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An increasing number of health plans are initiating disease management programs, particularly for asthma, congestive heart failure and diabetes, in their effort to reduce costs without compromising the quality medical care they provide to patients. However, some of the programs are not producing cost savings. The reasons for the minimal cost savings include insufficient program design, ineffective management and unrealistic goals., The increased development and implementation of disease management programs reflect attempts by a growing number of health plans to reduce costs while providing patients with high-quality care. Unfortunately, few of [...]

Purpose: To assess the technical feasibility, thrombogenicity, and biocompatibility of a new biodegradable poly-L-lactic acid (PLLA) anastomotic stent.Methods: A polytetrafluoroethylene bifurcated graft was implanted in 17 pigs through a midline abdominal incision. After transverse graft incision, 17 316L stainless steel stents and 17 PLLA stents were randomly implanted at both iliac anastomotic sites and deployed with a 6-mm balloon under direct vision without angiography. Intended follow-up was 1 week in 6 pigs receiving oral acetylsalicylic acid (ASA) and in 7 pigs receiving ASA/clopidogrel; 4 pigs receiving ASA/clopidogrel were followed for 6 weeks. At the end of the study, the segments containing the stents were surgically explanted and processed for histology to measure the mean luminal diameter, intimal thickness, and the vascular injury and inflammation scores.Results: Initial technical success of stent placement was achieved in all animals without rupture of the suture. Two pigs died (unrelated to the stent) at 3 days after operation (1 in groups A and B). At 1 week, all PLLA stents showed thrombotic occlusion with the use of ASA alone. In contrast, all PLLA stents remained patent with concurrent administration of ASA/clopidogrel. All metal stents were patent regardless of the antiplatelet regimen. The mean luminal diameter of patent PLLA stents (4.13±0.17 mm) was comparable to metal stents (4.27±0.35 mm, p=0.78) at 1 week, but significantly diminished at 6 weeks (3.21±0.44 versus 4.19±0.18 mm, p=0.005). Histological analysis showed no signs of excessive recoil. PLLA stents induced a higher inflammation score (1.79±0.56) and more intimal hyperplasia (0.34±0.11 mm) compared to metal stents [1.27±0.44 mm (p<0.001) and 0.18±0.04 mm (p=0.006), respectively] at 6 weeks. Vascular injury was comparable between PLLA and metal stents.Conclusion: Biodegradable PLLA stents showed higher thrombogenicity and reduced patency compared to metal stents during early follow-up. Although ASA and clopidogrel prevented thrombotic occlusion, the increased inflammatory response and neointima formation remain major concerns of PLLA stents. A solution to this problem might be the incorporation of anti-inflammatory drugs into the PLLA stent.