BACKGROUND Few studies have compared long-term outcomes among specific treatment modalities for critical limb ischemia. The aim of this study was to compare long-term outcomes with percutaneous transluminal angioplasty (PTA), stent placement, atherectomy, or surgical bypass in patients diagnosed with critical limb ischemia. METHODS In this observational study using Medicare claims data, we identified incident cases with a primary critical limb ischemia diagnosis who received PTA, stent placement, atherectomy, or surgical bypass. We used propensity score weighting to determine the association of treatment type with all-cause mortality and major (above ankle) amputation over 4 years follow-up. RESULTS Among 36 860 patients (10 904 PTA; 11 295 stent placement; 4422 atherectomy; 10 239 surgical bypass), all-cause mortality over 4 years was 49.3% with atherectomy, 51.4% with surgical bypass, 53.7% with stent placement, and 54.7% with PTA (P<0.05 for all pairwise comparisons). Major amputation rates over 4 years were 6.8% with atherectomy, 7.8% with stent placement, 8.1% with PTA, and 10.8% with surgical bypass (P<0.05 for all pairwise comparison except PTA versus stent). CONCLUSIONS Among Medicare beneficiaries who received PTA, stent placement, atherectomy, or surgical bypass for critical limb ischemia, high mortality and major amputation rates were observed with minor differences among treatment groups. Statistically significant group differences of uncertain clinical importance were observed for several comparisons. Results from observational research may be susceptible to bias because of unmeasured confounders and, therefore, these comparative results should be interpreted with caution.

中文翻译：

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倾向评分调整后的严重肢体缺血血运重建策略中长期结果的比较。

背景技术很少有研究比较了严重肢体缺血的特定治疗方式中的长期结局。这项研究的目的是比较经诊断为严重肢体缺血的患者的经皮腔内血管成形术（PTA），支架置入，旋切术或手术旁路的长期预后。方法在这项使用Medicare索赔数据的观察性研究中，我们确定了患有原发性严重肢体缺血诊断并接受PTA，支架置入，旋切术或手术搭桥的事件病例。我们使用倾向评分权重来确定治疗类型与全因死亡率和4年随访中大面积（踝以上）截肢的关系。结果在36 860例患者中（10 904 PTA； 11 295支架置入； 4422斑块旋切术； 10 239手术搭桥），4年的全因死亡率为49。斑块切除术为3％，手术旁路为51.4％，支架置入为53.7％，PTA为54.7％（所有成对比较中P <0.05）。斑块切除术4年的主要截肢率为6.8％，支架置入为7.8％，PTA为8.1％，手术旁路为10.8％（除PTA与支架相比，所有成对比较的P <0.05）。结论在接受PTA，支架置入，旋切术或手术旁路治疗严重肢体缺血的Medicare受益人中，观察到高死亡率和大截肢率，各治疗组之间存在细微差异。观察到具有统计学意义的，临床意义不确定的显着性组差异，进行了几次比较。观察性研究的结果可能会由于无法衡量的混杂因素而易于产生偏差，因此，