https://www.jvascsurg.org/article/S0741-5214(98)70157-0/pdf

Lower extremity arterial reconstruction in the very elderly: Successful outcome preserves not only the limb but also residential status and ambulatory function ☆ ☆☆ ★

https://www.jvascsurg.org/article/S0741-5214(95)70055-2/pdf

Impact of clinical pathways on hospital costs and early outcome after major vascular surgery.

Hospital costs of revascularization procedures for femoropopliteal arterial disease

https://www.jvascsurg.org/article/S0741-5214(97)70177-0/pdf

Do clinical pathways for major vascular surgery improve outcomes and reduce cost

background : The crisis in health care brings a new focus to defining successful outcomes of medical treatments. The surgical literature has been criticized for not assessing functional outcomes in addition to technical success. methods : We evaluated the functional outcomes of limb salvage surgery over 3 years in 38 patients 65 years of age and older with limb-threatening ischemia. The RAND-36-Item Health Survey 1.0 was used as a health assessment tool. results : In spite of an 80% limb salvage rate, only 58% of patients survived 3 years and only 25% survived with the index limb and were able to walk. The RAND scores of patients whose limbs were amputated did not significantly differ from those of patients whose surgery was successful. conclusion : Functional outcome goals need to be better defined for patients who need limb salvage vascular operations to enhance the quality of care given these patients and to be in concert with emerging health policy.

Functional outcomes in limb salvage vascular surgery

Inadequacy of diagnosis related group (DRG) reimbursements for limb salvage lower extremity arterial reconstructions

Purpose: The efficacy of autogenous infrainguinal reconstruction for patients with varying degrees of chronic renal insufficiency was reviewed because it has not been well defined. Methods: Pertinent data were retrieved from hospital records and the vascular registry for all patients with chronic renal insufficiency (serum creatine > 2 mg/dl) who required surgical intervention for ischemic lower limbs during the past 15 years at Brigham and Women's Hospital. Results: During the past 15 years, 56 patients underwent 70 autogenous vein bypass procedures, and 31 underwent 42 primary major amputations. All patients had serum creatinine levels greater than 2 mg/dl. Limb salvage was the indication for intervention in 84% of reconstructed limbs, and 48% required infrapopliteal bypass. No significant difference was found in the operative mortality rate associated with primary amputation (17%) and reconstruction (11%), but overall 5-year survival for the group undergoing reconstruction (40%) was significantly superior to that observed in the group undergoing amputation (9%). The 5-year cumulative limb salvage rate for the group having reconstruction was 80%, with a primary graft patency of 74% and a secondary patency of 77%. Patients with diabetes had lower rates of both limb salvage (63%) and survival (21%). No patient on dialysis survived beyond the third-year interval, but the limb salvage rate after 2 years was 76%. Conclusion: Patients with chronic renal insufficiency achieved graft patency and limb salvage results comparable to those obtained in patients with normal lrddney function, but they sustained higher perioperative morbidity and reduced survival. (J VAsc SURG 1993;17:32-41.)

https://www.jvascsurg.org/article/0741-5214(93)90007-9/pdf

Infrainguinal chronic renal reconstruction for insufficiency patients

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Inadequacy of diagnosis related group (DRG) reimbursements for limb salvage lower extremity arterial reconstructions

Infrainguinal chronic renal reconstruction for insufficiency patients