Use of Intravascular Ultrasound during Peripheral Vascular Interventions for Claudication Is Not Associated with
Chen Dun1, M Libby Weaver2, Sanuja Bose3
1Department of Biomedical Informatics and Data Science, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Intravascular ultrasound (IVUS) use is increasing for peripheral vascular interventions (PVIs) in claudication patients. However, IVUS did not show clear benefits and was linked to higher risks in one study.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Health Outcomes Research
Background:
- The effectiveness of intravascular ultrasound (IVUS) in enhancing outcomes for peripheral vascular interventions (PVIs) remains understudied.
- This study evaluates the association between IVUS utilization and long-term results in patients undergoing PVI for claudication.
Purpose of the Study:
- To assess the impact of IVUS on long-term outcomes in patients with femoropopliteal PVI for claudication.
- To analyze trends in IVUS use across different settings and procedures.
Main Methods:
- A two-cohort study utilizing Medicare fee-for-service claims (2018-2022) and the Vascular Quality Initiative (VISION; 2016-2019).
- Inclusion of patients undergoing index femoropopliteal PVI for claudication, excluding those with chronic limb-threatening ischemia (CLTI) or acute limb ischemia.
- Multivariable Cox proportional hazards models were used to evaluate associations of IVUS with repeat PVI, CLTI conversion, and amputation, with adjustments for patient characteristics and anatomic factors.
Main Results:
- In the Medicare cohort (N=69,092), 22.1% received IVUS; in the VISION cohort (N=6,722), 3.8% received IVUS.
- IVUS use increased significantly over time, particularly in outpatient settings and with atherectomy.
- Medicare data showed IVUS associated with higher hazards of repeat PVI (aHR 1.07) and progression to CLTI (aHR 1.11); VISION data found no significant outcome differences.
Conclusions:
- Intravascular ultrasound (IVUS) use for claudication treatment is rapidly increasing.
- Current evidence does not demonstrate clear benefits of IVUS for improving outcomes in this patient population.
- Further investigation is warranted to clarify the role of IVUS in managing claudication.
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