Vascular Quality Initiative Assessment of Compliance with Society for Vascular Surgery Practice Guidelines for the Endovascular Management of Claudication

Introduction: In 2015, Society for Vascular Surgery 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 2010-2021 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 to 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 post operative 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 5-15cm lesions. Guideline aligned care worsened for isolated infrapopliteal treatments and use of bare metal stents for 5-15 cm SFA 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.

Conclusion: While 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.