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Endovascular therapy has overtaken surgical revascularization for the treatment of critical limb ischemia -- with implications for outcomes, a study found.

While the annual rate of critical limb ischemia admissions remained constant between 2003 and 2011, the proportion getting endovascular treatments during those hospitalizations rose from 5.1% in 2003 to 11.0% in 2011. At the same time, the proportion getting surgical procedures shrank from 13.9% to 8.8%, found , of the Cleveland Clinic, and colleagues.

Their findings were reported online in the along with release of the abstract slated for presentation at the American College of Cardiology meeting in Chicago in April.

Coinciding with the rise of endovascular therapy were reductions of in-hospital mortality (5.4% in 2003 versus 3.4% in 2011, P<0.001) and major amputation (16.7% versus 10.8%, P<0.001).

After multivariable adjustment, endovascular revascularization was associated with:

• Lower in-hospital mortality (2.34% versus 2.73% for surgery, odds ratio 0.69, 99% CI 0.62-0.77)
• Shorter stays (8.7 days versus 10.7 days, OR 0.80, 99% CI 0.79-0.81)
• Decreased costs of hospitalization ($31,679 versus $32,485, OR 0.95, 99% CI 0.94-0.96)

However, major amputation rates were similar between patients receiving endovascular therapy and surgery (6.5% versus 5.7%, OR 0.99, 99% CI 0.91-1.07).

"Although the results are encouraging, there remain significant disparities and gaps that must be addressed," the authors wrote, citing differences in age, sex, geography, hospital type, and hospital size.

For example, urban teaching hospitals were associated with higher risk of in-hospital mortality (OR 1.20, 99% CI 1.1-1.30), and Midwest institutions had the fewest deaths (OR 0.73, 99% CI 0.68-0.79).

The data came from 642,433 U.S. admissions in the Nationwide Inpatient Sample with administrative codes indicating critical limb ischemia, projected to represent nearly 3 million admissions for the condition nationally, from 2003 through 2011.

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