Purpose

To evaluate temporal trends, practice variation, and associated outcomes with the use of intravascular ultrasound (US) during deep venous stent placement among Medicare beneficiaries.

Materials and Methods

All lower extremity deep venous stent placement procedures performed between January 1, 2017, and December 31, 2019 among Medicare beneficiaries were included. Temporal trends in intravascular US use were stratified by procedural setting and physician specialty. The primary outcome was a composite of 12-month all-cause mortality, all-cause hospitalization, or repeat target vessel intervention. The secondary outcome was a composite of 12-month stent thrombosis, embolization, or restenosis.

Results

Among the 20,984 deep venous interventions performed during the study period, 15,184 (72.4%) utilized intravascular US. Moderate growth in intravascular US use was observed during the study period in all clinical settings. There was a variation in the use of intravascular US among all operators (median, 77.3% of cases; interquartile range, 20.0%–99.2%). In weighted analyses, intravascular US use during deep venous stent placement was associated with a lower risk of both the primary (adjusted hazard ratio, 0.72; 95% confidence interval [CI], 0.69–0.76; P < .001) and secondary (adjusted hazard ratio, 0.32; 95% CI, 0.27–0.39; P < .001) composite end points.

Conclusions

Intravascular US is frequently used during deep venous stent placement among Medicare beneficiaries, with further increase in use from 2017 to 2019. The utilization of intravascular US as part of a procedural strategy was associated with a lower cumulative incidence of adverse outcomes after the procedure, including venous stent thrombosis and embolization.

中文翻译：

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医疗保险受益人深静脉支架置入期间血管内超声的使用和相关结果

 目的

旨在评估 Medicare 受益人在深静脉支架置入期间使用血管内超声 (US) 的时间趋势、实践变化和相关结果。

 材料和方法

医疗保险受益人在 2017 年 1 月 1 日至 2019 年 12 月 31 日期间进行的所有下肢深静脉支架置入手术均包含在内。血管内超声使用的时间趋势按程序设置和医生专业进行分层。主要结局是 12 个月全因死亡率、全因住院或重复靶血管干预的综合结果。次要结局是 12 个月支架内血栓形成、栓塞或再狭窄的综合结果。

 结果

在研究期间进行的 20,984 例深静脉介入治疗中，15,184 例（72.4%）使用了血管内超声。研究期间，所有临床环境中均观察到血管内超声使用量适度增长。所有操作者中血管内超声的使用情况存在差异（中位数为 77.3%；四分位数范围为 20.0%–99.2%）。在加权分析中，深静脉支架置入期间血管内超声的使用与主要风险（调整后的风险比，0.72；95% 置信区间 [CI]，0.69–0.76； P < .001）和次要风险（调整后的风险比，0.32；95% CI，0.27-0.39； P < .001）复合终点。

 结论

血管内超声在医疗保险受益人的深静脉支架置入过程中经常使用，从 2017 年到 2019 年，使用量进一步增加。使用血管内超声作为手术策略的一部分与手术后不良后果的累积发生率较低相关，包括静脉支架血栓形成和栓塞。