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Int J Angiol 2008; 17(2): 78-82
DOI: 10.1055/s-0031-1278285
Original Articles

© Georg Thieme Verlag KG Stuttgart · New York

A six-year study of diagnostic lower extremity imaging practice patterns and outcomes in the Veterans Affairs health care system

Richard E Scranton1 2 , Ravi Dhingra1 , Elizabeth V Lawler1 2 , Kent Yucel, Amy Guo3 , Subha P Chittamooru1 , David R Gagnon1 , Joel W Hay4 , John M Gaziano1 2
  • 1Veterans Affairs Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Cooperative Studies Programs, California, USA
  • 2Division of Aging, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts, California, USA
  • 3Bayer Healthcare Pharmaceuticals, Wayne, New Jersey, California, USA
  • 4University of Southern California, Los Angeles, California, USA
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Publication History

Publication Date:
28 April 2011 (online)

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Abstract

BACKGROUND: The use of diagnostic imaging in the United States continues to increase, while investigations of the clinical implications following testing are lacking. The objectives of the present study are to describe the practice patterns and clinical outcomes that follow lower extremity diagnostic imaging. This is a retrospective cohort study with six years of data (1999 to 2004).

METHODS: The sources of data for the present study were Veterans Affairs Hospital administrative and clinical databases. The study population included 19,209 American veterans who had either contrast- enhanced magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) for the assessment of peripheral artery occlusive disease. Descriptive statistics of the characteristics were provided, as well as adjusted ORs for having interventions or complications following an imaging procedure.

RESULTS: The number of patients initially imaged with a contrast- enhanced MRA increased from 1999 to 2004, while those imaged with DSA decreased. The overall imaging rate remained relatively constant. In the multivariate model adjusted for the risk of complications within 30 days of the initial imaging procedure, the risk of complications following DSA increased 2.29-fold (95% CI 1.60 to 3.30). More patients had an intervention following DSA (DSA 41% versus MRA 23%, P<0.0001) but were also twice as likely to have an intervention with an amputation (adjusted OR 2.36, 95% CI 1.79 to 3.12).

CONCLUSIONS: The present study illustrates the need for prospective evaluation of diagnostic imaging to determine how best to employ screening strategies that will optimize diagnostic imaging and treatment in patients diagnosed with peripheral artery occlusive disease.