Iannuzzi James C, Animilli Shravan, Simons Jessica P, Tonnessen Britt H, Koleilat Issam, Indes Jeffrey E, Conte Michael S, Eldrup-Jorgensen Jens
Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA.
Vascular Quality Initiative Patient Safety Organization, Rosemont, IL.
J Vasc Surg. 2025 May;81(5):1155-1163. doi: 10.1016/j.jvs.2025.01.007. Epub 2025 Jan 15.
In 2015, Society for Vascular Surgery (SVS) guidelines on claudication management were released, spanning optimal medical management, procedural, and post-procedure recommendations. Uptake of guidelines and changes to clinical practice over time remain unknown. This study hypothesized that guideline-aligned practice increased after guideline release.
The Vascular Quality Initiative Peripheral Vascular Intervention (VQI PVI) dataset was queried for years 2010 to 2021 for cases of claudication from occlusive disease. Only the initial procedure was considered, and subsequent interventions were excluded. The primary endpoint was care aligned with the 2015 SVS claudication treatment guidelines that were possible to evaluate in the VQI PVI dataset. Guideline-aligned practice before 2016 was compared with that after 2016. A hierarchical regression was used to control for hospital-level variation introduced by changing VQI membership during the study timeframe.
A majority of the 2015 SVS guideline GRADE 1-A recommendations can be assessed using the VQI PVI dataset. Overall, 93,654 cases were included, 30.9% before 2016 and 69.1% after guideline release. After controlling for hospital-level variation, guideline-aligned care improved for preoperative smoking cessation, aspirin, clopidogrel, and statin use, and postoperative medical therapy with antiplatelet, dual antiplatelet, and statin therapy. Guideline aligned care did not change over time for aorto-iliac stent use, covered stent use in calcified aortoiliac disease, or superficial femoral artery stenting for 5- to 15-cm lesions. Guideline-aligned care worsened for isolated infrapopliteal treatments and use of bare metal stents for 5- to 15-cm superficial femoral artery occlusions. Secondary analysis identified an association between area deprivation index and increased odds of smoking and decreased odds of meeting post-discharge optimal medical therapy.
Although guideline-aligned care improved after guideline release for medical management of claudication, procedural elements did not improve. Those with social deprivation were less likely to receive guideline-aligned care for medical management, representing a future area of study and improvement. High-grade recommendations can be tracked using the VQI PVI dataset and should be monitored to help improve care.
2015年，血管外科学会（SVS）发布了关于间歇性跛行管理的指南，涵盖了最佳药物治疗、手术及术后建议。随着时间的推移，指南的采用情况以及临床实践的变化尚不清楚。本研究假设指南发布后符合指南的实践有所增加。
查询血管质量倡议外周血管介入（VQI PVI）数据集2010年至2021年期间因闭塞性疾病导致间歇性跛行的病例。仅考虑初始手术，排除后续干预措施。主要终点是与2015年SVS间歇性跛行治疗指南相符且可在VQI PVI数据集中评估的治疗。将2016年前符合指南的实践与2016年后的进行比较。采用分层回归来控制研究时间段内VQI成员变化所引入的医院层面差异。
2015年SVS指南1-A级推荐中的大多数可通过VQI PVI数据集进行评估。总体而言，共纳入93,654例病例，2016年前占30.9%，指南发布后占69.1%。在控制医院层面差异后，符合指南的护理在术前戒烟、使用阿司匹林、氯吡格雷和他汀类药物以及术后抗血小板、双联抗血小板和他汀类药物治疗方面有所改善。对于腹主动脉-髂动脉支架使用、钙化性腹主动脉-髂动脉疾病中覆膜支架使用或5至15厘米病变的股浅动脉支架置入术，符合指南的护理随时间未发生变化。对于孤立的腘下治疗以及5至15厘米股浅动脉闭塞使用裸金属支架，符合指南的护理情况恶化。二次分析确定了地区贫困指数与吸烟几率增加以及出院后达到最佳药物治疗几率降低之间的关联。
尽管指南发布后间歇性跛行药物管理方面符合指南的护理有所改善，但手术方面并未改善。社会贫困人群接受符合指南的药物管理护理的可能性较小，这是未来研究和改进的一个领域。高级别推荐可通过VQI PVI数据集进行跟踪，应进行监测以帮助改善护理。
