Peripheral Artery Disease, or PAD, is a common condition in which circulation in the legs becomes reduced due to artery blockages (generally due to atherosclerosis). Most patients with PAD have a mild form which causes minimal symptoms, but all patients with PAD should be treated medically to reduce the risk of heart attacks and strokes, and should be monitored by a vascular specialist for progression of the disease in their legs. For patients with a more severe form, resulting in disability (severe pain with walking) or potential risk of limb loss, two major treatment options are available to improve blood flow in the leg. One option is percutaneous angioplasty (stent insertion), the other option is bypass surgery (vein graft). Choosing the proper option requires a careful assessment of a number of factors including general health, risk factors, and the nature of the arterial blockages in the limb. While quality measures in this area are not yet standardized, we have done our best to provide data that we believe is helpful in objectively assessing quality of care for PAD at a hospital.
| Angioplasty Volumes* (click for details) | BWH Performance |
| Total Peripheral Angioplasty Volume | 355 |
| Iliac Angioplasty Volume | 70 |
| Infrainguinal Angioplasty Volume | 251 |
| Other Peripheral Angioplasty Volume | 34 |
*Angioplasty volumes are for the 12-month period ending 6/30/07.
PAD Bypass Graft Procedure Volume
The number of surgeries a hospital or surgeon performs is easily measured and has been used to denote clinical expertise. Procedure volume (number of cases performed) has therefore become a widely-used quality indicator for surgical procedures.
BWH vascular surgeons performed 73 PAD bypass graft procedures in the 12-month period ending 6/30/07.
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30-Day All Causes Mortality Rate for PAD Bypass Graft
The "30-Day All Causes" mortality rate measures how well patients do both in and out of the hospital. Patient deaths from any cause, within 30 days of surgery, are included in this rate. When looking at mortality rates, it is important to remember that some hospitals care for sicker-than-average patients. Patients with PAD often have other medical problems, so 30-day survival reflects not only the quality of the surgical care provided, but also the quality of the overall medical care received.
The 30-day all causes mortality rate for PAD bypass graft at BWH is 2.4%.
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PAD Bypass Graft Vein Material Usage Rate
Vein is the material of choice for performing leg bypass surgery, as documented by numerous studies. Artificial (prosthetic) grafts are generally reserved for patients who do not have adequate vein for the procedure, or in other extenuating circumstances. Whether or not natural vein is used depends on many factors, such as availability of sophisticated ultrasound to identify usable vein, and the care taken by the surgeon. Even with optimal care, not all patients will have a usable vein. The Dartmouth Atlas of Vascular Care shows a U.S. average vein material usage rate of 60.9% (published in 1996).
At BWH, 81.3% of PAD bypass graft cases employ vein as the graft material, which is higher that the national average of 60.9%.
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30-Day PAD Bypass Graft Success Rate
Early failure of graft can occur for several reasons, including technical factors or individual patient circumstances. Despite these reason, 30-day success rates should be quite high in specialty centers (such as BWH), at least 90%.
The 30-day PAD bypass graft success rate at BWH is 94.9%.
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Five-Year PAD Bypass Graft Patency Rate
The long-term success of vein grafts depends on many technical and individual patient factors, such as smoking, cholesterol, and continued surveillance by a vascular surgeon. Bypass grafts can develop the same blockages as the arteries they replaced, so they need to be monitored over time.
The five-year PAD bypass graft patency rate for BWH is 72%.
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Peripheral Angioplasty Volume
The number of surgeries a hospital or surgeon performs is easily measured and has been used to denote clinical expertise. Procedure volume (number of cases performed) has therefore become a widely-used quality indicator for surgical procedures.
BWH performed 355 peripheral angioplasty procedures between 7/1/06 and 6/30/07. Of those, 70 were iliac, 251 were infrainguinal, and 34 were in other locations.
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