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Peripheral Vascular Disease and Intervention
Endovascular Intervention vs. Open Surgery for Lower Limb Ischemia - Resources Optimization
Yew Toh Wong1
Vascular & Endovascular Surgery Unit, Australia1
Surgical bypass was considered gold standard treatment for lower limb ischaemia with low rate of re-intervention, however endovascular intervention is increasingly used as first line treatment option. Endovascular treatment require the use of expensive equipment. This retrospective study analyse the cost and re-intervention rate in a 2 years period for both surgical bypass and endovascular procedures performed at Flinders Medical Centre, Australia.
ICD codes were used to retrieve all lower limb bypasses and endovascular interventions performed at Flinders Medical Centre in financial year 2015/2016 and 2016/2017. Cost data were provided by the Finance Department. Each episode is then matched with electronic medical record to record the type of intervention performed (aorto-iliac, femoral popliteal, tibial pedal). Intervention was analysed according to the most distal level treated. Cost, length of stay, re-intervention rate was compared between endovascular and surgical treatment. Statistical analysis was performed with student t test.
971 episodes were identified using ICD codes. 734 episodes related to lower limb revascularization. 151 episodes were excluded from analysis due to having multiple endovascular and bypass operations on the same limb. 583 episodes on 434 limbs are available for analysis. 384 limbs were treated by endovascular intervention and 50 limbs treated by surgical bypass. The mean age of patients was (endovascular 74.1 SD11.0 years vs bypass 72.7 SD10.6 years). Mean cost of femoral popliteal segment intervention was(endovascular $ 18933 SD16565 vs bypass $47793 SD44875; P 0.01). Mean cost of femoral tibial intervention was (endovascular $25825 SD20648 vs bypass $45026 SD35035; P 0.05). Re-intervention rate was endovascular 21%vs bypass 24%. Mean length of stay of femoral popliteal segment intervention was (endovascular 3.65 SD7.42 days vs bypass 15.98 SD21.34 days; P 0.01). Mean length of stay of femoral tibial intervention was (endovascular 9.06 SD10.22 days vs bypass 17.55 SD15.21 days; P 0.05).
Endovascular intervention is cheaper than surgical bypass with similar rate of re-intervention. Surgical bypass is associated with significantly longer hospital stay. The role of surgical bypass as gold standard treatment for lower limb ischaemia needs revaluation in modern endovascular era to best allocate limited resources. 
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