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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
A Systematic Review and Meta-Analysis of the Evidence for Overuse of Vascular Diagnostic Imaging Tests and Procedures
Aidan M Kirkham1, Emma E Sypes2, Chen Chen Xu2
1Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Methodological and Implementation Research Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Background:
We sought to synthesize and evaluate evidence for the overuse of vascular diagnostic imaging tests and procedures in high-income countries as they may be overused in asymptomatic, minimally symptomatic, and/or high-risk patients with limited life expectancy.
Methods:
After protocol registration (CRD42021257490), we searched Medline, Embase, and Evidence-Based Medicine Reviews (January 1, 2010-May 14, 2025) for English language studies that reported the incidence/prevalence of overuse of vascular diagnostic imaging tests and/or procedures in high-income countries; adjusted predictors of overuse; or adjusted associations between overuse and outcomes. Three investigators independently reviewed titles/abstracts and full-texts, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Grading of Recommendations, Assessment, Development, and Evaluation was used to assess estimate certainty.
Results:
Among 11,748 citations, we included 14 studies (n = 16,706,904 patients) that examined two unique vascular diagnostic imaging tests and eight unique procedures. The most frequently overused vascular imaging tests included carotid (pooled cumulative incidence = 19%; 95% confidence interval [CI] = 10-30%; moderate certainty) and venous duplex (cumulative incidence = 46%; 95% CI = 43-48%; moderate certainty). The most frequently overused vascular procedures included renal artery angioplasty (pooled cumulative incidence = 92%; 95% CI = 85-97%; low certainty) and inferior vena cava filter placement (pooled cumulative incidence = 72%; 95% CI = 0-100%; low certainty). Adjusted risk factors for carotid duplex overuse included increasing age and higher median neighborhood income quartile. Adjusted risk factors for overuse of endovascular intervention for claudication included ever smoking and end-stage renal disease. Overuse was associated with increased health-care costs in all studies examining this outcome.
Conclusion:
Overuse of vascular diagnostic imaging tests and procedures may be common in high-income countries and associated with increased healthcare costs. However, because the included studies had important limitations, our findings that should be confirmed before methods to reduce the above overuse are developed.
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