Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions: Variation in Utilization and Impact on In-Hospital Outcomes From the Nationwide Inpatient Sample (2006-2011)

J Endovasc Ther. 2016 Feb;23(1):65-75. doi: 10.1177/1526602815620780. Epub 2015 Dec 4.


Purpose: To examine the impact of intravascular ultrasound (IVUS) utilization during lower limb endovascular interventions as regards postprocedural complications and amputation.

Methods: The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database between the years 2006 and 2011. Peripheral endovascular interventions were identified using appropriate ICD-9 procedure codes. Two-level hierarchical multivariate mixed models were created. The co-primary outcomes were in-hospital mortality and amputation; the secondary outcome was postprocedural complications. Model results are given as the odds ratio (OR) and 95% confidence interval (CI). Hospitalization costs were also assessed.

Results: Overall, among the 92,714 patients extracted from the database during the observation period, IVUS was used in 1299 (1.4%) patients. IVUS utilization during lower extremity peripheral vascular procedures was independently predictive of a lower rate of postprocedural complications (OR 0.80, 95% CI 0.66 to 0.99, p=0.037) as well as lower amputation rates (OR 0.59, 95% CI 0.45 to 0.77, p<0.001) without any significant impact on in-hospital mortality. Multivariate analysis also revealed IVUS utilization to be predictive of a nonsignificant increase in hospitalization costs ($1333, 95% CI -$167 to +$2833, p=0.082).

Conclusion: IVUS use during lower limb endovascular interventions is predictive of lower postprocedural complication and amputation rates with a nonsignificant increase in hospitalization costs.

Keywords: amputation; angioplasty; complications; cost analysis; intravascular ultrasound; mortality; peripheral vascular interventions; resource utilization; stents; ultrasound.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical
  • Chi-Square Distribution
  • Cost-Benefit Analysis
  • Databases, Factual
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / economics
  • Endovascular Procedures / mortality
  • Endovascular Procedures / statistics & numerical data*
  • Female
  • Hospital Costs
  • Hospital Mortality
  • Humans
  • Limb Salvage
  • Linear Models
  • Lower Extremity / blood supply*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Peripheral Vascular Diseases / diagnostic imaging
  • Peripheral Vascular Diseases / mortality
  • Peripheral Vascular Diseases / surgery
  • Peripheral Vascular Diseases / therapy*
  • Practice Patterns, Physicians'* / economics
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Interventional / economics
  • Ultrasonography, Interventional / statistics & numerical data*
  • United States
  • Young Adult