Journal of vascular surgery
October 16, 2026 · via Europe PMC
ArtAssist Sequential Compression Biomechanical Device as a Cost-Dominant Limb-Salvage Strategy for No-Option Chronic Limb-Threatening Ischaemia: A Decade and Half, Single-Centre Cohort Study with Health Economic and Q-TWiST Analysis.
Sultan S, Tsapara AS, Harrison P, +7 more, Soliman O
AI summary — for doctors, generated from the abstract only
In a single-centre cohort, the ArtAssist compression device was associated with high limb salvage and large cost savings compared with amputation in patients with no-option limb-threatening ischaemia.
What was studied
A single-centre longitudinal cohort of 428 patients with non-reconstructible chronic limb-threatening ischaemia treated with ArtAssist (2008-2025), with survival, cost-effectiveness and Q-TWiST analyses.
Key findings
- Crude limb salvage was 85% (294/347)
- Estimated 5-year limb salvage was 95%, with 8% cumulative major amputation accounting for death
- Male sex, hypertension and ischaemic heart disease predicted failure (HRs 1.70, 1.80, 1.71)
- Modelled savings were about 76,500 euros per patient with 3.37 QALYs gained and ICER 21,900 euros per QALY
Clinical relevance
Vascular teams managing patients with no revascularisation option may find this relevant when considering limb-preserving alternatives.
Who should care
Limitations
It is an uncontrolled single-centre cohort, so selection bias is likely and the economic modelling relies on assumptions, which tempers the strong conclusions.
The device may be a reasonable option to consider for no-option patients, pending controlled evidence.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
Major lower limb amputation for no-option chronic limb-threatening ischaemia (CLTI) costs the Irish Health Service Executive (HSE) a median €88,820 per patient; long-term health economic and quality-adjusted survival evidence for ArtAssist SCBD is lacking.
METHODS
Longitudinal cohort analysis of 428 patients with non-reconstructible CLTI managed with ArtAssist SCBD at a single tertiary centre (January 2008-June 2025). Primary endpoints were limb salvage, cost-effectiveness versus primary amputation, and Q-TWiST. Kaplan-Meier analysis of limb salvage, multivariable Cox regression for major amputation, competing-risks analysis, and health economic modelling using contemporaneous cost data were performed.
FINDINGS
Overall crude limb salvage, defined as freedom from major amputation, was achieved in 85% (294/347 patients). At last follow-up, 48% of patients were alive without major amputation. Kaplan-Meier estimated 5-year limb salvage at 95%. The cumulative incidence of major amputation at 5 years was 8% when accounting for death as a competing event, confirming durable limb preservation despite substantial long-term mortality in this elderly, comorbid population. Male sex, hypertension, and ischaemic heart disease independently predicted major amputation or limb-salvage failure (HRs 1·70, 1·80, 1·71; all P ≤ ·012). Comorbidity burden showed a dose-response relationship (P = ·008). 90-day rental (€1,373/patient) reduced total expenditure six-fold versus primary amputation (€5·3M vs €30·8M), saving €76,500/patient. Q-TWiST yielded a gain of 3·37 QALYs per patient; ICER €21,900/QALY confirms a dominant strategy.
INTERPRETATION
ArtAssist SCBD achieves a six-fold reduction in costs versus primary amputation, +3·37 QALYs/patient, and an ICER of €21,900/QALY a dominant strategy supported by durable limb preservation, with 85% overall crude limb salvage and an estimated 5-year limb salvage of approximately 95% in the largest single-centre cohort reported. These findings support universal commissioning of ArtAssist SCBD for non-reconstructible CLTI.
DOI
10.1016/j.jvs.2026.09.051
PMID
42887569
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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