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Diagnosis Of Acute Limb Ischemia

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INTRODUCTION
Acute limb ischemia (ALI) is defined as a sudden decrease in limb perfusion that threatens the viability of the limb and requires urgent evaluation and management.1 There are more than one treatments for ALI and these interventions of ALI have shown similar outcomes. A meta-analysis of five randomized trials comparing catheter-directed thrombolytic therapy (CDT) with surgery showed similar rates of limb salvage but thrombolysis was associated with higher rates of stroke and major hemorrhage within 30 days.2 The higher risk of complications in CDT must be balanced with the risk of surgery in each patient. Considering the acceptance of economic studies in making clinical decisions, there is a need to include the cost aspects for the interventions of ALI. Even in large trials like TOPAS (thrombolysis or peripheral arterial surgery), the costs associated with the interventions were not considered. Although equal morbidity and mortality were reported in various trials, the cost effectiveness of the interventions of ALI remain unclear.
An important challenge of using the data from randomized controlled trials (RCTs), is to translate the evidence found into the real world practice. The availability of real world data on the cost and interventions not only helps with this challenge of RCTs, but also in developing strategies to improve clinical and economic outcomes. Generating real world cost of interventions for the treatment of ALI is quite challenging.

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