Interventions associated with ‘poor’ two-year relief of intermittent claudication symptoms

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Peripheral vascular interventions for intermittent claudication were linked to “poor” two-year relief of symptoms in the Vascular Quality Initiative (VQI) database, a new study published in the May issue of the Journal of Vascular Surgery (JVS) found.

First-named author Jonathan Bath, MD, an assistant professor in the division of vascular surgery at the University of Missouri in Columbia, Missouri, and colleagues analyzed the real-world practice patterns and outcomes of endovascular procedures to treat intermittent claudication in the VQI to determine whether they met The Society of Vascular Surgery (SVS) guidelines, which recommend that any treatment offered provide “reasonable likelihood of sustained benefit”—more than 50% likelihood of clinical efficacy for two or more years.

The VQI was accessed for patients treated for intermittent claudication between 2004 and 2017 for whom there was complete data and more than nine months of follow-up. The primary outcome measures were condition recurrence and repeat procedures performed within two years of the initial treatment, the research team reported.

A total of 16,152 patients met the inclusion criteria, with a mean age of 66 years—61% were men, 45% were current smokers, and 28% had been discharged without antiplatelet or statin medication.

The authors reported that adjusted analyses revealed that treatment of more than two arteries was associated with a shorter time to recurrence (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.09–1.31) and a shorter time to repeat procedures (HR, 1.25; 95% CI, 1.09–1.45). The use of atherectomy was also associated with a shorter time to recurrence (HR, 1.29; 95% CI, 1.08–1.33) and a shorter time to repeat procedures (HR, 1.31; 95% CI, 1.13–1.52). Discharge with antiplatelet and statin medications was associated with a longer time to recurrence (HR, 0.84; 95% CI, 0.78–0.91) and a longer time to repeat procedures (HR, 0.77; 95% CI, 0.69–0.87).

The researchers concluded that “most patients who had undergone intervention for [intermittent claudication] had not been medically optimized before the intervention, with high rates of smoking and poor use of antiplatelet agents and statins.”

The authors reported that their work demonstrated interventions “frequently fail to meet the recommendations from the SVS guidelines from a patient symptom recurrence and medical treatment perspective.”

They added: “Given the financial incentives to treat patients, with particular emphasis on reimbursement for using technologies such as atherectomy, we must ensure that clinical decision-making for elective procedures for [intermittent claudication] is evidence-based and undertaken only once risk factor modification has been aggressively pursued.”

SOURCE: doi.org/10.1016/j.jvs.2020.10.067

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