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Trends & Outcomes in the Treatment of Peripheral Arterial Disease among the elderly population in the State of Florida from 2000 to 2014
Poster Title: Trends & Outcomes in the Treatment of Peripheral Arterial Disease among the elderly population in the State of Florida from 2000 to 2014
Submitted on 08 Feb 2018
Author(s): Adarsh Bellur MS; Eduardo Rodriguez MD; Nirmani.Karunathilake; Brian Graves PhD & Peter Nelson MS, MD
Affiliations: University of South Florida
This poster was presented at USF Health Research Day 2018
Poster Views: 366
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Poster Information
Abstract: Objective: In this study, we aim to compare the recent trends in the use of endovascular therapy in elderly patients (defined as > 80yrs of age) with peripheral arterial disease (PAD) in the State of Florida.

Methods: The Florida Agency for Health Care Administration provides a database of admissions at all non-federally run hospitals in the State of Florida. We queried this database from 2000-2014 and identified endovascular, bypass and amputation procedures for PAD by CPT and ICD-9 codes. In order to isolate patients undergoing revascularizations or amputations for only PAD (excluding other indications such as trauma, malignancy, etc.), we selected a population with the diagnosis “atherosclerosis of the extremities.” We further divided the patient data by age into those under 80 years old and those 80 years and above in order to investigate differences in trends among the elderly in Florida. Within these two age groups, we also obtained presenting symptoms which included claudication vs critical limb ischemia (rest pain, ulcerations, and/or gangrene).

Results: The query resulted in a total of 350,734 cases of PAD in the State of Florida from 2000 – 2014. Of this total number, 260,226 were under the age of 80yrs and 90,508 were 80yrs or older. Overall use of only endovascular therapy for PAD increased by 79% (4,355 to 7,777) while use of only bypass therapy decreased by 35% (5,499 to 3,575) from 2000 to 2014. In patients under the age of 80yrs, the use of only endovascular therapy increased by 77% (3,362 to 5,939) compared to 85% (993 to 1,838) in patients 80yrs or older during the same period of time. The use of only bypass therapy decreased by 32% (4425 to 2998) compared to 46% (1074 to 577).

Conclusion: The preliminary findings appear to suggest a greater adoption of endovascular management with a concurrent larger reduction in the use of bypass therapy in the elderly population compared to control (under 80yrs) in the State of Florida from 2000 to 2014. Additional analysis using presenting symptoms and outcomes should be performed to help correlate these findings.
Summary: Endovascular therapy has provided an alternative and less invasive approach in the management of peripheral arterial disease (PAD). In contrast, bypass procedures are more aggressive and not traditionally performed in the outpatient setting. Patients undergoing endovascular procedures have shown fewer wound complications and improved recovery [1, 2].

Our goal is to observe differences in trends in the management of patients with critical limb ischemia and claudication in the context o
References: 1. Bradbury, A.W., et al., Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg, 2010. 51(5 Suppl): p. 5s-17s.

2. Hong, M.S., A.W. Beck, and P.R. Nelson, Emerging national trends in the management and outcomes of lower extremity peripheral arterial disease. Ann Vasc Surg, 2011. 25(1): p. 44-54.

3. Park, Y.Y., et al., National trends for the treatment of peripheral arterial disease in Korea between 2004 and 2013. Ann Surg Treat Res, 2015. 89(6): p. 319-24.
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