BACKGROUND The optimal revascularization strategy for acute limb ischemia (ALI) remains unclear, and contemporary comparative effectiveness data on endovascular versus surgical revascularization are lacking. METHODS We used the 2010 to 2014 National Inpatient Sample databases to identify hospitalizations with a primary diagnosis of ALI. Patients were propensity-score matched on the likelihood of undergoing endovascular versus surgical revascularization using a logistic regression model. The primary outcome was in-hospital mortality. Secondary outcomes included myocardial infarction, stroke, composite of death/myocardial infarction/stroke, any amputation, fasciotomy, acute kidney injury, major bleeding, transfusion, vascular complications, length of stay, and hospital costs. RESULTS Of 10 484 (weighted national estimate=51 914) hospitalizations for ALI, endovascular revascularization was performed in 5008 (47.8%) and surgical revascularization in 5476 (52.2%). In the propensity-score matched cohort (n=7746; 3873 per group), patients who underwent endovascular revascularization had significantly lower in-hospital mortality (2.8% versus 4.0%; P=0.002), myocardial infarction (1.9% versus 2.7%; P=0.022), composite of death/myocardial infarction/stroke (5.2% versus 7.5%; P<0.001), acute kidney injury (10.5% versus 11.9%; P=0.043), fasciotomy (1.9% versus 8.9%; P<0.001), major bleeding (16.7% versus 21.0%; P<0.001), and transfusion (10.3% versus 18.5%; P<0.001), but higher vascular complications (1.4% versus 0.7%; P=0.002), compared with those undergoing surgical revascularization. Rates of any amputation were similar between the 2 groups (4.7% versus 5.1%; P=0.43). Median length of stay was shorter and hospital costs higher with endovascular versus surgical revascularization. CONCLUSIONS In patients with ALI, endovascular revascularization was associated with better in-hospital clinical outcomes compared with surgical revascularization. Contemporary randomized controlled trials are needed to determine the optimal revascularization strategy for ALI.

中文翻译：

---

急性肢体缺血的血管内对比外科手术血运重建：倾向评分匹配分析。

背景技术急性肢体缺血（ALI）的最佳血运重建策略仍不清楚，并且缺乏关于血管内与手术血运重建的当代比较有效性数据。方法我们使用2010年至2014年的国家住院患者样本数据库来确定主要诊断为ALI的住院患者。使用logistic回归模型对患者进行血管内和外科血管重建术的可能性进行倾向评分匹配。主要结局是院内死亡率。次要结果包括心肌梗塞，中风，死亡/心肌梗塞/中风，任何截肢，筋膜切开术，急性肾损伤，大出血，输血，血管并发症，住院时间和住院费用。结果在ALI的10 484例住院（加权国家估计为51 914例）中，进行了血管内血运重建的有5008例（47.8％），有手术血运重建的有5476例（52.2％）。在倾向评分匹配的队列中（n = 7746；每组3873名），接受血管内血运重建的患者的院内死亡率（2.8％比4.0％； P = 0.002），心肌梗塞（1.9％比2.7％；显着降低）。 P = 0.022），死亡/心肌梗塞/中风（5.2％对7.5％; P <0.001），急性肾损伤（10.5％对11.9％; P = 0.043），筋膜切开术（1.9％对8.9％; P < 0.001），大出血（16.7％vs 21.0％; P <0.001）和输血（10.3％vs 18.5％; P <0.001），但与之相比，血管并发症更高（1.4％vs 0.7％; P = 0.002）进行外科血运重建。两组之间的截肢率相似（4.7％比5.1％； P = 0.43）。与手术血运重建相比，血管内停留的中位时间较短，住院费用较高。结论在ALI患者中，血管内血运重建术与外科手术血运重建术相比具有更好的院内临床结局。需要当代随机对照试验来确定ALI的最佳血运重建策略。