Restoring Blood Flow Improves Survival Rates, Decreases Healthcare Costs Compared with Amputation

ACV’s Dr. Jihad Mustapha recently led a groundbreaking study that found patients with peripheral artery disease may survive longer and pay less money when forgoing amputation and instead opting for treatments that restore blood flow to their limbs.

The study, “Determinants of Long-Term Outcomes and Costs in the Management of Critical Limb Ischemia: A Population-Based Cohort Study,” is the first study to investigate long-term outcomes and costs associated with treatment of first major CLI. It was sponsored by the CLI Global Society and published in the Journal of the American Heart Association.

The 22-page paper explored three major issues:

“Many patients diagnosed with critical limb ischemia are told amputation is their only option, but amputation is associated with many poor outcomes, including shorter survival, depression and loss of independence,” said Mustapha, co-founder and cardiologist at Advanced Cardiac & Vascular Amputation Prevention Centers, which he and co-founder Dr. Fadi A. Saab opened in early 2018.

“This study underscores what we have known intuitively for years: outcomes are better – and costs are lower – when we avoid amputation.”

In collaboration with members of the board of the CLI Global Society, including Drs. Barry T. Katzen, president; Richard F. Neville, Robert A. Lookstein, Thomas Zeller and Michael R. Jaff, Mustapha reviewed medical records of more than 72,000 Medicare patients diagnosed with primary CLI between 2010 and 2015.

The study found that 29 percent of patients with CLI will either die or have an amputation within the first year of diagnosis. Survival rates throughout the four years of the study were 38 percent for those with endovascular revascularization, 40 percent for those with surgical revascularization and 23 percent for those who had a major amputation.

Additionally, the study found that healthcare costs during follow-up associated with endovascular revascularization were $49,700, while surgical revascularization was $49,200. Costs for a major amputation were 12 percent higher at $55,700.

“Amputation is not the only solution, so it’s critical that people always get a second opinion,” Mustapha said. “By doing simple due diligence, limbs – and lives – can be saved. With the proper treatment for CLI, patients are given back control of their health.”

To read the full study, visit For more information about the CLI Global Society, visit