347.26 ± 3352.96, $3339.28 ± 3459.53 = .005 v.s. $3318.67 ± 2874.55,$904.42 ± 1209.97 < .001, respectively). Care costs were increased in OS group when compared with EV group ($2434.85 ± 2641.89 v.s. $1028.56 ± 1397.77 < .001). The highest total, medical supplies, and care costs were determined in EV + OS group ($13071.32 ± 13717; $6784.91 ± 8332.04; $6286.41 ± 7652.12, respectively).Graft/wound infection related and amputation related costs were 21% of all costs. Amputation-free survival was 71.42% (95% CI) with 21 total amputations. There were linear correlations between mortality and amputation ( = .002); also between mortality and cost ( = .001).
In mid-long-term period, the care costs are increased with OS; however, EV treatment significantly increases the medical supplies and total costs. The increase in cost is correlated with poor outcome. Although the comorbidities and risk factors of these patients lead the clinicians to perform more challenging endovascular approaches, in mid-long-term period, particularly failed endovascular procedures are not promising in terms of outcomes and costs. We consider that the best-fit therapy on time is cost-effective, life and extremity-saving either, by avoiding deleterious effects of severe ischemia, such as severe pain, tissue loss, and related major adverse cardiaovascular events.
随着 20 世纪 70 年代血管内治疗选择的首次应用，下肢动脉疾病（LEAD）的手术数量（包括开放手术[OS]和血管内治疗[EV]）均有所增加，但这并未导致截肢数量减少。LEAD 的负担仍然构成了全球医疗保健费用的很大一部分。
纳入 2014 年 10 月至 2019 年 12 月在我院就诊且需要血运重建的 LEAD 患者。登记与 LEAD 相关的总住院费用，并分为护理费用和医疗用品费用两组。
133 例患者共行 181 例手术。平均年龄为 63.98 ± 11.65 岁，115 例（86.5%）为男性。平均随访时间为 31.19 ± 17.99 个月（95%CI）。最常见的合并症是糖尿病（DM）（n=86，66.2%）和主动吸烟（n=59，44.4%）。与 OS 组相比，EV 组的总费用和医疗用品费用增加（$4347.26 ± 3352.96，$3339.28 ± 3459.53，p=0.005 与$3318.67 ± 2874.55，$904.42 ± 1209.97，p<.001）。与 EV 组相比，OS 组的护理费用增加（$2434.85 ± 2641.89，p<.001）。EV+OS 组的总费用、医疗用品费用和护理费用最高（$13071.32 ± 13717，$6784.91 ± 8332.04，$6286.41 ± 7652.12）。与感染和截肢相关的费用占总费用的 21%。无截肢生存率为 71.42%（95%CI），共发生 21 例截肢。死亡率与截肢率呈线性相关（p=0.002）；死亡率与费用呈线性相关（p=0.001）。
在中-长期内，OS 治疗会增加护理费用；然而，EV 治疗会显著增加医疗用品和总费用。费用的增加与不良结局相关。尽管这些患者的合并症和危险因素导致临床医生进行更具挑战性的血管内治疗，但在中-长期内，特别是失败的血管内治疗在结局和费用方面都没有前景。我们认为，在避免严重缺血的有害影响（如严重疼痛、组织损失和相关的重大心血管不良事件）方面，及时采用合适的治疗方法可以节省成本、挽救生命和肢体，是有效的。
