BACKGROUND: Multiple reports document the higher costs of primary amputation (PA) compared to @entity1104 ( @entity1104 ). Recent reports document 40-50% cost-effectiveness for percutaneous transluminal angioplasty ( @entity865 ) compared to @entity1104 . The literature suggests appropriate initial treatment for @entity63 ( @entity63 ) to be @entity1104 = 38%, @entity865 = 28%, and PA = 16%. The encouraging 6-month Laser Angioplasty for @entity63 (LACI) 93% limb salvage rate prompted an independent @entity63 and LACI clinical and economic analysis. METHODS: Between 1999-2001 a reference amputation population (RAP) of 417 @entity1 with at least one infrainguinal amputation were identified from a 2.5 million @entity1 Medicare/insurance dataset. Clinical data and all medical cost claims for 18 continuous months, 12-month prior and 6-month post-amputation, were analyzed for @entity865 , @entity1104 , and PA treatment pathways. Based on multiple assumptions and the LACI phase II results, economic outcomes were used for a LACI pathway analysis compared to @entity865 , @entity1104 and PA pathways by substituting the LACI trial pathway as the initial treatment in lieu of the RAP actual treatment. RESULTS: Initial treatments for @entity63 RAP were PA = 67%, @entity1104 = 23%, @entity865 = 10%; A majority of wound complications (80%) and @entity583 7/9 (77.7%), @entity64 13/16 (81.2%), and death 2/2 (100%) occurred in the PA RAP. Only 35% of the RAP had an ankle brachial index (ABI) and only 16% angiography before PA. 227/417 (56%) of the RAP had multiple procedures. Average total costs / @entity1 =  31,638 without LACI and  25,373 with LACI. Average savings/ @entity1 with LACI =  6,265. CONCLUSION: The most common current treatments in the US for @entity63 are still characterized by high rates of primary amputations, multiple procedures, and high rates of procedure-related complications. Despite the limitations and assumptions of this analysis, the utilization of a LACI pathway first revascularization treatment strategy may provide clinical and economic cost savings in treating @entity1 with @entity63 .

XXXX : a global epidemic.A critical analysis of current treatment unmasks the clinical and economic costs of @entity63 .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity63 :: ('MESH:D007511', 'Disease') :: ['critical limb ischemia', 'CLI', 'Critical Limb Ischemia'] @entity865 :: ('CHEBI:61432', 'Chemical') :: ['PTA'] @entity1104 :: ('MESH:D000267', 'Disease') :: ['infrainguinal bypass surgery', 'IBS']
@entity63 :: (MESH:D007511,Disease) :: ['Critical limb ischemia']
