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IVUS Utilization Beneficial During Lower-Limb Peripheral Interventions
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Researchers analyzed data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample on peripheral endovascular interventions performed from 2006 to 2011 (n = 92,714; 55% men; mean age, 60 years). The primary outcomes were in-hospital mortality and amputation; the secondary outcome was complications after the procedure.
In total, IVUS was utilized in 1.4% of cases analyzed.
IVUS utilization during lower-extremity peripheral vascular procedures independently predicted reduced postprocedural complications (OR = 0.8; 95% CI, 0.66-0.99; P = .037) and amputations (OR = 0.59; 95% CI, 0.45-0.77; P < .001). The lower amputation rate with IVUS utilization was observed for below-knee, above-knee and minor amputations (P < .001 for all). IVUS was also predictive of lower amputation rates in subgroups including patients with acute limb ischemia, emergent admissions and higher baseline comorbidities.
In other findings, the overall rate of vascular complications in this cohort was 11.3%, and was lower among patients in whom IVUS was used (9.2% vs. 11.4%; P < .001). Renal complications were also reduced with IVUS use (0.2% vs. 0.4%; P = .007), according to the results.
The researchers reported no impact of IVUS utilization on in-hospital mortality.
According to multivariate analysis, IVUS utilization was also predictive of a nonsignificant rise in hospitalization costs ($1,333 [95% CI, –167 to 2,833; P = .082).
A propensity-matched cohort analysis yielded similar results.
“As the number of peripheral vascular interventions increases, more complex lesions are being treated; our study results provide supportive data for IVUS use, which should be particularly helpful as newer stents and [drug-eluting balloons] are introduced,” Sidakpal S. Panaich, MD, and colleagues wrote. “The nonsignificant increase in hospitalization costs with IVUS use should be weighed against the net clinical benefit. Future studies should also assess risk-adjusted costs of possible reduction in repeat revascularization procedures and rehospitalizations with the use of IVUS.” – by Katie Kalvaitis
Disclosure: The researchers report no relevant financial disclosures.
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