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1.
JBR-BTR ; 88(4): 178-83, 2005.
Article in English | MEDLINE | ID: mdl-16176074

ABSTRACT

This multicentre retrospective study describes the variation of therapeutic options, treatment outcomes and costs for treating infrarenal arterial stenoses as observed in daily practice in 1997-99 in seven Belgian hospitals. Data were obtained from clinical record review and from the sickness fund claims database, and included preoperative functional state, presence of acute ischaemia, diabetes and polyvascular disease, state of the lower-leg run-off arteries, anatomical site and type of lesion, type of treatment, result at 30 days and up to 4 years. A total of 442 episodes were studied, but most analyses dealt with a subgroup of 240 lesions in the common iliac up to the superficial femoral artery. The proportion of surgical treatments (as compared to an endovascular or mixed approach) varied from 15% to 81% between the hospitals. In univariate survival analysis, relapse or failure rates at 4 years ranged from 5% for the common iliac artery to 35% for the superficial femoral artery. Polyvascular disease, a poor run-off, multiple stenoses and chronic occlusion were significant risk factors; age and diabetes were not. In the multivariate (stratified Cox regression) analysis, only a location in the superficial femoral artery and a poor preoperative clinical stage were significant risk factors, but type of therapeutic approach was not. The total average cost of treatment was 5300 Euro, of which 15% was contributed by the patient. Surgery was associated with longer stays (median at 12 days) than endovascular treatments (median 2 d), and was 1.9 times more expensive. In conclusion, the results of the present study suggest that a multidisciplinary approach, orienting the patient to the most appropriate therapeutic pathway could increase both the quality and the cost-effectiveness of the care. In many clinical situations, the endovascular approach appears to offer similar long-term results as surgery, but at a substantially lower cost, both for the patient and for society, especially when performed in a (semi-)ambulatory radiology setting.


Subject(s)
Arterial Occlusive Diseases/therapy , Lower Extremity/blood supply , Peripheral Vascular Diseases/therapy , Practice Patterns, Physicians'/statistics & numerical data , Aged , Aged, 80 and over , Arterial Occlusive Diseases/surgery , Belgium , Constriction, Pathologic/surgery , Constriction, Pathologic/therapy , Diabetes Complications , Femoral Artery/pathology , Follow-Up Studies , Health Care Costs , Humans , Iliac Artery/pathology , Ischemia/complications , Length of Stay , Middle Aged , Peripheral Vascular Diseases/surgery , Recurrence , Regional Blood Flow/physiology , Retrospective Studies , Risk Factors , Treatment Outcome
2.
Acta Chir Belg ; 105(2): 148-55, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15906905

ABSTRACT

This multicentre retrospective study describes the variation of therapeutic options, treatment outcomes and costs for treating subrenal arterial stenoses as observed in daily practice in 1997-99 in seven Belgian hospitals. Data were obtained from clinical record review and from the sickness fund claims database, and included preoperative functional state, presence of acute ischaemia, diabetes and polyvascular disease, state of the lower-leg run-off arteries, anatomical site and type of lesion, type of treatment, result at 30 days and up to 4 years. A total of 442 episodes were studied, but most analyses dealt with a subgroup of 240 lesions in the common iliac up to the superficial femoral artery. The proportion of surgical treatments (as compared to an endovascular or mixed approach) varied from 15% to 81% between the hospitals. In univariate patency analysis, relapse or failure rates at 4 years ranged from 5% for the common iliac artery to 35% for the superficial femoral artery. Polyvascular disease, a poor run-off, multiple stenoses and chronic occlusion were significant risk factors; age and diabetes were not. In the multivariate (stratified Cox regression) analysis, only a location in the superficial femoral artery and a poor preoperative clinical stage were significant risk factors, but type of therapeutic approach was not. The total average cost of treatment was 5,300 Euros, of which 15% was contributed by the patient. Surgery was associated with longer stays (median at 12 days) than endovascular treatments (median 2 days), and was 1.9 times more expensive. In conclusion, the results of the present study suggest that a multidisciplinary approach, orienting the patient to the most appropriate therapeutic pathway, could increase both the quality and the cost-effectiveness of the care.


Subject(s)
Angioplasty/statistics & numerical data , Arterial Occlusive Diseases/surgery , Hospital Costs/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Vascular Surgical Procedures/statistics & numerical data , Adult , Aged , Aged, 80 and over , Angiography/statistics & numerical data , Angioplasty/economics , Angioplasty/standards , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/economics , Belgium , Cost-Benefit Analysis , Female , Hospitals, General/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Male , Middle Aged , Peripheral Vascular Diseases/diagnostic imaging , Peripheral Vascular Diseases/economics , Peripheral Vascular Diseases/surgery , Retrospective Studies , Risk Assessment , Severity of Illness Index , Treatment Outcome , Vascular Surgical Procedures/economics , Vascular Surgical Procedures/standards
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