A Shift In the Management Of Intermittent Claudication?

Introduction and Objectives:
Traditionally, revascularization for intermittent claudication (IC) is reserved for those with severe IC or those who fail medical therapy. The purpose of this study was to examine treatment patterns of IC at the national level to determine if a greater percentage of patients are being treated surgically and by what modality.
Methods:
Nationwide Inpatient Sample (1998-2003) was retrospectively analyzed. All patient-discharges with the diagnosis of IC (International Classification of Diseases diagnostic code ‘440.21’) were identified. In this group, patients who underwent procedures were categorized by either open revascularization (OR) or percutaneous angioplasty ± stenting (PA/S). Percentages were determined by Chi Square analysis. A multivariate logistic regression was performed to determine which factors were independently predictive of undergoing OR versus PA/S.
Results:
162,062 (weighted nationally) patients were identified who were treated for IC from 1998-2003. An annual increase in the total number of procedures was observed from 23,800 in 1998 to 27,900 in 2003 (p<.05). Although the majority of these patients were treated by open techniques (68.8% OR vs.32.3% PA/S) a trend towards PA/S was identified; year 1998 (77% OR vs. 23% PA/S) vs. year 2003 (61% OR vs. 39% PA/S), p<.05. Factors independently predictive of undergoing endovascular revascularization included older patient age (OR 1.40, 95% CI 1.23-1.61), treatment in 2003 vs. 1998 (OR 2.23, 95% CI 1.69-2.94), and treatment at a teaching hospital vs. non-teaching hospital (OR 1.28, 95% CI 1.03-1.58).
Conclusions:
In the United States a dramatic shift is occurring in the treatment of IC whereby an increasing number of patients are being surgically treated. A growing percentage of these patients are being treated by endovascular approach. The increasing utilization of endoluminal therapy may lead to a change in the therapeutic tendencies and recommendations for treatment of IC regardless of its severity.