Sidakpal S. Panaich, Shilpkumar Arora, Nilay Patel, Nileshkumar J. Patel, Sopan Lahewala, Shantanu Solanki, Sohilkumar Manvar, Chirag Savani, Sunny Jhamnani, Vikas Singh, Samir V. Patel, Badal Thakkar, Achint Patel, Abhishek Deshmukh, Ankit Chothani, Parth Bhatt, Ghanshyambhai T. Savani, Jay Patel, Keyur Mavani, Ronak Bhimani, Byomesh Tripathi, Tamam Mohamad, Michael S. Remetz, Jeptha P. Curtis, Robert R. Attaran, Cindy Grines, Carlos I. Mena, Michael Cleman, John K. Forrest, Apurva O. Badheka

The comparative data for angioplasty and stenting for treatment of peripheral arterial disease are largely limited to technical factors such as patency rates with sparse data on clinical outcomes like mortality, postprocedural complications, and amputation. The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Peripheral endovascular interventions were identified using appropriate International Classification of Diseases, Ninth Revision (ICD-9) Diagnostic and procedural codes. Two-level hierarchical multivariate mixed models were created. The primary outcome includes inhospital mortality, and secondary outcome was a composite of inhospital mortality and postprocedural complications. Amputation was a separate outcome. Hospitalization costs were also assessed. Endovascular stenting (odds ratio, 95% confidence interval, p value) was independently predictive of lower composite end point of inhospital mortality and postprocedural complications compared with angioplasty alone (0.96, 0.91 to 0.99, 0.025) and lower amputation rates (0.56, 0.53 to 0.60, <0.001) with no significant difference in terms of inhospital mortality alone. Multivariate analysis also revealed stenting to be predictive of higher hospitalization costs ($1,516, 95% confidence interval 1,082 to 1,950, p <0.001) compared with angioplasty. In conclusion, endovascular stenting is associated with a lower rate of postprocedural complications, lower amputation rates, and only minimal increase in hospitalization costs compared with angioplasty alone.