{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:26:12Z","timestamp":1791563172414,"version":"4.3.4"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,8,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The optimal treatment for critical limb ischemia remains controversial owing to conflicting conclusions from previous studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We obtained administrative claims on Medicare beneficiaries with initial critical limb ischemia diagnosis in 2011. Clinical outcomes and healthcare costs over 4\u00a0years were estimated among all patients and by first treatment (endovascular revascularization, surgical revascularization, or major amputation) in unmatched and propensity\u2010score\u2013matched samples. Among 72\u00a0199 patients with initial primary critical limb ischemia diagnosis in 2011, survival was 46% (median survival, 3.5\u00a0years) and freedom from major amputation was 87%. Among 9942 propensity\u2010score\u2013matched patients (8% rest pain, 26% ulcer, and 66% gangrene), survival was 38% with endovascular revascularization (median survival, 2.7\u00a0years), 40% with surgical revascularization (median survival, 2.9\u00a0years), and 23% with major amputation (median survival, 1.3\u00a0years;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001 for each revascularization procedure versus major amputation). Corresponding major amputation rates were 6.5%, 9.6%, and 10.6%, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001 for all pair\u2010wise comparisons). The cost per patient year during follow\u2010up was $49\u00a0700, $49\u00a0200, and $55\u00a0700, respectively (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001 for each revascularization procedure versus major amputation).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Long\u2010term survival and cost in critical limb ischemia management is comparable between revascularization techniques, with lower major amputation rates following endovascular revascularization. Primary major amputation results in shorter survival, higher risk of subsequent major amputation, and higher healthcare costs versus revascularization. Results from this observational research may be susceptible to bias because of the influence of unmeasured confounders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.118.009724","type":"journal-article","created":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T16:16:46Z","timestamp":1536941806000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":178,"title":["Determinants of Long\u2010Term Outcomes and Costs in the Management of Critical Limb Ischemia: A Population\u2010Based Cohort Study"],"prefix":"10.1161","volume":"7","author":[{"given":"Jihad A.","family":"Mustapha","sequence":"first","affiliation":[{"name":"Advanced Cardiac &amp; Vascular Amputation Prevention Centers Grand Rapids MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry T.","family":"Katzen","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology Miami Cardiac and Vascular Institute Miami FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard F.","family":"Neville","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery Department of Surgery Inova Heart and Vascular Institute Inova Fairfax Medical Campus Falls Church VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Lookstein","sequence":"additional","affiliation":[{"name":"Department of Radiology Icahn School of Medicine at Mount Sinai New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Zeller","sequence":"additional","affiliation":[{"name":"Department of Angiology Universit\u00e4ts\u2010Herzzentrum Freiburg\u2010Bad Krozingen Bad Krozingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry E.","family":"Miller","sequence":"additional","affiliation":[{"name":"Miller Scientific Consulting Asheville NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Jaff","sequence":"additional","affiliation":[{"name":"Newton\u2010Wellesley Hospital Newton MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.11.007"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.09.063"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.09.039"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67704-5"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2017.1361961"},{"key":"e_1_3_2_7_2","first-page":"A141","article-title":"The incidence and health economic burden of ischemic amputation in Minnesota, 2005\u20132008","volume":"8","author":"Peacock JM","year":"2011","unstructured":"Peacock JM, Keo HH, Duval S, Baumgartner I, Oldenburg NC, Jaff MR, Henry TD, Yu X, Hirsch AT. 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