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Cost-effectiveness of Leg Bypass versus Endovascular Therapy for Critical Limb Ischemia: A Systematic Review

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Systematic Review - Cost-effectiveness of Leg Bypass versus Endovascular Therapy for Critical Limb Ischemia: A Systematic Review

Prepared by:
Evidence Synthesis Program (ESP) Center West Los Angeles VA Medical Center Los Angeles, CA
Paul G. Shekelle, MD, PhD, Director

Recommended citation:
Childers C, Lamaina M, Liu C, Mak S, Booth M, Gibbons M, Shekelle PG. Cost-effectiveness of Leg Bypass versus Endovascular Therapy for Critical Limb Ischemia. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs.VA ESP Project#05-226; 2019.

Download PDF: Complete Report, Executive Summary, Report, Appendices

Introduction

Critical limb ischemia (CLI) is a severe form of peripheral arterial disease (PAD) marked by ischemic rest pain, tissue loss, or gangrene. CLI is associated with significant morbidity, mortality, and resource utilization. Patients can be treated with revascularization, either surgical or endovascular. To help clinicians, patients, and policymakers decide between surgery-first and endovascular-first approaches in patients with CLI, we were asked to conduct a systematic review of the literature.

Key Questions

KQ1: Among adults with CLI, what is the cost-effectiveness of leg bypass compared to endovascular procedures including balloon angioplasty, arterial stents, and atherectomy?

KQ2: Does the cost-effectiveness of leg bypass compared to endovascular procedures for CLI vary by patient population, setting, or time (short vs long-term)?