A written statement from the SVS:
The Society for Vascular Surgery, with more than 5,000 vascular surgeon and allied health members, reviewed with interest the study of Thomas T. Tsai, et al entitled “The Contemporary Safety and Effectiveness of Lower Extremity Bypass Surgery and Peripheral Endovascular Interventions in the Treatment of Symptomatic Peripheral Arterial Disease.”
Over the last decade there has been a dramatic evolution in the treatment of peripheral arterial disease with less invasive endovascular therapy far surpassing conventional open surgery as the first line therapy in the majority of cases. According to Dr. Bruce A. Perler, President of the Society for Vascular Surgery, “Vascular surgeons are truly comprehensive vascular specialists who perform both endovascular and open vascular surgical procedures, as well as medical management, and therefore have a unique perspective on the relative risks and benefits of treatment options for peripheral arterial disease.” Utilizing a community-based registry including more than 1,800 patients, Tsai, et al. found that while endovascular therapy was associated with fewer complications in the 30 day peri-procedural period, the rate of target lesion revascularization was significantly higher at one and three years following the procedure.
According to Dr. Perler, “These results are not unexpected, and are certainly consistent with the information we’ve been developing from our Vascular Quality Initiative which now includes more than 300,000 cases. While the less invasive approach to treating arterial occlusive disease would be expected to be associated with a lower rate of complications, and this is obviously appealing to patients and practitioners, the implications of the higher rate of subsequent reinterventions should not be ignored and will become an increasingly important consideration as we enter this era of value- based reimbursement with an emphasis on longitudinal care and bundled payments in the American health care system. In other words, will the lower rate of early complications be more than counterbalanced by a need for repeat interventions and greater costs mid- and long-term.”
The Society for Vascular Surgery has had a long-standing interest in cost efficacy analyses of treatment options. “As we continue to develop and publish clinical practice guidelines, in the future we will be including the relative costs of alternate treatment options in assessing and determining the most appropriate treatment option for our patients. In that regard, this study raises important questions that our research will address,” Dr. Perler said.
