In-Hospital Outcomes and Temporal Trends of Surgical Versus Intravascular Ultrasound–Guided Endovascular Interventions for Femoropopliteal Disease

TL;DR

This study compares hospital outcomes for surgical and ultrasound-guided treatments of leg artery disease, finding that the ultrasound method has lower risks and shorter recovery times.

Contribution

The study provides new evidence on the comparative safety and effectiveness of IVUS-guided endovascular interventions versus surgery for femoropopliteal disease.

Findings

IVUS-guided EVI had lower in-hospital mortality (1.6%) compared to surgery (3.5%).

IVUS-guided EVI resulted in fewer periprocedural complications and shorter hospital stays.

No significant differences were found in costs, cardiac complications, or major amputation rates.

Abstract

Peripheral artery disease is a global health concern, with femoropopliteal disease being a common manifestation. Recent advancements in endovascular interventions (EVI), guided by intravascular ultrasound (IVUS), have introduced promising treatment options. This study aims to compare in-hospital outcomes and trends of surgical versus IVUS-guided EVI for femoropopliteal disease.

The National Inpatient Sample database (2016-2021) was analyzed. Procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes, and the Cochran-Armitage test was used to assess temporal trends. Propensity score matching balanced baseline characteristics between the surgical (weighted N = 6700) and IVUS-guided EVI (weighted N = 6700) groups. Multivariable regression analysis adjusting for matched covariates was conducted to compare outcomes.

Multivariable logistic regression revealed that in-hospital mortality was lower in the IVUS-guided EVI group (1.6%) compared to the surgical group (3.5%) (OR, 0.386; 95% CI, 0.216-0.692). IVUS-guided EVI also had significantly fewer periprocedural complications (20.6% vs 24.7%; OR, 0.767; 95% CI, 0.636-0.924), including lower rates of bleeding, shock, infections, wound disruption, and respiratory failure. Multivariable linear regression showed that the length of stay was shorter for the IVUS-guided EVI group (β = –1.7 days; 95% CI, –2.2 to –1.1). No statistically significant differences were observed in inflation-adjusted costs, cardiac complications, major amputation, stroke, or renal failure.

Intravascular ultrasound–guided EVI for femoropopliteal disease are associated with better in-hospital outcomes compared to surgical revascularization, including lower in-hospital mortality, periprocedural complications, and a shorter length of stay. However, future prospective studies are needed to validate these results.

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