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dc.contributor.authorArous, Edward J.
dc.contributor.authorSimons, Jessica P.
dc.contributor.authorFlahive, Julie
dc.contributor.authorBeck, Adam W.
dc.contributor.authorStone, David H.
dc.contributor.authorHoel, Andrew W.
dc.contributor.authorMessina, Louis M.
dc.contributor.authorSchanzer, Andres
dc.date2022-08-11T08:08:34.000
dc.date.accessioned2022-08-23T15:59:19Z
dc.date.available2022-08-23T15:59:19Z
dc.date.issued2015-10-01
dc.date.submitted2016-03-23
dc.identifier.citationJ Vasc Surg. 2015 Oct;62(4):937-44. doi: 10.1016/j.jvs.2015.04.438. Epub 2015 Jun 8. <a href="http://dx.doi.org/10.1016/j.jvs.2015.04.438">Link to article on publisher's site</a>
dc.identifier.issn0741-5214 (Linking)
dc.identifier.doi10.1016/j.jvs.2015.04.438
dc.identifier.pmid26067201
dc.identifier.urihttp://hdl.handle.net/20.500.14038/30638
dc.description.abstractOBJECTIVE: Carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis is among the most common procedures performed in the United States. However, consensus is lacking regarding optimal preoperative imaging, carotid duplex ultrasound criteria, and ultimately, the threshold for surgery. We sought to characterize national variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic CEA. METHODS: The Society for Vascular Surgery Vascular Quality Initiative (VQI) database was used to identify all CEA procedures performed for asymptomatic carotid artery stenosis between 2003 and 2014. VQI currently captures 100% of CEA procedures performed at > 300 centers by > 2000 physicians nationwide. Three analyses were performed to quantify the variation in (1) preoperative imaging, (2) carotid duplex ultrasound criteria, and (3) threshold for surgery. RESULTS: Of 35,695 CEA procedures in 33,488 patients, the study cohort was limited to 19,610 CEA procedures (55%) performed for asymptomatic disease. The preoperative imaging modality used before CEA varied widely, with 57% of patients receiving a single preoperative imaging study (duplex ultrasound imaging, 46%; computed tomography angiography, 7.5%; magnetic resonance angiography, 2.0%; cerebral angiography, 1.3%) and 43% of patients receiving multiple preoperative imaging studies. Of the 16,452 asymptomatic patients (89%) who underwent preoperative duplex ultrasound imaging, there was significant variability between centers in the degree of stenosis (50%-69%, 70%-79%, 80%-99%) designated for a given peak systolic velocity, end diastolic velocity, and internal carotid artery-to-common carotid artery ratio. Although 68% of CEA procedures in asymptomatic patients were performed for an 80% to 99% stenosis, 26% were performed for a 70% to 79% stenosis, and 4.1% were performed for a 50% to 69% stenosis. At the surgeon level, the range in the percentage of CEA procedures performed for a < 80% asymptomatic carotid artery stenosis is from 0% to 100%. Similarly, at the center level, institutions range in the percentage of CEA procedures performed for a < 80% asymptomatic carotid artery stenosis from 0% to 100%. CONCLUSIONS: Despite CEA being an extremely common procedure, there is widespread variation in the three primary determinants-preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery-of whether CEA is performed for asymptomatic carotid stenosis. Standardizing the approach to care for asymptomatic carotid artery stenosis will mitigate the significant downstream effects of this variation on health care costs.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=26067201&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.jvs.2015.04.438
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAngiography
dc.subjectCarotid Arteries
dc.subjectCarotid Stenosis
dc.subjectComorbidity
dc.subjectDatabases, Factual
dc.subject*Endarterectomy, Carotid
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectPreoperative Period
dc.subjectUltrasonography, Doppler, Duplex
dc.subjectSurgery
dc.titleNational variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic carotid artery stenosis
dc.typeJournal Article
dc.source.journaltitleJournal of vascular surgery
dc.source.volume62
dc.source.issue4
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/914
dc.identifier.contextkey8371001
html.description.abstract<p>OBJECTIVE: Carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis is among the most common procedures performed in the United States. However, consensus is lacking regarding optimal preoperative imaging, carotid duplex ultrasound criteria, and ultimately, the threshold for surgery. We sought to characterize national variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic CEA.</p> <p>METHODS: The Society for Vascular Surgery Vascular Quality Initiative (VQI) database was used to identify all CEA procedures performed for asymptomatic carotid artery stenosis between 2003 and 2014. VQI currently captures 100% of CEA procedures performed at > 300 centers by > 2000 physicians nationwide. Three analyses were performed to quantify the variation in (1) preoperative imaging, (2) carotid duplex ultrasound criteria, and (3) threshold for surgery.</p> <p>RESULTS: Of 35,695 CEA procedures in 33,488 patients, the study cohort was limited to 19,610 CEA procedures (55%) performed for asymptomatic disease. The preoperative imaging modality used before CEA varied widely, with 57% of patients receiving a single preoperative imaging study (duplex ultrasound imaging, 46%; computed tomography angiography, 7.5%; magnetic resonance angiography, 2.0%; cerebral angiography, 1.3%) and 43% of patients receiving multiple preoperative imaging studies. Of the 16,452 asymptomatic patients (89%) who underwent preoperative duplex ultrasound imaging, there was significant variability between centers in the degree of stenosis (50%-69%, 70%-79%, 80%-99%) designated for a given peak systolic velocity, end diastolic velocity, and internal carotid artery-to-common carotid artery ratio. Although 68% of CEA procedures in asymptomatic patients were performed for an 80% to 99% stenosis, 26% were performed for a 70% to 79% stenosis, and 4.1% were performed for a 50% to 69% stenosis. At the surgeon level, the range in the percentage of CEA procedures performed for a < 80% asymptomatic carotid artery stenosis is from 0% to 100%. Similarly, at the center level, institutions range in the percentage of CEA procedures performed for a < 80% asymptomatic carotid artery stenosis from 0% to 100%.</p> <p>CONCLUSIONS: Despite CEA being an extremely common procedure, there is widespread variation in the three primary determinants-preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery-of whether CEA is performed for asymptomatic carotid stenosis. Standardizing the approach to care for asymptomatic carotid artery stenosis will mitigate the significant downstream effects of this variation on health care costs.</p>
dc.identifier.submissionpathfaculty_pubs/914
dc.contributor.departmentDepartmetn of Surgery, Division of Vascular and Endovascular Surgery
dc.source.pages937-44


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