Jornal Vascular Brasileiro
Jornal Vascular Brasileiro
Original Article

Epidemiological analysis of lower limb revascularization for peripheral arterial disease over 12 years on the public healthcare system in Brazil

Análise epidemiológica da revascularização de membros inferiores para doença arterial periférica em 12 anos no sistema público de saúde do Brasil

Nelson Wolosker; Marcelo Fiorelli Alexandrino da Silva; Maria Fernanda Cassino Portugal; Nickolas Stabellini; Antônio Eduardo Zerati; Claudia Szlejf; Edson Amaro Junior; Marcelo Passos Teivelis

Downloads: 2
Views: 812


Abstract: Background: Worldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people.

Objectives: Our objective was to analyze surgical treatment for PAD provided on the Brazilian Public Healthcare System over 12 years using publicly available data.

Methods: The study was conducted with analysis of data available on the Brazilian Health Ministry’s database platform, assessing distributions of procedures and techniques over the years and their associated mortality and costs.

Results: A total of 129,424 procedures were analyzed (performed either for claudication or critical ischemia, proportion unknown). The vast majority of procedures were endovascular (65.49%) and this disproportion exhibited a rising trend (p<0.001). There were 3,306 in-hospital deaths (mortality of 2.55%), with lower mortality in the endovascular group (1.2% vs. 5.0%, p=0.008). The overall governmental expenditure on these procedures was U$ 238,010,096.51, and endovascular procedures were on average significantly more expensive than open surgery (U$ 1,932.27 vs. U$ 1,517.32; p=0.016).

Conclusions: Lower limb revascularizations were performed on the Brazilian Public Healthcare System with gradually increasing frequency from 2008 to 2019. Endovascular procedures were vastly more common and were associated with lower in-hospital mortality rates, but higher procedure costs.


big data, arteries, database, public health, vascular diseases


Resumo: Contexto: A doença arterial periférica (DAP) é uma doença com alta morbidade global, afetando mais de 200 milhões de pessoas.

Objetivos: Neste estudo, analisamos o tratamento cirúrgico para DAP no sistema público de saúde do Brasil no período de 12 anos, com base em dados publicamente disponíveis.

Métodos: O estudo foi conduzido a partir da análise de dados disponíveis na plataforma do Departamento de Informática do Sistema Único de Saúde (DATASUS), do Ministério da Saúde, avaliando a distribuição da técnica cirúrgica utilizada, a mortalidade e o custo ao longo dos anos.

Resultados: Um total de 129.424 procedimentos foram analisados (para claudicantes e isquemia crítica, em proporção desconhecida). A maiora dos procedimentos foi via endovascular (65,49%), com tendência de aumento nessa desproporção (p < 0,001). Houve 3.306 mortes intra-hospitalares (mortalidade de 2,55%) com menor mortalidade no grupo endovascular (1,2% vs. 5,0%; p = 0,008). O investimento governamental total para esses procedimentos foi de US$ 238.010.096,51, e os procedimentos endovasculares foram significativamente mais caros que a cirurgia aberta convencional (US$ 1.932,27 vs. US$ 1.517,32; p = 0,016).

Conclusões: No sistema público de saúde brasileiro, as revascularizações de membros inferiores ocorreram com frequência crescente entre 2008 e 2019. Os procedimentos endovasculares foram mais comuns e relacionados a menor mortalidade intra-hospitalar, mas a maiores custos.


big data, artérias, saúde pública, doenças vasculares


1 World Health Organization. Global status report on noncommunicable diseases 2014 [Internet]. Geneva, Switzerland: WHO; 2014 [cited 2020 Aug 30]. Available from:

2 GBD 2013 Mortality and Cause of Death Collaborators. Global, regional, and national age – sex specifi c all-cause and cause-specifi c mortality for 240 causes of death, 1990 – 2013 : a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-71. PMid:25530442.

3 Alwan A, Maclean DR. A review of non-communicable disease in low- and middle-income countries. Int Health. 2009;1(1):3-9. PMid:24036289.

4 Cucato GG, Forjaz CLM, Kanegusuku H, et al. Effects of walking and strength training on resting and exercise cardiovascular responses in patients with intermittent claudication. Vasa. 2011;40(5):390-7. PMid:21948782.

5 Wolosker N, Rosoky RA, Nakano L, Basyches M, Puech-Leão P. Predictive value of the ankle-brachial index in the evaluation of intermittent claudication. Rev Hosp Clin Fac Med Sao Paulo. 2000;55(2):61-4. PMid:10959125.

6 Conte SM, Vale PR. Peripheral arterial disease. Heart Lung Circ. 2018;27(4):427-32. PMid:29150158.

7 Castaneda P, Sales A, Osborne NH, Corriere MA. Scope, themes, and medical accuracy of eHealth peripheral artery disease community. Ann Vasc Surg. 2019;54:92-102. PMid:30267913.

8 Lazar A, Morrissey N. Recent advances in endovascular treatment of peripheral arterial disease. F1000Res. 2020;9:1-5. PMid:32148765.

9 Gheorghe A, Griffiths U, Murphy A, Legido-quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries : a systematic review. BMC Public Health. 2018;18(1):975. PMid:30081871.

10 Nascimento BR, Brant LCC, Lana M, et al. Trends in procedure type, morbidity and in-hospital outcomes of patients with peripheral artery disease : data from the brazilian public health system. Ann Vasc Surg. 2016;31:143-51. PMid:26616503.

11 Wolosker N, Fiorelli M, Braga D, et al. Lower limb revascularization for peripheral arterial disease in 10, 951 procedures over 11 years in a public health system : a descriptive analysis of the largest Brazilian city. Ann Vasc Surg. 2020;70:223-9. PMid:32781262.

12 IBGE: Instituto Brasileiro de Geografia e Estatística. Estimativas populacionais [Internet]. Rio de Janeiro: IBGE; 2020 [cited 2020 Aug 30]. Available from:

13 Agência Nacional de Saúde Suplementar do Brasil. Sala de Situação. 2020 [cited 2020 Aug 30]. Available from:

14 Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116(9):1509-26. PMid:25908725.

15 Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJE. Trends and outcomes after surgical lower limb revascularization in England. Br J Surg. 2011;98(10):1373-82. PMid:21618211.

16 Office for National Statistics. 2011 Census: population estimates for the United Kingdom. 2011 [cited 2012 Dec 18]. Available from:,compared%20with%202.4%20in%202001.

17 Cea-soriano L, Fowkes FGR, Johansson S, Allum AM, García Rodriguez LA, Rodriguez G. Time trends in peripheral artery disease incidence, prevalence and secondary preventive therapy: a cohort study in The Health Improvement Network in the UK. BMJ Open. 2018;8(1):e018184. PMid:29358428.

18 getABI Study group. getABI: German epidemiological trial on ankle brachial index for elderly patients in family practice to dedect peripheral arterial disease, significant marker for high mortality. Vasa. 2002;31(4):241-8. PMid:12510548.

19 Riviere AB, Bouée S, Laurendeau C. Outcomes and management costs of peripheral arterial disease in France. J Vasc Surg. 2018;67(6):1834-43. PMid:29502999.

20 Puech-Leão P, Wolosker N, Zerati AENL, Nascimento LD. Impact of endovascular technique in vascular surgery training at a large university hospital in Brazil. J Surg Educ. 2011;68(1):19-23. PMid:21292210.

21 Goodney PP, Beck AW, Nagle J, Welch HG, Zwolak RM. National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. YMVA. 2009;50(1):54-60. PMid:19481407.

22 Hirsch AT. Treatment of peripheral arterial disease — extending “Intervention” to “Therapeutic Choice.”. N Engl J Med. 2006;354(18):1944-7. PMid:16672707.

23 Duda SH, Bosiers M, Lammer J, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery : long-term results from the SIROCCO trial. J Endovasc Ther. 2006;13(6):701-10. PMid:17154704.

24 Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113(11):e463-654. PMid:16549646.

25 Tang Q, Hu C, Zhang X. Comparison between endovascular and open surgery for the treatment of peripheral artery diseases: a meta-analysis. Ann Vasc Surg. 2020;62:484-95. PMid:31476425.

26 Adam DJ, Beard JD, Cleveland T, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925-34. PMid:16325694.

27 Bradbury AW, Adam DJ, Bell J, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. YMVA. 2010;51(5, Suppl):5S-17S. PMid:20435258.

28 Doshi R, Gupta R, Shah J, Patel K, Mbbs RD, Meraj P. University of Nevada Reno School of Medicine US CR. Am J Cardiol. 2018;122(10):1790-6. PMid:30217372.

29 Fanari Z, Weintraub WS. Cost-effectiveness of medical, endovascular and surgical management of peripheral vascular disease. Cardiovasc Revasc Med. 2015;16(7):421-5. PMid:26238266.

30 Stabellini N, Wolosker N, Leiderman DBD, et al. Epidemiological analysis of carotid artery stenosis intervention during 10 years in the public health system in the largest city in Brazil: stenting has been more common than endarterectomy. Ann Vasc Surg. 2020;66:378-84. PMid:31931132.

Submitted date:

Accepted date:

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
631b9280a9539555c277f3b7 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections