The treatment of disabling intermittent claudication in patients with superficial femoral artery occlusive disease--decision analysis.

Full Abstract

OBJECTIVE: To determine the preferred approach to superficial femoral artery (SFA) revascularization of Trans-Atlantic Inter-Societal Consensus (TASC) B and C lesions in claudicants requiring intervention based on a review of published data. DESIGN: Decision analysis, Markov state transition model. SUBJECTS: Hypothetical cohorts of claudicants with TASC B or TASC C superficial femoral artery lesions considered candidates for either angioplasty with selective stenting (PTA/S) or greater saphenous vein bypass (GSVB). MAIN OUTCOME MEASURE: Quality adjusted life years (QALYs). RESULTS: For a 65-year-old man with disabling claudication, percutaneous transluminal angioplasty and selective stenting (PTA/S) was preferred over GSVB for a TASC B SFA lesion. In an otherwise identical patient with a TASC C lesion, bypass was the preferred therapy. Treating PTA/S failures with subsequent bypass increased the utility of PTA/S but bypass remained the preferred initial therapy for TASC C lesions. Sensitivity analysis showed that PTA/S surpasses bypass efficacy for TASC C lesions if PTA/S primary patency is >32% at 5 years, patient age is >80 years, or GSVB operative mortality is >6%. CONCLUSION: PTA/S is the preferred initial therapy over GSVB for TASC B SFA lesions in patients with disabling intermittent claudication who require intervention. Given contemporary published outcomes for TASC C lesions, GSVB is the preferred therapy in operative candidates. In elderly patients or patients at high risk for bypass, PTA/S should be considered over GSVB. Improved technology that results in a 5-year primary patency of 32% would also justify PTA/S for TASC C SFA lesions.

Author information

Author/s: Nolan, Brian (B); Finlayson, Samuel (S); Tosteson, Anna (A); Powell, Richard (R); Cronenwett, Jack (J);

Affiliation: Center for Evaluative Clinical Sciences, Dartmouth Medical School, Division of Vascular Surgery Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. Brian.Nolan(-atsign-)Hitchcock.org

Journal and publication information

Publication Type: Journal Article

Journal: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter (J Vasc Surg), published in United States. (Language: eng)

Reference: 2007-Jun; vol 45 (issue 6) : pp 1179-84

Dates: Created 2007/06/04; Completed 2007/07/13;

PMID: 17543682, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

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