Large-Scale Analysis Supports Endovascular Treatment for Lower Extremity Peripheral Artery Disease

May 5, 2015—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that a study of approximately 90,000 procedures performed over a 6-year period showed that vascular stenting is associated with a significantly lower rate of postprocedural complications and amputations versus angioplasty alone in patients undergoing lower extremity peripheral vascular interventions. 

Shilpkumar Arora, MD, will present the study, “Impact of Infrainguinal Percutaneous Vascular Stenting on In-Hospital Mortality and Complications: 6 Years US Perspective," as a Best-of-the-Best abstract at the SCAI 2015 Scientific Sessions being held May 6–9 in San Diego, California. 

In the SCAI press release, Dr. Arora commented, “This analysis is important because it provides data regarding the clinical efficacy of vascular stenting in lower extremity vascular interventions from a large, unrestricted, and real-world population sample.” 

According to SCAI, angioplasty without stenting in lower extremity vascular interventions has been associated with high rates of restenosis, especially in patients with long and complex disease. Until now, the literature on comparative outcomes of angioplasty and stenting in peripheral vascular interventions has been primarily limited to smaller studies with few data on clinical outcomes such as amputation rates. 

To determine the efficacy of lower extremity vascular stenting, Dr. Arora et al searched the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample database, which includes data on approximately 7 to 8 million hospital discharges per year and is designed to reflect a 20% sample of community hospitals in the United States.

As summarized by SCAI, the investigators used procedure codes for bare metal (BMSs) and drug-eluting stents (DESs) and angioplasty to analyze angioplasty procedures performed between 2006 and 2011 in patients age 18 years and older. The primary outcome was in-hospital mortality. The secondary outcome was defined as a combination of mortality and postprocedural complications. Amputation was studied as a separate outcome. 

Of the 88,324 lower extremity vascular interventions analyzed by the investigators, BMSs were used in approximately 52% of the patients, and DESs were used in less than 2% of patients. Both types of stents were associated with a significant reduction in amputation (7.3% for BMSs and 8.1% for DESs vs 13.6% for angioplasty alone; P < .001), as well as a reduction in the composite secondary outcome compared with angioplasty alone. The analysis did not show a link between stenting and in-hospital mortality alone, noted SCAI.