National variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic carotid artery stenosis Presented at the Forty-third Annual Symposium of the Society for Clinical Vascular Surgery, Miami, Fla, March 29-April 2, 2015.

Vascular Quality Initiative

Research output: Contribution to journalArticle

Abstract

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. 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

Original languageEnglish (US)
Pages (from-to)937-944
Number of pages8
JournalJournal of Vascular Surgery
Volume62
Issue number4
DOIs
StatePublished - Oct 1 2015

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Carotid Endarterectomy
Carotid Stenosis
Pathologic Constriction
Blood Vessels
Ultrasonography
Asymptomatic Diseases
Cerebral Angiography
Magnetic Resonance Angiography
Common Carotid Artery
Internal Carotid Artery
Cohort Studies
Databases
Physicians

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Medicine(all)

Cite this

@article{11f035de142a4a2bbc5350e35112cb33,
title = "National variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic carotid artery stenosis Presented at the Forty-third Annual Symposium of the Society for Clinical Vascular Surgery, Miami, Fla, March 29-April 2, 2015.",
abstract = "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. 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",
author = "{Vascular Quality Initiative} and Arous, {Edward J.} and Simons, {Jessica P.} and Flahive, {Julie M.} and Beck, {Adam W.} and Stone, {David H.} and Hoel, {Andrew W.} and Messina, {Louis M.} and Andres Schanzer and Jeb Hallett and Abularrage, {Christopher Joseph} and Daniel Clair and Alex Shepard and Joseph Schneider and Amy Reed and Grace Wang and Gary Lemmon and Ronald Dalman and Jeffrey Gilbertson and Fred Weaver and Mark Davies and Michael Costanza and Steven Kappes and Evan Lipsitz and Jens Jorgensen and Gilbert Upchurch",
year = "2015",
month = "10",
day = "1",
doi = "10.1016/j.jvs.2015.04.438",
language = "English (US)",
volume = "62",
pages = "937--944",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
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TY - JOUR

T1 - National variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic carotid artery stenosis Presented at the Forty-third Annual Symposium of the Society for Clinical Vascular Surgery, Miami, Fla, March 29-April 2, 2015.

AU - Vascular Quality Initiative

AU - Arous, Edward J.

AU - Simons, Jessica P.

AU - Flahive, Julie M.

AU - Beck, Adam W.

AU - Stone, David H.

AU - Hoel, Andrew W.

AU - Messina, Louis M.

AU - Schanzer, Andres

AU - Hallett, Jeb

AU - Abularrage, Christopher Joseph

AU - Clair, Daniel

AU - Shepard, Alex

AU - Schneider, Joseph

AU - Reed, Amy

AU - Wang, Grace

AU - Lemmon, Gary

AU - Dalman, Ronald

AU - Gilbertson, Jeffrey

AU - Weaver, Fred

AU - Davies, Mark

AU - Costanza, Michael

AU - Kappes, Steven

AU - Lipsitz, Evan

AU - Jorgensen, Jens

AU - Upchurch, Gilbert

PY - 2015/10/1

Y1 - 2015/10/1

N2 - 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. 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

AB - 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. 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

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U2 - 10.1016/j.jvs.2015.04.438

DO - 10.1016/j.jvs.2015.04.438

M3 - Article

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SP - 937

EP - 944

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 4

ER -