Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative Peter A. Soden, MD, Sara.

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Presentation transcript:

Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative Peter A. Soden, MD, Sara L. Zettervall, MD, MPH, Thomas Curran, MD, MPH, Ageliki G. Vouyouka, MD, Philip P. Goodney, MD, MS, Joseph L. Mills, MD, John W. Hallett, MD, Marc L. Schermerhorn, MD Journal of Vascular Surgery Volume 65, Issue 1, Pages 108-118 (January 2017) DOI: 10.1016/j.jvs.2016.06.105 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Patient characteristics for claudication (A) and chronic limb-threatening ischemia (CLI) (B) by intervention type. Diabetes includes both insulin and noninsulin dependent. All variation was significant (P < .001) except that denoted by an asterisk (*). Each symbol on a line represents a region with a vertical line for the region-level median. CAD, Coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease. Journal of Vascular Surgery 2017 65, 108-118DOI: (10.1016/j.jvs.2016.06.105) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Preoperative imaging in bypass. All variation was significant (P < .001). Emergent cases excluded chronic limb-threatening ischemia (CLI). CTA, Computed tomography angiogram; MRA, magnetic resonance angiogram. Journal of Vascular Surgery 2017 65, 108-118DOI: (10.1016/j.jvs.2016.06.105) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Proportion of chronic limb-threatening ischemia (CLI) (vs claudication) for elective cases only by procedure type and region (deidentified). Journal of Vascular Surgery 2017 65, 108-118DOI: (10.1016/j.jvs.2016.06.105) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Treatment details. Distal bypass defined as below-knee popliteal and more distal targets. Completion study defined as arteriogram or duplex. All variation was significant (P < .001). CLI, Chronic limb-threatening ischemia; PTA, percutaneous transluminal angioplasty; TASC, TransAtlantic Inter-Society. Journal of Vascular Surgery 2017 65, 108-118DOI: (10.1016/j.jvs.2016.06.105) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 5 Proportion of target vessels for bypass (A) and most distal vessel treated for endovascular intervention (B). Above-knee includes common femoral artery (CFA), superficial femoral artery (SFA), profunda, and above-knee popliteal. Tibial defined as tibioperoneal trunk, anterior tibial, posterior tibial, and peroneal. Endovascular-popliteal intervention not stratified to above- or below-knee. BK, Below-knee; CLI, chronic limb-threatening ischemia; Pedal, dorsalis pedal, posterior tibial at ankle level, and tarsal/plantar. Journal of Vascular Surgery 2017 65, 108-118DOI: (10.1016/j.jvs.2016.06.105) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 6 Medications both preoperatively (A) and at time of discharge (B) by intervention type and symptoms. Preoperative anticoagulation only for years 2012-2014 because of reporting of this variable. All variation was significant (P < .001). CLI, Chronic limb-threatening ischemia; DAPT, dual antiplatelet therapy. Journal of Vascular Surgery 2017 65, 108-118DOI: (10.1016/j.jvs.2016.06.105) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 7 Process measures for bypass and endovascular intervention. All variation was significant (P < .001). CLI, Chronic limb-threatening ischemia; US, ultrasound. Journal of Vascular Surgery 2017 65, 108-118DOI: (10.1016/j.jvs.2016.06.105) Copyright © 2016 Society for Vascular Surgery Terms and Conditions