Outcomes of Peripheral Interventions on Survival from Vascular Quality Initiative Data: Atherectomy Curtails Longevity

Purpose: To evaluate if there were significant differences in survival after the type of intervention for lower extremity claudication and critical limb ischemia (CLI) from the Vascular Quality Initiative database.

Materials and Methods: We interrogated the regional Society of Vascular Surgery–Patient Safety Organization database for Peripheral arterial interventions during the interval 2011 to 2019. This data set was analyzed in tandem with Centers for Medicare and Medicaid Services data for the same population of patients. Interventions were done for claudication or CLI. Specific procedures were broken down into three groups, balloon angioplasty alone (balloon), stenting with and without balloon (stent), and atherectomy with or without stenting or balloon (atherectomy). Pairwise propensity-score matching was used to construct comparable cohorts. Primary outcome was overall survival. Multivariable Cox regression were used to compare different procedures.

Results: There were 15,281 eligible cases in total, with 9441 undergoing balloon, 3547 stent, and 2293 atherectomy. After pairwise matching, we compared 3541 patients in balloon versus stenting, 2281 balloon versus atherectomy, and 2198 stenting versus atherectomy. These groups were well matched with regards to demographics and comorbidities. Results of multivariable regression models were consistent with Kaplan-Meier estimators using matched cohorts, in which stenting reduced the hazard of mortality by 35% compared with balloon and 31% compared with atherectomy, and there was no significant difference between atherectomy and balloon in terms of overall survival. Advanced age, congestive heart failure, diabetes mellitus, and CLI were significant predictors of poor survival with hazard ratio of greater than 1 in all three pairwise comparisons.

Conclusions: The exact nature of the intervention for peripheral arterial disease has a profound influence on overall patient survival. Stenting appears to be superior to atherectomy or plain balloon angioplasty in patients undergoing intervention for both claudication as well as CLI as far as survival is concerned.