OBJECTIVES: Lower-limb peripheral arterial disease (LLPAD) is associated with high rates of mortality and amputation. The main objective of this study was to compare patients treated for long and complex femoro-popliteal lesions in France with either dedicated vascular endoprosthesis or open surgery.

METHODS: This retrospective population-based study used the French national medico-administrative data available for almost the entire population of hospitalized patients. Diagnoses and procedures were coded using ICD-10 and the French CCAM classification. Patients with LLPAD hospitalized between January 2018 and December 2022 were identified from a combination of diagnosis, endoprosthesis type and procedure codes and allocated to 2 groups: dedicated vascular endoprosthesis (group 1) and open surgery (group 2). To ensure between-group comparability, we conducted a case-control study (1:3) using a propensity score to match with demographic and clinical characteristics of the index hospital stay (such as age, gender, disease severity, Charlson score). Endpoints were post-operative in-hospital mortality, amputation rate and direct costs (National Health Insurance [NHI] perspective) during the index stay.

RESULTS: After matching, the study comprised 2,246 (age 72.3 ± 12.0, male: 70.9%) and 6,738 patients (age 71.6 ± 11.3, male: 75.5%) in group 1 and 2, respectively. The proportion of patients with severe disease was similar in both groups. All-cause hospital mortality was 1.4% in group 1 versus 3.4% in group 2 (OR: 0.39, [95%CI: 0.27-0.58]). In-hospital amputation occurred in 6.6% versus 8.3% of patients in group 1 and 2 (OR: 0.78, [95%CI: 0.64-0.94]), respectively. The associated costs were €6,954 (IQR: €5,569–€9,587) in group 1 and €8,575 (IQR: €6,577–€12,957) in group 2 (non-significant difference).

CONCLUSIONS: In this real-world nationwide cohort of PAD patients, those treated with dedicated vascular endoprosthesis had a lower risk of both in-hospital mortality and major amputation than their matched counterparts treated with open surgery, at 19% lower costs.