Chart review after EVAR demonstrated a 6% 1-year and 16% 3-year reintervention rate, and almost all (92%) of these events were accurately captured using VQI-Medicare data. Linking VQI data with Medicare claims allows an accurate assessment of reintervention rates after EVAR without labor-intensive physician chart review.

Objective Accurate and complete long-term post-operative outcome data is critical to improving value in healthcare delivery. The Society for Vascular Surgery – Vascular Quality Initiative (VQI) is an important tool to achieve this goal in vascular surgery. To improve on the capture of long term outcomes after vascular surgery procedures for patients in the VQI, we sought to match VQI data to Medicare Claims for comprehensive capture of major clinical outcomes in the first several years following vascular procedures. Methods Patient and procedure characteristics for abdominal aortic aneurysm procedures captured in the SVS-VQI between January 1, 2002, and December 31, 2013 were matched to Medicare claims data using an indirect identifier methodology. Late outcomes captured in the VQI and in Medicare claims were compared. Results Matching procedures yielded 9,895 endovascular aneurysm repair (EVAR) patients (82.4% of eligible VQI patients) and 3,405 open aneurysm repair (OAR) patients (74.4% of eligible). Comparison of patients that did and did-not match to a Medicare claim demonstrated similar patient and procedure characteristics. Evaluation of late outcomes revealed good patient-level agreement on mortality for both EVAR (kappa 0.64) and OAR (kappa 0.82). Post-operative reintervention rates demonstrated lower agreement for both EVAR (kappa 0.26) and OAR (kappa 0.16). Conclusions This work demonstrates the feasibility of an algorithm using indirect identifiers to match VQI patients and procedures to Medicare claims data. The refinement of this strategy will focus on establishing and improving algorithms related to identifying and categorizing late events after EVAR, and may serve as a mechanism to ensure the best quality follow-up information is achieved within the Vascular Quality Initiative.

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Background The long‐term effectiveness of atherectomy treatment for peripheral arterial disease is unknown. We studied 5‐year clinical outcomes by endovascular treatment type among patients with peripheral arterial disease. Methods and Results We queried the Medicare‐linked VQI (Vascular Quality Initiative) registry for endovascular interventions from 2010 to 2015. The exposure was treatment type: atherectomy (with or without percutaneous transluminal angioplasty [ PTA] ), stent (with or without PTA ), or PTA alone. The outcomes were major amputation, any amputation, and major adverse limb event (major amputation or any reintervention). We used the center‐specific proportions of atherectomy procedures performed in the 12 months before a patient's procedure as the instruments to perform an instrumental‐variable Cox model analysis. Among 16 838 eligible patients (median follow‐up: 1.3–1.5 years), 11% underwent atherectomy, 40% received PTA alone, and 49% underwent stenting. Patients receiving atherectomy commonly underwent femoropopliteal artery treatment (atherectomy: 65%; PTA : 49%; stenting: 43%; P <0.001) and had worse disease severity (Trans‐Atlantic Inter‐Society Consensus score [TASC] B and greater; atherectomy: 77%; PTA : 68%; stenting: 67%; P <0.001). The 5‐year rate of major adverse limb events was 38% in patients receiving atherectomy versus 33% for PTA and 32% for stenting (log rank P <0.001). Controlling for unmeasured confounding using instrumental‐variable analysis, patients treated with atherectomy experienced outcomes similar to those of patients treated with PTA , except for a higher risk of any amputation (hazard ratio: 1.51; 95% CI , 1.08–2.13). However, compared with stenting, atherectomy patients had a higher risk of major amputation (hazard ratio: 3.66; 95% CI , 1.72–7.81), any amputation (hazard ratio: 2.73; 95% CI , 1.60–4.76), and major adverse limb event (hazard ratio: 1.61; 95% CI , 1.10–2.38). Conclusions Atherectomy is used to treat severe femoropopliteal and tibial peripheral arterial disease even though long‐term adverse outcomes occur more frequently after this treatment modality.

Background: Limited evidence suggests that women and men might be treated differently for peripheral arterial disease (PAD). This analysis evaluated sex-based differences in disease presentation and its effect on treatment modality among patients who underwent endovascular treatment for PAD. Methods and Results: Using national registry data from the Vascular Quality Initiative between 2010–2013, we examined patient, limb, and artery characteristics by sex through descriptive statistics. We studied 26,750 procedures performed in 23,820 patients to treat 30,545 limbs and 44,804 arteries. Women presented at an older age (69 vs 67 years, p<0.001) and were less often current or former smokers (72% vs 85%, p<0.001). TASC classification was similar among men and women (TASC C or D: 37% in men vs 37% in women, p=0.81), as was mean occlusion length (4.5cm in men vs 4.6cm in women, p=0.04), even after accounting for lesion location. Women more frequently underwent treatment for rest pain (11% in men vs 16% in women, p<0.001) versus claudication (59% in men vs 53% in women, p<0.001) or tissue loss (28% in men vs 27% in women, p=0.75). Treatment modality did not differ by sex, but was associated with disease severity (p for trend<0.001) and lesion location (p for trend<0.001). Conclusions: Women undergo PVI for PAD at an older age with critical limb ischemia. Treatment modalities do not vary by sex, but are determined by disease severity and site. While there exist sex differences in presentation, these differences do not lead to differential treatment for women with PAD.

BackgroundLimited data exist to describe factors that influence the use of different endovascular treatments for peripheral arterial disease. Therefore, we studied sex differences in the utilization of endovascular treatment modalities and their impact on arterial patency.Methods and ResultsWe analyzed procedures from 2010 to 2016 in the Vascular Quality Initiative for arteries treated with percutaneous transluminal angioplasty (PTA) alone, stenting (with/without PTA), and atherectomy (with/without PTA). We explored sex differences in treatment modality by arterial segment (iliac, femoropopliteal, and tibial) with multivariable logistic regression. We used Kaplan–Meier survival analysis and multivariable Cox regression to study sex differences in arterial reintervention and occlusion. In this cohort, patients (n=58 247, mean age 68 years, 41% women,) had 106 073 arteries treated (median=2 arteries, interquartile range=1–3). Half (50%) of these arteries were treated with stents, 39% with PTA alone, and 11% with atherectomy. After risk adjustment, women were less likely to undergo stenting or atherectomy (versus PTA alone) in the femoropopliteal (stent risk ratio=0.78 [0.74–0.82]; atherectomy risk ratio=0.69 [0.58–0.82]) and tibial arteries (stent risk ratio=0.70 [0.55–0.89]; atherectomy risk ratio=0.87 [0.70–1.07]). In the iliac arteries there was no sex difference in stenting, and atherectomy was rarely used (0.2%). Women underwent reintervention in the femoropopliteal arteries (hazard ratio=1.28 [1.17–1.40]) or developed an occlusion in the iliac (hazard ratio=1.42 [1.12–1.81]) and femoropopliteal arteries (hazard ratio=1.19 [1.06–1.34]) more frequently than men.ConclusionsWomen were less likely to undergo stenting or atherectomy and had higher rates of occlusion and reintervention, especially in the femoropopliteal arteries. Evidence‐based guidelines are needed to guide optimal use of endovascular treatments for men and women.

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