INTRAVASCULAR ultrasound (IVUS) is associated with reduced healthcare costs and fewer complication-related rehospitalisations in certain lower limb vein procedures, according to a large study of Medicare patients.1
Lower extremity venous disease affects the deep veins in the legs. Endovascular interventions such as catheter-directed thrombolysis, mechanical thrombectomy and stent placement are commonly used to remove clots or restore venous blood flow in these patients.2 The study assessed whether IVUS guidance, which provides real-time imaging from within the vessel, affects both costs and complication rates.
Cost Reductions Most Pronounced in Stenting
The analysis examined 52,610 Medicare beneficiaries aged 65 and older who underwent lower extremity venous interventions from 2016 to 20211. Of these, 42.6% received IVUS-guided procedures.
Across inpatient and outpatient settings, IVUS use was associated with lower costs at 90 days, with reductions ranging from 25-30%. These savings persisted at one and three years. Cost reductions were largest for stenting procedures, whereas thrombectomy and thrombolysis showed cost neutrality.
Adoption Patterns Across Settings
IVUS use was highest in outpatient and ambulatory surgical centre procedures and lowest in inpatient interventions. Although cost savings were observed in all care settings overall, the magnitude of reduction varied, ranging from a cost ratio of 0.71 in ambulatory surgical centres to 0.91 in inpatient settings.
As a retrospective study based on Medicare claims data, the analysis cannot establish causality. Statistical adjustments accounted for demographics and comorbidities, but other unmeasured factors may have influenced the outcomes.
Implications for practice
The findings suggest that IVUS is a cost-effective adjunct in lower extremity venous interventions, particularly for stent placement. Wider adoption may reduce both healthcare spending and complication-related hospital use, though its benefit appears limited for thrombectomy and thrombolysis.
Reference
- Herzig et al. A Cost Analysis of Intravascular Ultrasound during Lower Extremity Deep Venous Interventions Among Medicare Beneficiaries. Vasc Interv Radiol. 2026;DOI:10.1016/j.jvir.2026.108749.
- Sista AK et al. Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art. 2015;276(1):31-53
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