b'Scientific Session Abstracts SUNDAY APRIL 21, 2024 38: COST OF LIMB SALVAGE FOR NO OPTION CHRONIC LIMB-THREATENING ISCHEMIA: HOW MUCH IS ONE LEG WORTH?Aldin Malkoc, MD, Catherine Lai, BS, Lana Mamoun, BS, Xinfei Miao, BS,Raja Gnanadev, MD, Michelle Lee, MD, Samuel Lee, MD, Samuel Schwartz, MDDepartment of Vascular Surgery, Arrowhead Regional Medical CenterBackground: 20% of patients with chronic limb-threatening ischemia (CLTI) are classified as having No Option anatomy due to the presence of severe tibial and pedal disease not permitting conventional open surgical bypass or endovascular therapies. For this group of patients, superficial and deep venous arterialization (VA) has been shown to improve blood flow and increase limb salvageability. Our study objective is to estimate the long-term cost of successful VA coupled with adjunct therapy (wound care, hyperbaric oxygen) in a quaternary vascular center.Methods: Retrospective review of all patients undergoing VA with chronic limb ischemia at a single quaternary vascular center from 2022-2023 was collected. Patients identified with Rutherford stage 5 and 6 and no conventional endovascular/open options were considered for VA. Patients with long-term ( 6 months) of limb salvage status post VA were included. Demographic data including length of stay (LOS), phase of care, repeat hospitalizations, VA index procedure cost, cost subsequent procedures (angiography, debridement, etc) and wound care/adjuncts. Cost data was obtained from Medicare claims and published sources.Results: Three patients undergoing VA were identified for review; these patients all had limb salvage 180 days post VA. The average age of the patients was 72 years of age. All patients were male. Patients had undergone a combination of transcatheter venous arterialization and hybrid VA.Over the course of twelve months, patient one had a total hospital stay of 132 days with 10 repeat procedures. Patient two had a total hospital stay of 206 days with 11 procedures required over one year. Patient three had a total hospital stay of 124 days with 7 procedures required over one year. The average procedure cost was $320,850. The average hospital cost (hospitalization and wound care adjuncts) was $895,546. The overall total cost average was $1,216,396. There were no immediate procedural complications.Conclusion: Venous arterialization and an associated multi-disciplinary wound care approach for No Option CLTI does not appear to be a cost-effective strategy with a total cost average of over a million dollars per patient. Future research should aim to protocol a treatment pathway for these frail patients that results in shorter hospital stays and fewer secondary procedures.96SOUTHERN CALIFORNIA VASCULAR SURGICAL SOCIETY'