Vascular Quality Initiative assessment of compliance with Society for Vascular Surgery Practice Guidelines for the endovascular management of claudication

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

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.