THE CHOICE OF STRATEGY IN THE TREATMENT OF CRITICAL LEG ISCHEMIA - A DECISION-TREE APPROACH

In critial leg ischaemia the main treatment options are primary amputa tion or reconstructive vascular surgery, but in some cases nonoperativ e treatment can be considered. The choice between the treatment altern atives is made difficult by significant complication rates, reoperatio n rates and perioperative mortality. Different alternatives are associ ated with different risks. The limited life expectancy for many of the se patients increases the importance of considering risk when choosing the treatment. Rational decision making ought to be founded on an ana lysis of outcomes produced in routine clinical practice. Practices and beliefs may thus be challenged. In this study a very tentative decisi on analysis was performed. A decision tree was designed describing the three treatment options. The probabilities and the expected utilities of the various outcomes were calculated using data extract ed from re cent Swedish medical publications and from the Vascular Registry in So uthern Sweden (VRISS). Two different health indices were used in evalu ating outcomes. The completed exercise showed that the results of the analyses were highly sensitive to the use of utility values, so no fir m conclusions regarding the best treatment option could be made. Since there is not yet any international consensus as to the appropriate va lues to attach to health states, the need for more research into this area is emphazised.