Quality Indicators in Peripheral Arterial Occlusive Disease Treatment: A Systematic Review

Eur J Vasc Endovasc Surg. 2019 Nov;58(5):738-745. doi: 10.1016/j.ejvs.2019.06.029. Epub 2019 Sep 13.


Objectives: This systematic review aimed to identify evidence based quality indicators for invasive revascularisation of symptomatic peripheral arterial occlusive disease (PAOD).

Methods: A systematic search of clinical practice guidelines, consensus statements, systematic reviews, and meta-analyses reporting quality indicators in patients undergoing invasive open and percutaneous revascularisations for symptomatic PAOD (PROSPERO registration number: CRD42019116317) was performed. Furthermore, a grey literature search was conducted involving databases of professional vascular medical organisations. The identified publications were screened independently by two reviewers for possible inclusion and full texts of potentially relevant records were independently evaluated for eligibility. Disagreement was resolved by discussion involving a third reviewer.

Results: From 685 articles initially identified, one systematic review and one consensus statement focusing on quality indicators were selected for inclusion in the review. From these sources, a total of three process quality indicators matched the search criteria: one on pharmacological intervention, another on smoking cessation, and a third on surveillance of lower extremity vein bypass grafts. The grey literature search revealed an additional 31 structure, process, and outcome quality indicators.

Conclusions: This study revealed a lack of published evidence based quality indicators concerning invasive treatment for PAOD in the literature. An additional 31 indicators from the databases of professional societies and organisations have not been incorporated in prior guidelines. Interestingly, no indicator related to patient reported outcomes could be identified from either high quality sources or grey literature. Further research and harmonisation of different quality indicators is needed to enhance their evidence and subsequently improve patient centred decision making on invasive treatment.

Keywords: Chronic limb threatening ischaemia; Chronic peripheral arterial disease; Intermittent claudication; Outcomes; Quality indicators; Systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Humans
  • Intermittent Claudication / etiology
  • Intermittent Claudication / surgery
  • Outcome Assessment, Health Care
  • Peripheral Arterial Disease* / complications
  • Peripheral Arterial Disease* / surgery
  • Quality Indicators, Health Care*
  • Vascular Surgical Procedures* / methods
  • Vascular Surgical Procedures* / standards