Abstract 4144037: Association Between Imaging Follow Up and 1-Year Reintervention Risk After Peripheral Vascular Intervention for Claudicatio

Background: One-third of patients undergoing peripheral vascular intervention (PVI) for refractory claudication undergo a reintervention within 1 year. It is unknown whether receiving follow up imaging after PVI for claudication is associated with 1-year reintervention risk. Aim: To assess the association between receiving imaging follow-up within 3 months after PVI for claudication and 1-year reintervention risk before occurrence of major amputation. Method: We studied patients with claudication undergoing PVI who were alive and without reintervention at 3 months (2015-2018) in the Vascular Quality registry. Reintervention and imaging data were defined from Medicare data. Imaging follow-up included ankle brachial index (ABI), duplex ultrasound (DU), computed tomography angiography (CTA), and magnetic resonance angiogram (MRA) within 3 months post-PVI. We propensity-matched 1:1 for imaging follow-up status (No vs. Yes). The Aalen-Johansen method and Fine-Gray model assessed the 1-year cumulative incidence and reintervention risk (sub-hazard ratio, sHR) in patients without vs. with imaging follow-up, accounting for the competing mortality risk. Sensitivity analysis excluded ABI from imaging follow-up. Results: Each imaging follow-up status included 2,208 patients. Mean age was 71.3±8.4 years and 39.0% female. In patients with imaging, 47.1% received 1 imaging test, of which 75.1% were ABIs. Over 50% received ≥2 imaging tests within 3 months post-PVI, with 5% receiving ≥1 per month. The 1-year cumulative incidence and reintervention risk was similar in patients without vs. with imaging (17.5% 95%CI 15.9-19.2 vs. 18.8% 95%CI 17.1-19.2 and sHR 0.92 95%CI 0.80-1.06, P =0.259). When excluding ABI, the 1-year cumulative incidence and reintervention risk was lower in those without vs. with imaging (18.3% 95%CI 16.6-20.2 vs. 21.1% 95%CI 19.2-23.0 and sHR 0.86 95%CI 0.74-0.99, P =0.039) ( Figure ). Conclusion: Although over half of patients received multiple imaging tests within 3 months post-PVI for claudication, extensive imaging beyond ABI follow-up, was not associated with reintervention risk, which remained high with 1-year rates around 20%. Future efforts should study optimal imaging strategies and cost-benefit ratios.