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Evaluating the Management of Intermittent Claudication before and after Publication of the Society of Vascular Surgery’s Appropriate Use Criteria
Andrea Alonso
1, Anna Kobzeva-Herzog, MD
1, Maha Haqqani
1, Stephen Dalton-Petillo
1, Alik Farber
1, Elizabeth King
1, Cailtin Hicks
2, Mahmoud Malas
3, Karan Garg
4, Nicholas Osborne
5, Jessica Simons
6, Jeffrey Siracuse
1
1Boston University School of Medicine, Boston, MA, 2Johns Hopkins Medicine, Vascular Surgery, Baltimore, MD, 3University of California San Diego, Vascular Surgery, San Diego CA, 4New York University Langone Health, Vascular Surgery, New York, NY 5University of Michigan Health, Vascular Surgery, Ann Arbor, MI, 6University of Massachusetts Memorial Health, Vascular Surgery, Worcester, MA
Background: In April 2022, the Society for Vascular Surgery published the appropriate use criteria (AUC) for the management of intermittent claudication (IC). Our goal was to assess early practice changes that may be associated with these guidelines.
Methods: The Vascular Quality Initiative (VQI) peripheral vascular intervention (PVI), suprainguinal and infrainguinal bypass registries were analyzed. Key characteristics pre-AUC (2018-2019) and post-AUC (May 2022-December 2023) were compared, including medical risk, claudication severity, optimal medical therapy (OMT) use, smoking status, and interventions for complex disease (TASC II C/D).
Results: There were 15,892 PVI, 2352 suprainguinal, and 3480 infrainguinal interventions analyzed (Table). PVI changes consistent with the AUC included more interventions for severe disease (72% vs 66.6%, P<.001), increased post-operative OMT use (83% vs 79.7%, P<.001), and fewer interventions on complex aortoiliac (6.3% vs 9.5%, P<.001) and femoropopliteal disease (4.5% vs 5.8%, P <.001). No changes were seen in preoperative smoking, OMT use, or extra-anatomic bypasses. Inconsistent with AUC guidelines were more PVI on common femoral artery (CFA) (5.2% vs 3.4%, P<.001), and isolated infrapopliteal disease (5.7% vs 3.5%, P<.001).
Conclusion: Since the publication of the AUC, there have been early improvements in care including improved post-operative OMT and less endovascular interventions on complex disease. However, improvements are needed to increase preoperative medical optimization and decrease endovascular interventions on CFA disease and infrapopliteal revascularizations.
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