2018 Detailed Annual Report

1. Executive Summary: The Value of Participation in the VQI 3 2. VQI Members Profile 5 3. Outcomes and Data Quality Dashboards 6 4. Regional Quality Groups 7 5. Quality Improvement Projects: Learning from the Data 8 6. VQI National QI Projects 9 7. VQI Data Analysis 12 8. Using VQI Data for Collaborative Projects 12 9. Future Developments 15

APPENDICES

A. Participating Sites 17 B. SVS Patient Safety Organization 19 C. Medstreaming/M2S Technology Partner 19 D. VQI Registry Dashboards 20 E. Sample COPI Report (Endovascular AAA Length of Stay) and Best Practice Dashboard (Center-level) 32 F. VQI Regional Quality Groups and Leadership 37 G. VQI Quality Improvement Projects 2017/18 38 H. National Approved Project List, October 2017 – September 2018 39 I. National Publications, October 2017 – September 2018 44 J. SVS PSO Councils and Registry Committees 49

SVS VQI 2018 Annual Report 1. EXECUTIVE SUMMARY—THE VALUE OF PARTICIPATION IN THE VASCULAR QUALITY INITIATIVE (VQI)

“If you can’t measure it, you can’t improve it.” This management catchphrase has been attributed to Edwards Deming, Peter Drucker, Lord Kelvin and others, but it could serve as the founding principle of the Vascular Quality Initiative. Our mission is to gath- er data to help hospitals and providers assess their performance and provide better vascular care.

VQI’s 12 registries contain demographic, clinical, use the strength of different societies (VQI, NCDR, procedural and outcomes data from more and SIR) to enhance device evaluation and than 500,000 vascular procedures performed to develop objective performance criteria for nationwide and in Canada. Each record the endovascular treatment of lower-extremity includes information from the patient’s initial arterial occlusive disease. VQI also works with hospitalization and at one-year follow-up. The industry to provide clinically detailed data for wealth of data allows centers and providers to device performance, post-market surveillance, compare their performance to regional and and label expansion. VQI has partnered with national benchmarks. All centers and providers vascular registries from Europe and Asia to receive biannual dashboards and regular form the International Consortium of Vascular performance reports, so they can use their Registries (ICVR) to bring a global perspective to data to support quality improvement initiatives. improving vascular care and device evaluation. Biannual regional meetings allow physicians of different specialties, nurses, data managers, quality officers, and others to meet, share information and ideas, and learn from each other in a positive and supportive environment. Members have used VQI data to significantly new56 centers improve the delivery of vascular care at local and national levels, reducing complications and 502 expenses. total centers

Investigators have used VQI data for risk 519,178 stratification, outcomes analysis, quality procedures improvement, defining best clinical practices, comparative effectiveness research and new99 data reducing resource utilization. This work has analysis projects resulted in more than 140 scientific publications in peer-reviewed journals since 2011. VQI 63 membership also facilitates participation new published journal articles in clinical trials and other medical device evaluation efforts.

The VQI collaborates with multiple organizations, 18 including the American College of Cardiology, new quality Society of Interventional Radiology, governmental improvement regulatory agencies, device manufacturers, and abstracts and payers. The Registry Assessment of Peripheral posters Interventional Devices (RAPID) is a collaboration of VQI with these other groups. RAPID plans to

www.VQI.org Activities for 2017/2018 INTRODUCTION TO THE VQI 1. Center and procedure growth: As of September The Vascular Quality Initiative® (VQI®) is a 2018, VQI had reached two new milestones, with more collaboration of the Society for Vascular Surgery than 500 member centers and more than 500,000 Patient Safety Organization (SVS PSO), 18 vascular procedures in its registries. regional quality improvement groups organized under the SVS PSO, and Medstreaming/M2S, its 2. Projects and journal articles: In the past year, commercial technology partner. Other partners VQI’s Research Advisory Council approved 99 data include the American Venous Forum (AVF), the analysis projects using VQI data, and 63 articles were Society for Vascular Medicine (SVM), Vascular published in peer reviewed journals. Access Society of America (VASA) and the Society of Vascular Ultrasound (SVU), along 3. National quality improvement initiatives: The SVS with an additional 15 endorsing societies (see PSO launched two major quality initiatives, working Appendix B for the full list). with regional quality groups and centers to develop strategies to 1) increase the prescription of appropri- The mission of VQI is to improve the quality, ate discharge medications for secondary prevention safety, effectiveness and cost of vascular and 2) increase the use of imaging for long-term healthcare. follow-up of endovascular AAA patients. The SVS PSO is a wholly-owned LLC of the 4. Quality project program: There are 55 VQI centers Society for Vascular Surgery, with headquarters working on specific quality improvement projects. Re- in Chicago. The SVS PSO governs all functions sults will be presented as posters and abstracts at the of VQI, including the specification of data VQI@VAM meeting to take place in June 2019. elements captured in each registry, the types of standard reports made available to regional 5. Dashboards and Center Opportunity Profile groups, member hospitals and physicians, for Improvement (COPI) reports: The center-level and national quality improvement projects and physician-level dashboard reports are produced sponsored by VQI. quarterly for each VQI registry to report outcomes and provide benchmarks. COPI reports use VQI data to The SVS PSO is supported by 170 physician highlight process of care for improvement. volunteers who dedicate their time and effort in support of VQI’s mission. These physicians 6. VQI@VAM: The SVS PSO hosts this annual meeting in provide governance, clinical support to all conjunction with the SVS Vascular Annual Meeting to the registries and data analyses and ad-hoc present the latest quality activities, including in-depth support in areas such as industry partnerships case reviews, case study presentations, and outcomes and communications. In addition, all centers analysis as well as presentations from quality experts. and regions have lead physicians and regional VQI@VAM19 will be held at National Harbour, MD. medical directors to provide guidance, identify best practices and develop regional initiatives. 7. Industry projects: Five post-approval surveillance projects are currently underway in VQI. In addition, the The SVS PSO is funded by annual registry Transcarotid Surveillance Project (TSP) allows centers subscription fees from participating hospitals or to participate in the study and receive reimburse- physician groups, and additional contributions ment for eligible cases. VQI allows data collection for VQI projects are provided by corporate for CREST-2 participation and works with industry and supporters. regulatory agencies in the Registry Assessment of Pe- ripheral Interventional Devices (RAPID) and Superficial Popliteal EvidEnce Development (SPEED) projects.

8. Development: The SVS PSO is currently working on enhancements to VQI’s PVI and Hemodialysis registries, and two new registries are nearing completion – the Vascular Medicine Registry and the Venous Stent VascularVascularRegistry. Quality Quality Initiative® Initiative®

4 SVS VQI 2018 Annual Report YEAR IN REVIEW 2017/2018 YEAR IN REVIEW 2017/2018

Bard LifeStent® Popliteal Artery Initial work has been completed on defining a Technology Improvements VQI Activity Stent Project set of core data elements as well as unique with External This post-approval surveillance project is device identifiers.The current phase involves Through M2S Outcomes Reporting designed to further evaluate the Bard analyzing device performance. The 4th Annual Stakeholders LifeStent® for treatment of popliteal artery Meeting was held recently in Silver Spring, MD. atherosclerosis. It will enroll 74 patients with Daniel Bertges, MD, University of Vermont Registry Revisions New Quarterly Dashboards Medical Center, presented a preliminary MEDICAL DEVICE two-year follow up, and remains open for Transition to the newly revised CAS registry was completed, with These Registry-specific reports allow physicians and centers to compare member participation. analysis of endovascular device performance in MANUFACTURE PROJECTS the superficial femoral and popliteal artery mapping of old registry data elements such that all data are available to their performance to regional and national benchmarks on dozens of location. The goal is to share data from multiple centers in the Analytic Engine. Enhancements to the PVI registry included process and outcome measures. Medtronic IN.PACT Admiral DCB the addition of drawings to illustrate TASC grading and regular updates to TCAR Surveillance Project registries to provide a larger database for ISR Project analysis. The FDA hopes to use this real-world devices through GUDID data importing. Semi-Annual Regional Reporting This project is designed to collect one-year This post-approval surveillance project is experience to assist in regulatory decision The SVS PSO produces de-identified reports in the spring and fall that follow up data to assess the real-world making. IVC Filter Retrieval Report & Email Notification outcomes of trans-carotid artery revasculariza- designed to confirm that IN.PACT Admiral drug give centers detailed information about their performance on more than tion (TCAR) in comparison with carotid coated balloons are safe and effective for This report identifies patients with a temporary IVC filter at the time that 20 key measures, such as postop stroke and length of stay, across all treatment of in-stent restenosis lesions in the removal is indicated and notifies the provider or staff by email to assist registries. These reports, which show how each center compares to other endarterectomy as performed in VQI centers. In International Consortium of September 2016, CMS approved reimburse- superficial femoral and popliteal arteries. This YEAR thisIN process. REVIEW This report facilitates 2017/2018 physician and office workflow centers2. in VQI its region MEMBERS and to other centers nationally,PROFILE are the principalYEAR IN REVIEW 2017/2018 ment for physicians and centers that perform project will enroll 300 patients with three-year Vascular Registries (ICVR) facilitating improved patient care. topic of discussion2. VQI Members at the spring Profile and fall meetings of the VQI regional follow-up and remains open for member groups. Reports are distributed to all users directly in secure file formats. THE VQI REGISTRIES TCAR procedures on both symptomatic and VQI and 11 other national vascular registries Figure 2.1: Growth of VQI Centers (YTD September 2018) participation. asymptomatic medical high-risk patients, from Europe and Australasia combined data to Audit & Supplemental Data Query Worklist As of September 2017, there were 12 VQI reg- Figure 2.1: Growth of VQI Centers (YTD September 2018) provided that those procedures and follow-up analyze variation in treatment of carotid and This new tool within PATHWAYS allows VQI participants to respond to Center Outcome Performance for Improvement istries that contained 413,905 vascular pro- COLLABORATIVE PROJECTS aortic aneurysm disease across countries. are entered into the VQI CAS Registry. The SVS Bard LifeStent® Poplitealdata audits Artery and queries initiatedInitial workby the has SVSbeen PSO. completed It provides on defininga rapid a Reports (COPI)Growth of VQI Centers cedures. During the past year (October 2017 PSO Steering Committee will make periodic WITH OTHER VQI CurrentActivity projects are analyzing volume-outcome YEARinterface IN with REVIEW Pathways data such2017/2018 that users can easily edit or add Technology ImprovementsYEAR IN REVIEW 2017/2018 Stent Project set of core data elements as well as unique The SVS PSO produces periodic analyses that look in depth at a single key through September 2018), there were over data analyses. Publication of data collected in ORGANIZATIONS relationships and variations between countries needed data identified bydevice SVS PSO identifiers.The audits. current phase involves outcome, determine patient and procedural factors that increase risk of withfor Externalcarotid and AAA treatment, as well asThis post-approval surveillance project is Through500 M2S 100,000Outcomes procedures addedReporting to the registries, for a this project which will help inform future CMS designed to further evaluate the Bard analyzing device performance. The 4th Annual that outcome, and show centers how they compare to their region and CAS coverage decisions and two abstracts will developing a core dataset for future PAD QCDR and MIPS Meeting was held recently in Silver Spring, MD. the nation on each of those risk factors. Recent topics have included LOS total of 519,178. Registry Assessment of PeripheralStakeholders projects. A project to evaluate EVAR devicesLifeStent® for treatment of popliteal artery be presented by the TCAR Steering Committee atherosclerosis. It will enrollM2S 74 was patients approved with by CMSDaniel as a QualifiedBertges, MD, Clinical University Data Registryof Vermont (QCDR) afterRegistry CEA and hematomaRevisions after PVI. New Quarterly Dashboards Interventional Devices (RAPID) used to treat ruptured AAA is underway. Medical Center, presented a preliminary at VAM18. two-yearBard follow LifeStent® up, and remainsfor Popliteal the open2018 forProgramArtery Year. ThisInitial is the 10thwork hasconsecutive been completed year thaton definingthe M2S a 400 VQI is an active participant in RAPID, whichMEDICAL has DEVICE analysis of endovascular device performance in TransitionTechnology to the newly revised CAS Improvementsregistry was completed, with These Registry-specific reports allow physicians and centers to compare VQI Activity member participation. has been involved in CMS’s PQRSset program,of core data and elements the 4th as year well that as unique the M2S mapping of old registry data elements such that all data are available to their performance to regional and national benchmarks on dozens of developed a minimum core dataset for the MANUFACTURE PROJECTS Stent Project the superficial femoral and popliteal artery TEVAR Dissection Project CREST-2 Registry has been an approved QCDR. Baseddevice on identifiers.The the VQI Registry, current M2S phase supports involves centers in the Analytic Engine. Enhancements to the PVI registry included process and outcome measures. evaluation of endovascular peripheral arterial with External This post-approval surveillance project is location. The goal is to share data from multiple This project, initiated in 2014, has demonstrat- This randomized controlled clinical trial Medtronic IN.PACTreporting Admiral of DCB 12 MIPS individualanalyzing measures device and performance.13 QCDR non-MIPS The 4th Annual the additionThrough of drawings to illustrateM2S TASC grading and regular updates to Outcomes Reporting devices from multiple data sources. RAPID is a designed to further evaluate the Bard registries to provide a larger database for 300 ed the value of expanding surveillance to real TCAR Surveillancecompares CEA Project and CAS to best medical therapy. individual measures for the 2018Meeting MIPS reportingwas held recently period, in whichSilver areSpring, MD. devices through GUDID data importing. Total Procedures Public Private Partnership between the FDA, Stakeholders ISR LifeStent®Project for treatment of popliteal artery analysis. The FDA hopes to use this real-world Semi-Annual Regional Reporting world device performance while meeting FDA This projectInvestigators is designed to use collect VQI one-yearto report CAS proceduresatherosclerosis. It willavailable enroll 74 to patients all VQI physicianwith experience members.Daniel toBertges, assist inMD, regulatory University decision of Vermont professional societies (SVS, ACC, SIR), academia, This post-approval surveillance project is Registry Revisions The SVSNew PSOCaptured Quarterly produces de-identified Dashboards reports5 in 1the9 spring,1 7and8 fall that requirements, with faster patient enrollment follow up todata become to assess qualified the real-world for this trial and then two-year follow up, and remains open for making.Medical Center, presented a preliminary IVC Filter Retrieval Report & Email Notification industry, payers, and others to support a outcomesMEDICAL of trans-carotid DEVICE artery revasculariza- designed to confirm that IN.PACT Admiral drug analysis of endovascular device performance in Transition to the newly revised CAS registry was completed, with give centersThese Registry-specific detailed information reports about allow their physicians performance and centers on more to compare than compared to traditional study methodology. In report non-randomized procedures during themember participation. 200 national medical device evaluation system. tionIn MANUFACTURE(TCAR) in comparison with PROJECTS carotid coated balloons are safe and effective for the superficial femoral and popliteal artery This reportmapping identifies of old registry patients data with elements a temporary such thatIVC allfilter data at arethe availabletime that to 20 keytheir measures, performance such as to postop regional stroke and nationaland length benchmarks of stay, across on dozensall of partnership with Gore and Medtronic, the SVS trial. This year more than 90 interventioniststreatment of in-stent restenosis lesions in the process and outcome measures. Phase 2, VQI data is being used to develop endarterectomy as performed in VQI centers. In location. The goal is to share data from multiple removalcenters is indicated in the Analytic and notifies Engine. the Enhancements provider or staff to theby emailPVI registry to assist included registries. These reports, which show how each center compares to other PSO and M2S completed enrollment of the used VQI to report more than 800 CAS superficialMedtronic femoral andIN.PACT popliteal Admiral arteries. This DCB International Consortium of this process.the addition This reportof drawings facilitates to illustrate physician TASC and gradingoffice workflow and regular updates to centersPeripheral in its region Vascular and to other Intervention centers nationally,164,793 are the principal objective performance criteria (OPC) for SeptemberTCAR 2016, Surveillance CMS approved Project reimburse - registries to provide a larger database for five-year cohort with annual follow ups procedures for the CREST-2 Registry project.project will enroll 300 patients with three-year Vascularanalysis. Registries The FDA hopes (ICVR) to use this real-world facilitatingdevices improved through GUDIDpatient data care. importing. topic of discussion at the spring and fall meetings of the VQI regional contemporary interventional treatment of ment for physicians and centers that perform ISR Project 100 Semi-Annual Regional Reporting continuing for five years, and the one-year This project is designed to collect one-year follow-up and remains open for member VQI and 11 other national vascular registries groups.Carotid Reports Endarterectomy are distributed to all users directly108,485 in secure file formats. SFA-popliteal arteries. TCAR procedures on both symptomatic and This post-approval surveillance project is experience to assist in regulatory decision The SVS PSO produces de-identified reports in the spring and fall that cohort of 200 patients otherwise recorded in asymptomaticfollow up datamedical to assess high-risk the real-worldpatients, participation. frommaking. Europe and Australasia combined data to AuditIVC & Filter Supplemental Retrieval ReportData Query & Email Worklist Notification outcomes of trans-carotid artery revasculariza- designed to confirm that IN.PACT Admiral drug Infra-Inguinalgive centers detailed Bypass information about their48,350 performance on more than the TEVAR registry. provided that those procedures and follow-up coated balloons are safe and effective for analyze variation in treatment of carotid and This newThis reporttool within identifies PATHWAYS patients allows with VQI a participantstemporary IVC to filterrespond at the to time that Center20 key Outcome measures, suchPerformance as postop stroke for and Improvement length of stay, across all tion (TCAR) in comparison with carotid COLLABORATIVE PROJECTS aortic aneurysm disease across countries. are entered into the VQI CAS Registry. The SVS data 0audits and queries initiated by the SVS PSO. It provides a rapid Reports (COPI) endarterectomy as performed in VQI centers. In treatment of in-stent restenosis lesions in the removalJan-10 Jan-11 is indicatedJan-12 Jan-13 andJan-14 notifiesJan-15 Jan-16 the providerJan-17 Jan-18 or staff by email to assist Endovascularregistries. These reports,AAA Repair which show how each43,773 center compares to other PSO Steering Committee will make periodic WITHsuperficial OTHER femoral and popliteal arteries. This CurrentInternational projects are analyzing Consortium volume-outcome of interfacethis process.with Pathways This report data facilitatessuch that usersphysician can easilyand office edit workflowor add The SVScenters PSO inproduces its region periodic and to analysesother centers that look nationally, in depth are at thea single principal key September 2016, CMS approved reimburse- relationships and variations between countries needed data identified by SVS PSO audits. data analyses. Publication of data collected in ORGANIZATIONSproject will enroll 300 patients with three-year Vascular Registries (ICVR) facilitating improved patient care. outcome,topic determineof discussion patient at the andspring procedural and fall meetingsfactors that of increase the VQI regionalrisk of this projectment for which physicians will help and inform centers future that CMSperform for carotid andVQI AAA treatment, Member as well as Characteristics Hemodialysis Access 42,967 TCAR procedures on both symptomatic and follow-up and remains open for member VQI and 11 other national vascular registries that outcome,groups. Reports and show are distributedcenters how to they all users compare directly to their in secure region file and formats. CAS coverage decisions and two abstracts will participation. developing a core dataset for future PAD QCDRSource: M2S and PATHWAYS MIPS Data, September 2018 the nation on each of those risk factors. Recent topics have included LOS asymptomatic medical high-risk patients, Registry Assessment of Peripheral projects.from A Europe project and to evaluate Australasia EVAR combined devices data to Audit & Supplemental Data Query Worklist Carotid Artery Stent 24,077 be presented by the TCAR Steering Committee FIGURE 2 FIGUREM2S 3 was approved by CMS as a Qualified Clinical Data Registry (QCDR) after CEA and hematoma after PVI. provided that those procedures and follow-up Interventional Devices (RAPID) used analyzeto treat variation ruptured inAAA treatment is underway. of carotid and This new tool within PATHWAYS allows VQI participants to respond to Center Outcome Performance for Improvement at VAM18. COLLABORATIVE PROJECTS aortic aneurysm disease across countries. FigureforFigure the 2.2: 20182.2: VQI Program Participating Participating Year. Hospital This is TypesHospital the 10th consecutiveTypes year that the M2S Industry Support are entered into the VQI CAS Registry. The SVS VQI is an active participant in RAPID, which has data audits and queries initiated by the SVS PSO. It provides a rapid VaricoseReports Vein (COPI) 23,526 Current projects are analyzing volume-outcome has been involved in CMS’s PQRS program, and the 4th year that the M2S PSO Steering Committee will make periodic developedWITH a minimum OTHER core dataset for the interface with Pathways data such that users can easily edit or add The SVS PSO produces periodic analyses that look in depth at a single key TEVAR Dissection Project VQI PhysicianCREST-2 Specialtyrelationships Registry andDistribution variations between countries hasTypes been an approved of Affiliation, QCDR. Based on theVQI VQI Registry,Centers M2S supports Quality Champions data analyses.Quality Publication Partners of data collected in evaluationORGANIZATIONS of endovascular peripheral arterial needed data identified by SVS PSO audits. Supra-Inguinaloutcome, determine Bypass patient and procedural 16,197factors that increase risk of This project, initiated in 2014, has demonstrat- This randomizedfor carotid andcontrolled AAA treatment, clinical trial as well as reporting of 12 MIPS individual measures and 13 QCDR non-MIPS this project which will help inform future CMS devices from multiple data sources. RAPID is a that outcome, and show centers how they compare to their region and ed the value of expanding surveillance to real comparesdeveloping CEA and a core CAS datasetto best formedical future therapy. PAD individual measures7% for the 2018 MIPS reporting period, which are CAS coverage decisions and two abstracts will Public Private Partnership between the FDA, QCDR and MIPS Thoracicthe nation & on Complex each of those EVAR risk factors. Recent12,665 topics have included LOS world device performance while meeting FDA Registry Assessment of Peripheral Investigatorsprojects. Ause project VQI to to report evaluate CAS EVAR procedures devices available to all VQI physician members. be presented by the TCAR Steering Committee professional societies (SVS, ACC, SIR), academia, M2S was approved by CMS as a Qualified Clinical Data Registry (QCDR) after CEA and hematoma after PVI. requirements, with faster patient enrollment Interventional Devices (RAPID) to becomeused to qualified treat ruptured for this AAAtrial isand underway. then at VAM18. industry, payers, and others to support a for the 2018 Program Year. This is the 10th consecutive year that the M2S compared to traditional study methodology. In report non-randomized procedures during the Lower Extremity Amputations 12,098 nationalVQI is medicalan active device participant evaluation in system.RAPID, whichIn has has been involved in CMS’s PQRS program, and the 4th year that the M2S partnership with Gore and Medtronic, the SVS trial. This year more than 90 interventionists 37% TEVAR Dissection Project Phasedeveloped 2, VQI data a minimumis being used core to dataset develop for the CREST-2 Registry has been an approved QCDR. Based on the VQI Registry, M2S supports PSO and M2S completed enrollment of the evaluation of endovascular peripheral arterial used VQI to report more than 800 CAS 27% Open AAA Repair 11,377 This project, initiated in 2014, has demonstrat- objective performance criteria (OPC) for This randomized controlled clinical trial reporting of 12 MIPS individual measures and 13 QCDR non-MIPS five-year cohort with annual follow ups devices from multiple data sources. RAPID is a procedures for the CREST-2 Registry project. ed the value of expanding surveillance to real contemporary interventional treatment of compares CEA and CAS to best medical therapy. individual measures for the 2018 MIPS reporting period, which are continuing for five years, and the one-year Public Private Partnership between the FDA, IVC Filter 10,870 world device performance while meeting FDA SFA-popliteal arteries. Investigators use VQI to report CAS procedures available to all VQI physician members. cohort of 200 patients otherwise recorded in professional societies (SVS, ACC, SIR), academia, requirements, with faster patient enrollment to become qualified for this trial and then the TEVAR registry. industry, payers, and others to support a compared to traditional study methodology. In report non-randomized procedures during the national medical device evaluation system. In partnership with Gore and Medtronic, the SVS trial. This year more than 90 interventionists Phase 2, VQI data is being used to develop PSO and M2S completed enrollment of the used VQI to report more than 800 CAS objective performance criteria (OPC) for five-year cohort with annual follow ups procedures for the CREST-2 Registry project. 29% VQI Member Characteristics continuing for five years, and the one-year contemporary interventional treatment of SFA-popliteal arteries. cohort of 200 patients otherwise recorded in FIGURE 2 FIGURE 3 the TEVAR registry. Industry Support Figure 2.3: Distribution of VQI Physician Specialties 6 www.vqi.org Quality Champions Quality Partners www.vqi.org VQI Physician Specialty Distribution 3 Types of Affiliation, VQI Centers 5% 3% VQI Member Characteristics 8% Industry Support FIGURE 2 FIGURE 3 9% Quality Champions Quality Partners VQI Physician Specialty43% Distribution Types of Affiliation, VQI Centers

15%

17%

6 www.vqi.org www.vqi.org 35 www.VQI.org

6 www.vqi.org www.vqi.org 3 3. OUTCOMES & DATA QUALITY DASHBOARDS

The VQI dashboards allow physicians and centers to compare their performance to regional and national benchmarks. The SVS PSO registry committees selected outcome measures to be reported in the dashboards, which are distributed quarterly to VQI members. The dashboards provide each physician his or her individual results, along with results for the physician’s center, region and across all VQI. Results that are in the top 25th percentile are highlighted in green and those in the bottom 25th percentile are highlighted in red.

Table 3.1: Sample Physician Dashboard, PVI Registry

Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data Number of cases reviewed 3 46 2466 28817 Hematoma Any Hematoma 0% 4.4% 4.2% 2.4% Moderate/Major Hematoma 0% 0% 0.7% 0.7% Discharge Medications (excludes death in Antiplatelet 100% 95.3% 96.1% 94.1% hospital) Statin 100% 93% 86.1% 82.3% Smoking in Claudicants Never 0% 0% 9.5% 11.4% Prior 0% 22.2% 56.7% 49.3% Current 100% 77.8% 33.8% 39.3% 9-Month Outcomes Your Your Your VQI (JulyCategory 2015-June 2016 Outcome/Complication9-Month AFS* for CLI No cases 100% 90.8% 87.4%*** Results Center Region Overall with 9-month LTFU) 9-Month MALE** for CLI No cases 0% 13% 20.6%*** Long term follow-up (July 2015-June 2016) Long term follow-up rate No cases 87.5% 88.9% 71.4%

4. REGIONAL QUALITY GROUPS

Regional quality groups distinguish VQI from almost all other registries. Each of the 18 groups hold biannual meetings that provide a forum for discussion and work on quality improvement.

Figure 4.1: VQI Regional Group Map

During each region’s biannual meeting, members review and discuss their region’s data. Many groups identify an area for improvement and launch region-wide efforts to improve care. Topics that the groups have chosen to focus on include:

• Use of ultrasound guidance for peripheral interventions

• Increased recording of hemodynamic data (ABI/TBI) prior to peripheral intervention

• Measuring aneurysm sac diameter one year following EVAR and TEVAR

• Renal protection from contrast administration during peripheral interventions

• Increasing rates of IVC filter retrieval • Reducing LOS for multiple registries

www.VQI.org 5. QUALITY IMPROVEMENT QUALITY IMPROVEMENT PROJECTS PROJECTS: LEARNING FROM In response to this new charter initiative, THE DATA 55 VQI centers have submitted charters in 2018. The charters included the two The QI Community national initiatives, Discharge Medications The SVS PSO is encouraging centers to submit and EVAR LTFU Imaging, as well as clinical quality improvement charters on projects using and documentation topics. Selected VQI data. This process has helped the SVS PSO charter projects are listed below. identify groups working on similar initiatives and Table 5.1 – Quality Improvement Projects to Date facilitate networking opportunities. All members are encouraged to participate in focused group PARTICIPATING calls whether or not they have a charter. As CENTERS these projects reach completion, the SVS PSO will TOPICS aggregate data and share best practices with the full VQI membership. Discharge Medications 20 (National Initiative)

The SVS PSO also provides resources to assist VQI LOS (CEA and EVAR) 11 centers with their QI projects: LTFU (including EVAR Imaging, a 8 National Initiative), IVCF Retrieval • QI Project Guide and National Initiative Supplement: These booklets provide the Clinical: Blood Transfusion, 6 foundation and step-by-step guidance to begin AAA Processes, Limb Salvage, SSI and complete a QI project. The QI Project Smoking Cessation 5 Guide is designed to assist centers that are just beginning a QI project but may be useful Documentation: Epic Workflow, 5 at any stage of the QI process. Subsequently, Preop ABI, PVI Documentation the SVS PSO created a National Initiative TOTAL 55 Supplement, which focused on the progress with the two national QI priorities: Optimal Discharge Medications for Vascular Patients and Endovascular AAA Long-Term Follow-Up with Imaging.

• The “Members Only” area of the VQI website (www.vqi.org) offers access to national QI materials, including presentations and videos, as well as a QI discussion forum to encourage interaction among centers.

• National and regional meetings and quarterly calls help VQI data managers share best practices and QI project ideas.

8 SVS VQI 2018 Annual Report 6. NATIONAL QUALITY From January 2012 to the present, the prescription of antiplatelets and statins at IMPROVEMENT INITIATIVES— discharge has risen steadily among VQI DISCHARGE MEDICATIONS members as information about its benefits was disseminated through presentation of the data AND EVAR LONG-TERM analysis, publication of the results and sharing of FOLLOW-UP IMAGING reports with centers and physicians. In addition to the original data analysis and publication led Experienced VQI centers have applied registry by Randall DeMartino, MD, the SVS PSO provided data and implemented innovative approaches webinars and presentations at the VQI Annual to improve success rates for these initiatives. Meeting as part of this national QI initiative. The SVS PSO seeks to build on these efforts and Individual QI charters and regional presentations help these QI initiatives expand from clusters of continue to reinforce the importance and innovation to coast-to-coast improvements. success of these efforts. Optimal Discharge Medications for Vascular Figure 6.2: Discharge Medications and Statin Rate for 123 VQIFigure Hospitals 6.2: Discharge (2012 Medications to Date) and Statin Rate for 123 VQI Hospitals (2012 to Date) Patients The VQI’s first national QI initiative is the prescribing of antiplatelet agents and statins at discharge to improve patients’ long-term vascular health. Discharge medications was selected because it is a treatment that affects most vascular surgery patients and is readily actionable. There is strong evidence that antiplatelet agents and statins increase patient survival.

VQI data has shown that patients undergoing arterial procedures who received a discharge SOURCE: VQI prescription of antiplatelet medications and a statin had significantly better 5-year survival. The SOURCE: VQI For example, South Bend Hospital used VQI data VQI provided physicians with individual reports For example, South Bend Hospital used VQI data to show that only 65.9% of their patients in 2014 received antiplatelet showing their prescribing rates for discharge toand show statin medications. that only They 65.9% used a combinationof their patients of clinical protocols, in 2014 education and workforce reallocation to increase medications and how they compared to their receivedthe rate to 97.9 antiplatelet% in early 2016. Theand SVS statin PSO is now medications. developing a program designed specifically to help centers with peers. The VQI also disseminated evidence- Theythe greatest used opportunity a combination for improvement. of clinical protocols based information and tools for providers and at discharge following a vascular operation, patients, such as templated communications to educationNational QI Initiative: and EVAR workforce Long Term Followreallocation-Up (LTFU) Imaging to EVAR requires long-term monitoring to ensure the durability of repair. EVAR patients are susceptible to the late development of primary care physicians, to increase the number increaseendoleaks, which the can rate occur in to up to97.9% 20% of patientsin early and may2016. result The in rupture SVS. To ensure that patients achieve successful of patients receiving optimal medications. PSOoutcomes is now after EVAR, developing long-term follow a-up program imaging is essential designed, though recent studies have demonstrated low compliance rates specificallywith long-term follow to-up helpimaging aftercenters EVAR. with the greatest

opportunity for improvement. ______EVAR(SIDEBAR/Quote Long-Term from Dr. Scali) Follow-Up (LTFU) Imaging

EVAR “Endovascular requires aortic aneurysm long-term repair (EVAR) monitoring is a non-curative to treatment ensure of infrarenalthe abdominal aortic aneurysm disease. When durabilitycommercially available of repair. devices areEVAR used withinpatients their instructions are susceptible for use, excellent long-term rupture-free survival can be toantic theipated. late However, development due to the persistent of presence endoleaks, of the aneurysm which and the life-long risk of device related failure and/or canendoleak occur, up to 20% in ofup patients to 20%may experience of patients some form and of aorta may-related result re-intervention after EVAR. For this reason, long-term follow-up (LTFU) imaging after EVAR is mandatory, and patients need to be educated about this preoperatively and repeatedly induring rupture. follow-up. Recent It is the obligation studies of the haveoperating demonstrated surgeon to stress the need for life-long imaging surveillance and integrate lowdiscuss complianceions about LTFU into ratesall stages with of AAA long-termEVAR care to ensure follow- that their patients achieve durable outcomes.” —Salvatore upScali, imaging MD after EVAR. To ensure that patients

achieve______successful outcomes after EVAR, long- term follow-up imaging is essential.

www.VQI.org SAMPLE NATIONAL QI INITIATIVE DASHBOARD:

Discharge Medications (2018 Procedures) Excludes patients who died in hospital and patients who were not treated for medical reason or non- compliant.Includes CEA, CAS, OAAA, EVAR, TEVAR, INFRA, SUPRA, PVI and LEAMP procedures entered in the VQI as of March 31,2018. For theExcludes 2018 patients Participation who died inAwards, hospital centersand patients that who are were above not treated the 2018 for medical 75th percentile reason or non-compliant. for the rate of dischargeIncludes antiplatelet+statinCEA, CAS, OAAA, EVAR, willTEVAR, receive INFRA, a SUPRA, point PVI toward and LEAMP their procedures final award entered (as inlong the VQIas theiras of Marchrate is 31, not 2018.significantly lower than their 2017 rate). Centers that are below the 75th percentile but show statisticallyFor the significant 2018 Participation improvement Awards, centers (p-value<.05) that are above overthe 2018 their 75th 2017 percentile rate forwill the also rate receive of discharge a point toward theirantiplatelet+statin final award. will receive a point toward their final award (as long as their rate is not significantly lower than their 2017 rate). Centers that are below the 75th percentile but show statistically significant improvement (p-value<.05) over their 2017 The ratefirst will two also lines receive of a thepoint table toward belowtheir final show award. your center’s current antiplatelet+statin rate for 2018 cases. OtherThe first rows two lines show of the the table rate below of discharge show your center’s antiplatelet+statin current antiplatelet+statin that must rate forbe 2018 achieved cases. Other among rows your expectedshow the numberrate of discharge of remaining antiplatelet+statin 2018 cases that must for be your achieved center among to yourreach expected the 75thnumber percentile of remaining for 2018 2017, cases or to showfor statistically your center to significantreach the 75th improvement percentile for 2017, over or to its show 2017 statistically rate. Note significant that improvementthe 75th percentile over its 2017 for rate. 2017 has been providedNote that the as 75tha benchmark, percentile for 2017but hasthe been 75th provided percentile as a benchmark, for 2018 but cases the 75th will percentile likely be for different 2018 cases than will it waslikely for 2017.be different Thus, than reaching it was for the 2017. 75th Thus, percentile reaching the 75thfor 2017 percentile will notfor 2017 guarantee will not guarantee that your that yourcenter center is isabove the above75th thepercentile 75th percentile for 2018. for 2018. Results Number of 2018 procedures meeting inclusion criteria that your center had entered as of March 31, 112 2018 N (%) of 2018 patients receiving antiplatelet+statin 105 (94%) 75th percentile of antiplatelet+statin rates among VQI centers for 2017 89% Your center’s antiplatelet+statin rate for 2017 cases 90% Estimated total number of procedures your center will enter for 2018* 493 Estimated number of cases remaining to be entered 381 If your center is above the 75th percentile for 2017, minimum rate among estimated remaining 2018 cases to stay there 336/381 (88%) If your center is below the 75th percentile for 2017, minimum rate among estimated remaining 2018 cases to reach the 75th percentile or show statistically significant improvement over your 2017 rate NA (above 75th percentile)

*Extrapolated from your center’s case volume for Jan-Mar 2018.

Follow-Up Imaging After EVAR (2016 Procedures) Excludes patients who died within 21 months of surgery. “Imaging” includes CT, CTA, MR, MRA, duplex, and/orFollow-Up angiogram imaging Imaging between After 9 and EVAR 21 months (2016 of surgery. procedures) Time from surgery to imaging = Date of follow-up visit where surgery was recorded — surgery date. Excludes patients who died within 21 months of surgery. “Imaging” includes CT, CTA, MR, MRA, duplex, and/or angiogram imaging between 9 and 21 months of surgery. Time from surgery to imaging = Date of follow-up visit EVARwhere is used surgery to wastreat recorded AAA to — preventsurgery date. rupture and improve survival. Patients must have good survival and successful aneurysm exclusion to offset the risk of operation and gain benefit. All EVAR patients EVAR is used to treat AAA to prevent rupture and improve survival. Patients must have good survival and successful should undergo annual imaging to confirm success of the procedure and demonstrate absence of aneurysm exclusion to offset the risk of operation and gain benefit. All EVAR patients should undergo annual imaging to endoleak,confirm success which of could the procedure lead toand rupture. demonstrate absence of endoleak, which could lead to rupture.

For the For2018 the Participation 2018 Participation Awards, Awards, centerscenters that that are above are abovethe 2016 the75th 2016percentile 75th for percentile EVAR follow-up for imaging EVAR willfollow- receive a point toward their final award (as long as their rate is not significantly lower than their 2015 rate). Centers that are up imagingbelow the 75thwill percentilereceive buta point show statisticallytoward their significant final improvement award (as over long their as2015 their EVAR rate follow-up is not imaging significantly rate will alsolower thanreceive their a 2015 point towardrate). theirCenters final award. that are below the 75th percentile but show statistically significant improvement over their 2015 EVAR follow-up imaging rate will also receive a point toward their final The table below shows your center’s current imaging rate for 2016 cases and the number of additional cases with award. imaging that must be reported for your center to reach the 75th percentile for 2015, or to show statistically significant improvement over its 2015 imaging rate. 10 SVS VQI 2018 Annual Report Excludes patients who died in hospital and patients who were not treated for medical reason or non-compliant. Includes CEA, CAS, OAAA, EVAR, TEVAR, INFRA, SUPRA, PVI and LEAMP procedures entered in the VQI as of March 31, 2018. The tableFor below the 2018 shows Participation your Awards,center’s centers current that are imaging above the rate 2018 for 75th 2016 percentile cases for and the rate the of numberdischarge of additionalantiplatelet+statin cases with will receive imaging a point that toward must their be final reported award (as for long your as their center rate is tonot reachsignificantly the lower 75th than percentile their 2017 for 2015,rate). or toCenters show that statistically are below the significant 75th percentile improvement but show statistically over significant its 2015 improvementimaging rate. (p-value<.05) over their 2017 rate will also receive a point toward their final award. Note thatThe the first 75thtwo lines percentile of the table for below 2015 show has your been center’s provided current antiplatelet+statin as a benchmark rate for because 2018 cases. centers Other rows have hadshow a full the 21 rate months of discharge to enter antiplatelet+statin follow-up thatfor mustthose be cases,achieved but among the your 75th expected percentile number for of remaining 2016 cases 2018 willcases likely be differentfor your center than to itreach was the for 75th 2015. percentile Thus, forreaching 2017, or tothe show 75th statistically percentile significant for 2015improvement will not over guarantee its 2017 rate. that your centerNote thatis above the 75th the percentile 75th percentilefor 2017 has been for 2016. provided as a benchmark, but the 75th percentile for 2018 cases will likely be different than it was for 2017. Thus, reaching the 75th percentile for 2017 will not guarantee that your center is above the 75th percentile for 2018. Results Number of 2018 procedures meeting inclusion criteria that your center had entered as of March 31, 112 2018 N (%) of 2018 patients receiving antiplatelet+statin 105 (94%) 75th percentile of antiplatelet+statin rates among VQI centers for 2017 89% Your center’s antiplatelet+statin rate for 2017 cases 90% Estimated total number of procedures your center will enter for 2018* 493 Estimated number of cases remaining to be entered 381 If your center is above the 75th percentile for 2017, minimum rate among estimated remaining 2018 cases to stay there 336/381 (88%) If your center is below the 75th percentile for 2017, minimum rate among estimated remaining 2018 cases to reach the 75th percentile or show statistically significant improvement over your 2017 rate NA (above 75th percentile)

*Extrapolated from your center’s case volume for Jan-Mar 2018.

Follow-Up Imaging After EVAR (2016 procedures) Excludes patients who died within 21 months of surgery. “Imaging” includes CT, CTA, MR, MRA, duplex, and/or angiogram imaging between 9 and 21 months of surgery. Time from surgery to imaging = Date of follow-up visit where surgery was recorded — surgery date. “Endovascular aortic aneurysm repair (EVAR) is a non-curative treatment of infrarenal EVAR is used to treat AAA to prevent rupture and improve survival. Patients must have good survival and successful abdominalaneurysm exclusion aortic to aneurysmoffset the risk disease. of operation When and gain commercially benefit. All EVAR available patients should devices undergo are annual used imaging within to their instructionsconfirm success for of use, the procedureexcellent and long-term demonstrate rupture-free absence of endoleak, survival which can could be lead anticipated. to rupture. However, due to the persistent presence of the aneurysm and the life-long risk of device-related failure and/ For the 2018 Participation Awards, centers that are above the 2016 75th percentile for EVAR follow-up imaging will orreceive endoleak, a point towardup to their20% final of patientsaward (as long may as theirexperience rate is not significantlysome form lower of aorta-relatedthan their 2015 rate). re-intervention Centers that are afterbelow EVAR. the 75th For percentile this reason, but show long-term statistically follow-up significant improvement (LTFU) imaging over their after 2015 EVAR EVAR follow-upis mandatory, imaging rateand will also patientsreceive a pointneed toward to be their educated final award. about this preoperatively and repeatedly during follow-up. It is the obligation of the operating surgeon to stress the need for life-long imaging surveillance and The table below shows your center’s current imaging rate for 2016 cases and the number of additional cases with integrateimaging that discussions must be reported about for yourLTFU center into toall reach stages the 75th of AAA percentile EVAR for care 2015, orto to ensure show statistically that their significant patients achieveimprovement durable over its outcomes.” 2015 imaging rate. —Salvatore Scali, MD, Professor of Surgery, University of Florida

www.VQI.org the use of protamine and carotid patching from the Vascular tudy roup of e England and for discharge medications from the V. As of ctober the RA has approved proects and of those have resulted in peerrevieed publications. n the past year proects ere approved and have been published.

ee Appendices and for a list of approved proposals and Vrelated publications.

______(SIDEBAR)

7. VQI DATA ANALYSIS Figure 7.1, VQI Approved Data Analysis Projects, February 2011 to September 2018 Figure 7.1: VQI Approved Data Analysis Projects

VQI physicians may request de-identified VQI Data Analysis Projects, datasets from each registry for analysis. The February 2011 to September 2018 SVS PSO Research Advisory Council (RAC) reviews and evaluates requests for datasets by investigators, who provide the RAC a description of their proposed project. These projects have improved clinical care by, for instance, developing practice recommendations for the use of protamine and carotid patching, and for discharge medications. As of October 2018, the RAC has approved 273 projects, and of those, 147 Feb Feb Feb Feb Feb Feb Feb Feb have been published in peer-reviewed journals. In the past year, 99 projects were approved, Figure 7.2, VQI Publications, May 2012 to September 2018 resulting in 63 publications so far. Figure 7.2: VQI Publications See the full digital version of the VQI Annual VQI Publications, 2012 to Present Report at www.vqi.org for a list of approved proposals and VQI-related publications.

8. USING VQI DATA FOR COLLABORATIVE PROJECTS Medical devices are an integral component of vascular healthcare. VQI collects clinical data ay ay ay ay ay ay ay to better understand device performance. Data Source: PubMed may be used to meet regulatory requirements to support post-approval surveillance, or expand labeling indications.

Post-Approval Surveillance Projects The use of VQI data for post-approval surveillance is consistent with the FDA vision of registry-based evaluation. Initial projects have leveraged VQI infrastructure and reduced recruitment time and expenses. For example, the Thoracic Aortic Dissection (TEVAR) project (see p.13) was completed in half the time initially estimated by industry sponsors, Medtronic and Gore.

VQI has partnered with several device manufacturers to provide aggregate data for product development, creation of performance standards, and expansion of device indications:

• Bard LifeStent® Popliteal Artery Stent Project: Designed to further evaluate the Bard LifeStent® for treatment of popliteal artery atherosclerosis. The surveillance project will enroll 74 patients and include one-year and two-year follow up.

12 SVS VQI 2018 Annual Report • Medtronic IN.PACT Admiral DCB ISR Project: Registry Assessment of Peripheral Interventional Designed to confirm the safety and Devices (RAPID) efficacy of IN.PACT Admiral DCBs for the RAPID is a collaboration of professional societies treatment of in-stent restenosis (ISR) lesions (Society for Vascular Surgery, American College of in the superficial femoral and popliteal Cardiology, Society for Interventional Radiology), arteries. This project will enroll 300 patients academia, industry, CMS, private payers and across 50 sites for one-, two- and three-year EMRs. The goal is to develop a coordinated follow-up. registry network (CRN). The FDA, through the Medical Device Epidemiology Network • TEVAR Post-Approval Surveillance Projects: (MDEpiNet), has promoted the concept of CRNs Initiated in October 2014, these efforts to generate real-world evidence about medical have demonstrated the value of device performance. Data are aggregated expanding surveillance to real-world from multiple registries to evaluate and monitor device performance while meeting FDA endovascular devices and may be used to requirements. In partnership with Gore create an objective performance criterion (OPC). and Medtronic, the SVS PSO and M2S has The initial phase (completed) developed core completed enrollment of the one-year and data elements and definitions that can be used five-year cohorts. Follow-up for the one-year by all registries and incorporated unique device cohort is expected to be completed by identifiers. The next phase is to perform a registry- December 2018. based analysis of device performance and create an OPC for infrainguinal occlusive disease. Expansion of Device Indications Medical devices are approved for specific-use Transcarotid Artery Revascularization (TCAR) cases as outlined in the instructions for use (IFU). Surveillance Project (TSP) However, almost all devices are not infrequently TSP is a unique effort that allows CMS to reimburse used “off-label” for indications not specified in centers performing TCAR based on a national the IFU. Data about off-label use is captured in coverage determination. Centers participate in VQI, offering the potential to provide important the TSP by entering patients into the VQI registry information about device performance for non- approved indications. The FDA has indicated to allow the SVS PSO to assess the safety and that it would consider such data in support of an efficacy of TCAR in comparison to the standard application for label expansion. Industry projects treatment, carotid endarterectomy. This project could combine both historic and prospective will enroll more than 15,000 subjects with one- VQI data on device performance. This year, VQI year follow-up. demonstrated the ability to supplement already collected procedure and one-year follow-up To date, 176 centers have contributed more data with new data added by sites that had than 3,195 TCAR cases to the CEA registry. This performed these procedures, greatly reducing represents the largest dataset of information project completion time. on TCAR procedures. In June 2018, two papers Objective Performance Data highlighting preliminary results of the study were 1,2 Although the treatment of infrainguinal occlusive presented at the SVS Vascular Annual Meeting. disease is undergoing rapid change with new stents, balloons, and other devices coming on 1 In-hospital Outcomes of TransCarotid Artery Revascularization (TCAR) and the market with increasing frequency, it has Carotid Endarterectomy (CEA) in the SVS Vascular Quality Initiative, Marc L. been more than 10 years since the publication Schermerhorn, MD, Hanaa Dakour Aridi, MD, Vikram S. Kashyap, MD, Grace of objective performance criteria (OPC) for the J. Wang, MD, MS4, Brian Nolan, MD, MS, Jack Cronenwett, MD, Jens Eldrup- Jorgensen, MD, Mahmoud B. Malas, MD, MHS, JVS, June 2018. treatment of lower extremity occlusive disease. Regulatory approval of new devices often 2 TransCarotid Artery Revascularization (TCAR) vs. Transfemoral Carotid Artery Stenting (TFCAS) in the SVS Vascular Quality Initiative, Mahmoud B. Malas, MD, requires comparison with the contemporary MHS, Hanaa Dakour Aridi, MD, Grace J. Wang, MD, MS, Vikram S. Kashyap, MD, performance of existing techniques and Raghu Motaganahalli, MD, Jens Eldrup-Jorgensen, MD, Jack Cronenwett, MD, devices. OPCs can provide supplemental or Marc L. Schermerhorn, MD, JVS, June 2018. historical data for device evaluation in support of approval. VQI is participating in a project to develop contemporary OPCs for the multiple modalities used in the treatment of infrainguinal occlusive disease.

www.VQI.org CREST-2 Registry This randomized, controlled clinical trial compares INTERNATIONAL CONSORTIUM OF CEA and CAS to best medical therapy, and the VASCULAR REGISTRIES (ICVR) VQI is one of two registries supporting the trial. The mission of the ICVR is to provide Investigators must report their carotid artery stent a collaborative platform through procedures to be qualified for this trial and then report non-randomized procedures during the which registries and other stakeholders trial. This year more than 90 interventionists used around the world can share data to VQI to report more than 1,771 CAS procedures improve vascular health care. The VQI for the CREST-2 Registry project. VQI participation is participating in this effort, along with in the CREST-2 Registry facilitates enrollment and Vascunet, a sub-committee of the participation by leveraging VQI infrastructure. European Society of Vascular Surgeons, among others. The ICVR will provide: Corporate Contributions to Ongoing VQI Programs • Development and testing of innovative The operations of the SVS PSO are financed by methodological approaches fees paid by participating sites. New project development, including addition of new registries, quality reports, and improved functionality in • Forums for discussion: workshops, VQI has been made possible through generous conferences unrestricted contributions by Quality Champion, Quality Partner and Quality Associate-level • Safety studies, surveillance and corporations. Corporate supporters of the SVS comparative outcome evaluation PSO for the past year are listed below: • Collaboration/peer-reviewed articles Quality Champions and white papers

Other participants include national device regulators and medical device manufacturers. Current projects include The Vascular Implant Surveillance and Interventional Outcomes Network (VISION) initiative in the US, which aims to develop a national device surveillance network. There also are two current ICVR prospective AAA device-performance projects, Quality Partners both of which aim to enroll consecutive patients for two years. An evaluation of treatment of ruptured AAA is under development and has the potential to lead to label expansion. Other projects include management of carotid and lower extremity arterial occlusive disease. For more information on the ICVR, please see http://www.icvr-initiative.org/ Quality Associates

14 SVS VQI 2018 Annual Report 9. FUTURE DEVELOPMENT POTENTIAL BENEFITS FROM VQI In 2019, the VQI plans to support improved care FOR KEY STAKEHOLDERS and promote patient safety in the following For Patients areas: • Improved care based on VQI data and quality initiatives • 30-Day Data Entry Forms: to better • Using benchmarks and best practices to reduce document post-operative outcomes (a key length of stay interest of hospitals and CMS) • Improved long-term care through emphasis on follow- up and secondary prevention • Vascular Medicine Registry: to collect For Physicians/Providers data on medical (or non-operative) • Developing best practices through VQI data analysis management of peripheral artery disease • Identify meaningful benchmarks for QA and QI efforts (AAA, claudication, and carotid artery • Better patient selection using VQI risk assessment stenosis). This new registry is a collaboration calculators between the SVS PSO and the Society for Vascular Medicine (SVM) to try to define For Policy-Makers the natural history and best medical • Better data to inform decision making on policy management of patients not requiring an development • Monitoring safety and efficacy using real world operation. evidence • Work collaboratively with the SVS to develop quality • Venous Stent Registry: to collect data on measures the management and outcomes of venous stents placed for lower extremity occlusive For Payers disease. This new registry is a collaboration • Adoption of best practices to reduce complications among the SVS PSO and industry partners and expenses with input from the FDA. • Comparative data to inform population health approaches • Reduction of expenses due to decreased length of • Vascular Ultrasound Registry: to collect stay and resource utilization and analyze vascular laboratory data, initially focused on diagnosis and treatment For Industry of carotid artery disease. This new registry • Enhanced efficiency for label expansion using registry will match ultrasound images with VQI data clinical data in the CEA and CAS registries. • Registry-based trials for pre-market approval and post-market surveillance • Better data for device monitoring

15 www.VQI.org APPENDICES

SVS VQI 2018 Annual Report APPENDIX A— VQI SITES LISTED BY STATE, AS OF OCTOBER 1, 2018 UNITED STATES CJW Medical- Johnston-Willis Hospital VA Hospital of the University of Pennsylvania PA Abington Memorial Hospital PA Cleveland Clinic, Heart and Vascular Insitute OH Houston Methodist St. John Hospital- Clear Lake TX Advocate Good Samaritan Hospital IL Coastal Vascular & Interventional, PLLC FL Inova Alexandria Hospital VA Alamance Regional Medical Center NC Cobb Hospital, Inc. (WellStar Health Inova Fair Oaks Hospital VA Albany Vascular Specialist Center GA System, Inc.) GA Inova Fairfax Hospital VA Alexian Brothers Medical Center IL Columbia St. Mary - Milwaukee WI Inova Gainesville Hospital VA Allegheny Health Network - Allegheny Clinic Columbia St. Mary - Ozaukee WI Inova Loudoun Hospital VA Vascular Surgery PA Columbia Surgical Services, Inc. MO Inova Mount Vernon Hospital VA Allina- Abbott Northwestern Hospital MN Columbia University Irving Medical Center NY Integris Baptist Medical Center, Inc. OK Allina- Mercy Hospital MN Columbus Regional Hospital IN Iowa Heart Center at Mercy Medical Center IA Allina- United Hospital MN Community Hospital East IN IU Health- Arnett Hospital IN Allina- Unity Hospital MN Community Hospital Heart & Vascular IN IU Health- Ball Memorial Hospital IN Altru Health System ND Community Hospital South IN IU Health- Bloomington Hospital IN Arizona Endovascular Center AZ Concord Hospital NH IU Health- Methodist Hospital IN Arnot Health NY Cone Health Heart & Vascular Center NC IU Health- Saxony Hospital IN Associates in Vascular Care NJ Confluence Health WA Jackson Madison County General Hospital TN Aultman Hospital OH Cooper University Medical Center NJ John Sealy Hospital, UTMB TX Aurora Baycare Medical Center WI Covenant Healthcare MI John T. Mather Hospital NY Aurora Lakeland Medical Center WI CTVS- CardioThoracic Vascular Surgeons TX Johns Hopkins Bayview Medical Center MD Aurora Medical Center in Kenosha WI Danbury Hospital CT Kadlec (Providence) WA Aurora Medical Center in Manitowoc County WI Dartmouth Hitchcock Medical Center NH Kaleida- Buffalo General Hospital NY Aurora Medical Center in Oshkosh WI Delray Medical Center, Inc. FL Kennedy University Hospital NJ Aurora Medical Center in Summit WI Diagnostic Imaging of Milford CT Kennestone Hospital, Inc. (WellStar Health Aurora Medical Center in Washington County WI Dignity Health (Sequoia Hospital) CA System, Inc.) GA Aurora Medical Center of Grafton WI DMC Harper University Hospital MI KentuckyOne Health- Jewish East KY Aurora Memorial Hospital of Burlington WI Doylestown Hospital PA KentuckyOne Health- Jewish Hospital KY Aurora Sheboygan Memorial Medical Center WI Duke University Medical Center NC King’s Daughters Medical Center KY Aurora Sinai Medical Center WI Eastern Maine Medical Center ME Lahey Hospital and Medical Center MA Aurora St. Luke’s Medical Center WI El Camino Hospital CA Lake Health - West Medical Center OH Aurora St. Luke’s South Shore WI Elkhart General Hospital IN Lakes Region General Hospital NH Aurora West Allis Medical Center WI Elliot Hospital NH Lancaster General Hospital PA Avera Heart Hospital of South Dakota SD Emory Healthcare GA Lee Memorial Health System (Gulf Coast Baptist Health Louisville KY Emory St. Joseph’s Hospital GA Medical Center) FL Baptist Health Madisonville- Jack L. Hamman Englewood Hospital and Medical Center NJ Lehigh Valley Hospital PA Heart & Vascular Center KY Excela Health PA Lifespan- Rhode Island Hospital RI Baptist Memorial Hospital- Memphis TN Fairlawn Surgery Center VA Lifespan- The Miriam Hospital RI Barnes Jewish Hospital MO Fairview- Southdale Hospital MN Loma Linda University Medical Center CA Baton Rouge General Medical Center LA Fairview- University of Minnesota Medical Loyola University Medical Center IL Bayfront Health Seven Rivers FL Center MN Lutheran Hospital of Indiana (IOM Health Baylor All Saints Medical Center TX Fletcher Allen HealthCare VT System) IN Baylor- Jack and Jane Hamilton Heart and Flint Hills Heart, Vascular, and Vein Clinic, LLC KS Lyerly Baptist Neurosurgery FL Vascular Hospital TX Florida Hospital FL Maimonides Medical Center NY Baylor- The Heart Hospital Denton TX Florida Hospital Memorial Medical Center FL Maine Medical Center ME Baylor- The Heart Hospital Plano TX Floyd Medical Center GA MaineGeneral Medical Center ME Baylor University Medical Center TX Forrest General Hospital Vascular ServicesMS Marin General Hospital CA Baystate Medical Center MA Froedtert Memorial Lutheran Hospital WI Mary Washington Hospital VA Beaufort Memorial Hospital SC Geisinger Community Medical Center PA Massachusetts General Hospital MA Beaumont Royal Oak Hospital MI Geisinger Medical Center PA Mayo Clinic MN Beebe Healthcare DE Geisinger Wyoming Valley Medical Center PA Mayo Clinic Arizona AZ Berkshire Medical Center MA Gilvydis Vein Clinic IL Mayo Clinic Florida FL Beth Israel Deaconess Medical Center MA Glens Falls Hospital NY Mayo Clinic Health System -- Northwest Wisconsin Bethesda North Hospital (TriHealth, Inc.) OH Good Samaritan Hospital (TriHealth, Inc.) OH Region, Inc. WI Borgess Hospital MI Goshen Hospital IN McLaren Bay Region MI Boston Medical Center MA Grady Memorial Hospital GA McLaren Regional Medical Center d/b/a Flint MI Brigham and Women’s Hospital MA Gregory L. Nedurian, M.D., P.A. FL McLeod Regional Medical Center SC Bronson Battle Creek Hospital MI Guthrie Clinic PA Medical Center Hospital TX Bronson Methodist Hospital MI Hackensack Meridian- Bayshore Community Medical University of South Carolina Hospital SC BSA Hospital TX Hospital NJ Medstar Georgetown University Hospital DC Camden Clark Medical Center WV Hackensack Meridian- Hackensack Medstar Good Samaritan Hospital MD Cape Cod Hospital MA University Medical Center NJ Medstar Union Memorial Hospital MD Capital Health Medical Center - Hackensack Meridian- Jersey Shore MedStar Washington Hospital Center DC Hopewell NJ University Medical Center NJ Memorial Hermann Greater Heights Hospital TX Capital Health Regional Medical Center NJ Hackensack Meridian- Ocean Medical Center NJ Memorial Hermann Heart & Vascular Carilion Roanoke Memorial Hospital VA Hackensack Meridian- Riverview Medical Institute- Texas Medical Center TX Carle Foundation Hospital IL Center NJ Memorial Hermann Katy Hospital TX Carolinas Healthcare - Pineville NC Hackensack Meridian- Southern Ocean Memorial Hermann Memorial City Medical Carolinas Healthcare System- Sanger Heart Medical Center NJ Center TX & Vascular Institute NC Harborview Medical Center WA Memorial Hermann Northeast Hospital TX Carondelet Specialists Group AZ Harlingen Medical Center TX Memorial Hermann Southeast Hospital TX Carson Tahoe Regional Hospital NV Harrison Medical Center (CHI Franciscan Memorial Hermann Southwest Hospital TX Catholic Health Mercy Hospital of Buffalo NY Health) WA Memorial Hermann Sugar Land TX Catholic Health Sister of Charity Hospital NY Hartford Hospital CT Memorial Hermann The Woodlands Hospital TX CTSA NH Health Park Medical Center (Lee Memorial Memorial Hospital of South Bend IN Cedars-Sinai Medical Center CA Health System) FL Memorial Hospital Pembroke FL Celebration Health FL Heart Hospital of Lafayette LA Memorial Hospital West FL Centra Health (Lynchburg General Hospital) VA Heart Hospital of New Mexico at Lovelace Memorial Regional Hospital FL Central Florida Regional Hospital FL Medical Center NM Memorial University Health Medical Central Maine Medical Center ME Henry County Medical Center TN Center- SHVI GA Centura- Penrose St. Francis Health Services CO Henry Ford Allegiance MI Mercy Hospital Springfield MO Centura- Porter Adventist Hospital CO Henry Ford Hospital MI Mercy Hospital St. Louis MO Centura- St. Mary Corwin Medical Center CO Henry Ford Hospital West Bloomfield MI Mercy Medical Center OH Charleston Area Medical Center WV Hoag Memorial Hospital Presbyterian CA Mercy Medical Center- Baltimore MD Chester County Hospital PA Hoenig Vascular Center MA Miami Vein Center FL Cheyenne Regional Medical Center WY Holy Spirit - Geisinger Affiliate PA Michigan Vascular Center MI CHI Health Nebraska Heart NE Horizon Vascular Specialists MD Midwest Institute Minimally Invasive Therapies IL Christiana Care Health System DE Hospital of Central Connecticut (Hartford Midwest Physician Alliance (Heart Care Center of CJW Medical- Chippenham Hospital VA Healthcare) CT Illinois - Premier Vascular, LLC) IL 17 www.VQI.org APPENDIX A— VQI SITES LISTED BY STATE, AS OF OCTOBER 1, 2018 Mission Hospital NC Providence Little Company of Mary, Torrance CA St. Luke’s Hospital & Health Network - Bethlehem Mobile Infirmary AL Providence Medford Medical Center OR Campus PA Montefiore Medical Center NY Providence Portland Medical Center OR St. Luke’s Hospital (f/k/a Saint Luke’s Episcopal Morton Plant Hospital (BayCare Health System) FL Providence Regional Medical Center WA Presbyterian Hospital) MO Mouint Sinai- Beth Israel Hospital NY Providence Sacred Heart Medical Center WA St. Luke’s Hospital MN Mount Carmel St Ann’s Hospital OH Providence Saint Joseph Medical Center CA St. Luke’s Methodist Hospital (Unity Point) IA Mount Carmel East Hospital OH Providence St. Mary Medical Center WA St. Mary Medical Center PA Mount Carmel West Hospital OH Providence St. Peter Hospital WA St. Mary’s Hospital WI Mount Sinai Hospital NY Providence St. Vincent Medical Center OR St. Mary’s Hospital (SCL Health) CO Mount Sinai- St.Luke’s Roosevelt Hospital Center NY Providence Tarzana Medical Center CA St. Mary’s Medical Center WV MultiCare Good Samaritan Hospital WA Radiology Associates - Fox Valley WI St. Patrick Hospital (Providence) MT MultiCare Tacoma General Hospital WA Rapid City Regional Hospital SD St. Vincent Healthcare (SCL Health) MT Nashville Vascular & Vein Institute TN Redmond Regional Medical Center GA St. Vincent Heart Center of Indiana, LLC IN Nebraska Medical Center NE Regents of the University of New Mexico NM St. Vincent Hospital & Healthcare Center IN New Hanover Regional Medical Center NC Regional Medical Center of Orangeburg & Stanford Hospital & Clinics CA Newark Beth Isreal Medical Center Calhoun Co SC Steward Good Samaritan Medical Center, Inc. MA (Barnabas Health) NJ Rex Healthcare (UNC Health System) NC Steward St. Anne’s Hospital Corporation MA North Okaloosa Medical Center FL Roper St. Francis Hospital SC Steward Trumbull Memorial Hospital, Inc. OH Northeast Georgia Medical Center GA Rose Medical Center CO Stockton Cardiothoracic Surgical Medical NorthShore University Health- NorthShore Rush Foundation Hospital MS Group CA Skokie Hospital IL Russell C. Lam MD PA TX Stony Brook University Medical Center NY Northside Hospital Atlanta GA Rutgers Robert Wood Johnson Medical School NJ Strong Memorial Hospital, University of Rochester Northside Hospital Cherokee GA Saint Barnabas Medical Center (Barnabas Medical Center NY Northside Hospital Forsyth GA Health) NJ Summa Health System OH Northwest Hospital & Medical Center WA Saint Francis Hospital and Medical Center CT SUNY Upstate- University Hospital Medical Northwestern Medicine Central DuPage Hospital IL Saint Francis Medical Center MO Center NY Northwestern Memorial Hospital IL Saint Joseph Hospital (SCL Health) CO Surgical Specialists of Central Florida FL Norton Healthcare, Inc. - Norton - Audubon KY Saint Joseph Regional Medical Center IN Swedish Cherry Hill (Providence) WA Norton Healthcare, Inc. - Norton - Brownsboro KY Saint Luke’s Hospital of Kansas City MO Swedish Edmonds (Providence) WA Norton Healthcare, Inc. - Norton - Downtown KY Saint Thomas Midtown Hospital TN Swedish First Hill (Providence) WA Norton Healthcare, Inc. - NWCH - St. Matthews KY Saint Thomas Rutherford Hospital TN Tampa General Hospital FL Novant Health Forsyth Medical Center NC Saint Thomas West Hospital TN Tenet Florida Physicians Services, LLC FL Novant Health Matthews Medical CenterNC San Diego Vascular Associates CA The Johns Hopkins Hospital MD Novant Health Presbyterian Medical Center NC Sanford Clinic Vascular Associates SD The Medical Center, Navicent Health (The Medical NSLIJ- Lenox Hill Hospital NY Sarasota Memorial Hospital FL Center of Central Georgia, Inc.) GA NSLIJ- Long Island Jewish Medical Center NY Scott & White Memorial Hospital TX The MetroHealth System OH NSLIJ- North Shore University Hospital NY Scripps Green Hospital (Scripps Health) CA The Ohio State University, Wexner Medical NSLIJ- Staten Island Hospital- North Site NY Scripps Mercy Hospital (Scripps Health) CA Center OH NYP/Weill Cornell Medical College NY Seattle Vascular Surgery WA The Practice of John F Lucas III, M.D. MS NYU Langone Medical Center NY Self Regional Healthcare SC The Reading Hospital and Medical Center PA Ochsner Medical Center LA Sentara Careplex Hospital VA The University of Arizona Medical Center- University OhioHealth Doctors Hospital OH Sentara Leigh Hospital VA Campus AZ OhioHealth Dublin Methodist Hospital OH Sentara Martha Jefferson VA The University of California Irvine Medical OhioHealth Grady Memorial Hospital OH Sentara Norfolk General Hospital VA Center CA OhioHealth Grant Medical Center OH Sentara Northern Virginia VA The University of Texas M.D. Anderson Cancer OhioHealth Mansfield Hospital OH Sentara Obici Hospital VA Center TX OhioHealth Marion General Hospital OH Sentara Princess Anne Hospital VA The University of Texas Southwestern Medical OhioHealth Riverside Methodist Hospital OH Sentara RMH Medical Center VA Center TX Oklahoma Heart Hospital South, LLC OK Sentara Virginia Beach General Hospital VA The Vascular Group NY Oklahoma Heart Hospital, LLC OK Sentara Williamsburg Regional Medical Center VA The Vein and Vascular Institute of Tampa Bay FL Oklahoma Heart Institute at Hillcrest Medical Sharp Grossmont Hospital CA Thomas Jefferson University Hospitals, Inc. PA Center OK Sharp Memorial Hospital CA Tift Regional Medical Center GA Orange Regional Medical Center NY SIH - Memorial Hospital of Carbondale IL Trident Medical Center SC Oregon Health & Sciences University OR Siragusa TN Tucson Medical Center AZ Oregon Vascular Specialists, LLC OR SIU School of Medicine, Memorial Medical Tufts Medical Center MA Orlando Health- Dr. P. Phillips Hospital FL Center IL UC Davis Health System CA Orlando Health- Health Central Hospital FL Southcoast- Charlton Memorial Hospital MA UCHA- Memorial Hospital Central CO Orlando Health- Orlando Regional Medical Southcoast- St. Luke’s Hospital MA UCLA- Harbor Medical Center, Los Angeles Center FL Spartanburg Regional Health Services County CA Orlando Health- South Seminole Hospital FL District, Inc. SC UCLA- Ronald Reagan Medical Center CA OSF- Saint Anthony Medical Center IL Spectrum Health Hospital MI UCSD Medical Center CA OSF- Saint Francis Medical Center IL SSM DePaul Health Center MO UCSF Medical Center CA OSF- St. Joseph Medical Center IL SSM Health St. Louis University Hospital MO UF Health- Shands Hospital FL OU Medical Center OK SSM St. Anthony Hospital OK United Hospital Center WV Our Lady of the Lake LA SSM St. Clare Health Center MO UnityPoint Health- Des Moines IA Overlook Hospital (Atlantic Health System) NJ SSM St. Joseph Health Center MO Univeristy of Washington Medical Center WA Palmetto Health Richland SC SSM St. Mary’s Health Center MO University Hospitals Health System OH Palo Alto Medical Foundation CA St. Anthony Medical Center (CHI Franciscan University of Alabama AL Penn Presbyterian Medical Center PA Health) WA University of Chicago Medical Center IL Penn State Milton S. Hershey Medical Center PA St. Anthony’s Hospital (BayCare Health System) FL University of Colorado - Denver CO Pennsylvania Hospital PA St. Anthony’s Medical Center MO University of Colorado - North Vascular Peripheral Vascular Associates TX St. Charles Health System, Inc. OR Services CO Piedmont Athens Regional Medical St. Charles Hospital NY University of Iowa IA Center, Inc. GA St. Elizabeth’s Medical Center MA University of Kansas Medical Center KA Piedmont Hospital Atlanta GA St. Francis Heart Center IN University of Kentucky KY PineHurst Surgical NC St. Francis Medical Center University of Maryland Medical Center MD Portsmouth Regional Hospital NH (CHI Franciscan Health) WA University of Massachusetts Memorial Hospital MA Presbyterian Hospital NM St. John’s Health Center (Providence) CA University of Michigan MI Presbyterian St. Luke’s Medical Center CO St. Joseph Medical Center University of Mississippi Medical Center MS Prime Healthcare Foundation - Southern (CHI Franciscan Health) WA University of Missouri Medical Center MO Regional Medical Center GA St. Joseph Mercy Health System MI University of North Carolina Hospitals NC ProHealth Care (Waukesha Memorial Hospital) WI St. Luke’s Healthcare- St. Luke’s Regional Medical University of Tennessee Medical Center TN ProMedica Toledo Hospital, Jobst Vascular OH Center ID University of Texas Health Science Center, Providence Alaska Medical Center AK St. Luke’s Hospital & Health Network - Allentown San Antonio TX Providence Holy Cross Medical Center CA Campus PA University of Utah Hospital and Clinics UT Providence Holy Family Hospital WA St. Luke’s Hospital & Health Network - Anderson University Surgical Associates TN Campus PA 18 SVS VQI 2018 Annual Report APPENDIX A— VQI APPENDIX B— SOCIETY FOR VASCULAR SITES LISTED BY STATE, SOCIETY PATIENT SAFETY ORGANIZATION AS OF OCTOBER 1, (SVS PSO) 2018 The Patient Safety and Quality VQI ENDORSING SOCIETIES Improvement Act of 2005 authorized American Venous Forum* UPMC Altoona PA the creation of Patient Safety Canadian Society for Vascular Surgery UPMC/ UPP Vascular Surgery PA Organizations (PSOs) to improve the Eastern Vascular Society UPMC/Hamot Hospital PA UVA Medical Center (UVA Health System) VA quality and safety of health care by the Florida Vascular Society Vanguard Vascular & Vein TX collection and analysis of patient data. Georgia Vascular Society Vascular & General Surgical Specialists of SWFL FL It protects any comparative outcome Michigan Vascular Society Vascular Associates of South Alabama AL Vascular Institute of Chattanooga TN analyses or other aggregated reports Midwestern Vascular Surgical Society Vascular Institute of Michigan MI that are generated by a PSO from New England Society for Vascular Vascular Surgery Associates FL discovery in state and federal court. Surgery Abrazo Arizona Heart Hospital AZ Vidant Medical Center NC These analyses and reports, called New York Society for Vascular Surgery Virginia Commonwealth University Hospital Patient Safety Work Products (PSWP) Peripheral Vascular Surgery Society Authority VA Virginia Mason WA can be used for quality improvement Rocky Mountain Vascular Society Wadley Regional Medical Center TX but not for disciplinary action against Society for Clinical Vascular Surgery Wake Forest Baptist Health NC a provider. It allows patient identifiers Society for Vascular Medicine* WakeMed Health & Hospitals -- Cary Campus NC WakeMed Health & Hospitals -- Raleigh to be collected, without specific IRB Society of Interventional Radiology* Campus NC or patient approval. This permits a PSO Society for Vascular Ultrasound* Washington Hospital Health System CA to match patients with other data Southern Association for Vascular Weiss Memorial Hospital IL West Virginia University Hospitals, Inc. WV sources, such as the Social Security Surgery Westchester Medical Center NY Death Index or Medicare claims data Southern California Vascular Surgical Western Maryland Health System MD Western Vascular Institute AZ to evaluate long-term effectiveness Society White Plains Hospital NY of procedures in terms of mortality or Vascular Access Society of America* Willis-Knighton North LA complications. The identity of patients, Western Vascular Society Winchester Medical Center VA Wright State Physician Group OH hospitals and providers cannot be Yale-New Haven Hospital CT disclosed by a PSO, although non- *Members of SVS PSO Governing Yavapai Regional Medical Center AZ identifiable data can be published Council for quality improvement research, CANADA adhering to both PSO and HIPAA CHUM QU CISSSO QC requirements. VQI embraced the use of Covenant Health - Grey Nuns Hospital AB a PSO to house its activities, because Nova Scotia Health Authority NS it provides substantially more security Thunder Bay Regional Health Sciences Centre ON and protection than most registries. Toronto General Hospital ON

APPENDIX C— MEDSTREAMING/M2S CLINICAL PLATFORM M2S PATHWAYS™ is a secure, cloud-based solution which enables physicians, institutions, clinical data managers, and researchers to collect, manage, analyze, and disseminate their clinical data to achieve optimal outcomes. Accessible by any compatible browser, PATHWAYS is designed to easily integrate into a variety of workflows by allowing multiple users to access and enter data on a single procedure form, and to spread the responsibilities of data entry to more than one individual. Authentication identifies users’ roles and permissions to ensure appropriate access to content within PATHWAYS. Real-time data validation through error-trapping and alerts ensure that only high-quality data is populated into the system. PATHWAYS has been designed to support large-scale quality improvement and research projects as dynamic content within registries can easily be added and/or modified.

Medstreaming-M2S is a medical informatics company specializing in workflow productivity technology, registry development and support services. To address challenges created by fragmentation of clinical data, Medstreaming created specialty- based workflow applications, which improves data workflow in electronic medical records (EMR) systems. Using this clinical workflow expertise, Medstreaming has also developed an integrated platform application that runs as an outpatient EMR, image management and reporting, and practice management workflow solution. All Medstreaming solutions act as aggregators for structuring clinical data which in turn creates powerful data service offerings for multi-purpose, web based, data mining and data analytics. Medstreaming is headquartered in Redmond, WA. M2S, a division of Medstreaming, is a healthcare performance management solutions company that provides innovative technology and services for the healthcare industry to manage clinical information and utilize that information to improve the quality of patient care and reduce costs. The Vascular Quality Initiative is built on M2S’s PATHWAYS clinical data performance platform, allowing users to track, measure, and analyze clinical information, promote collaboration, objectively drive decisions, and optimize performance. For more information, visit www.m2s.com.

19 www.VQI.org APPENDIX D – VQI BEST PRACTICE DASHBOARDS

APPENDIXVQI D Best – VQI PracticesBEST PRACTICE Scorecard DASHBOARDS

VQI BEST PRACTICES DASHBOARD:

1. Carotid Artery Stent (CAS) Timeframe: July 1, 2017-June 30, 2018 In the tableCarotid below, percentages Artery representStent the(CAS) rate of cases with the noted outcome or complication. If you performed procedures in more than one hospital, ‘Your Center’ shows the results for the hospital at which youTimeframe: performed July the most 1, 2017 procedures.-June 30, 2018 In the table below, percentages represent the rate of cases with the noted outcome or complication. If Your resultsyou are performed highlighted procedures in green in more if than you one are hospital, at or above‘Your Center’ the showstop 25th the resultspercentile for the hospitalamong at all VQI physicians,which and you in performedred if at theor belowmost procedures. the bottom 25th percentile. Your center’s results are similarly color- coded if they fall above or below the 75th or 25th percentiles among all VQI centers. Your results are highlighted in green if you are at or above the top 25th percentile among all VQI physicians, and in red if at or below the bottom 25th percentile. Your center’s results are similarly color- Note thatcoded percentiles if they fall are above based or below on the the 75th rates or 25th of individualpercentiles among physicians all VQI orcenters. centers, so it is possible for your rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) butNote still that be percentiles above are the based 75th on percentile the rates of individualacross all physicians physicians’ or cen orters, centers’ so it is possible individual for your rates. rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) but still be above the 75th percentile across all physicians’ or centers’ individual rates. Note also that percentages are computed only among cases with non-missing data for each outcome, so it is possible to have rates for some outcomes but “No cases” for others. Note also that percentages are computed only among cases with non-missing data for each outcome, so it is possible to have rates for some outcomes but “No cases” for others. Regional data are suppressed if your region has fewer than 3 centers participating in this registry. Regional data are suppressed if your region has fewer than 3 centers participating in this registry.

Legend: Green = Top 25th percentile Red = Bottom 25th percentile Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data Number of cases reviewed 2 84 466 5363 Median postop LOS (days) 1 1 1 1 Median total LOS (days) 1 1 1 1 Neurologic Events (at discharge) Ipsilateral TIA 0% 1.2% 1.3% 0.6% Ipsilateral stroke 0% 4.8% 1.7% 2% Contralateral TIA 0% 0% 0% 0.2% Contralateral stroke 0% 1.2% 1.3% 0.5% Your Your Your VQI OtherCategory Events Outcome/Complication Results Center Region Overall (at discharge) Reperfusion symptoms 0% 2.4% 0.6% 1.1%

IV meds for hypertension 0% 6% 8.6% 15.1% IV meds for hypotension 0% 11.9% 20.2% 14.6% MI (troponin only or EKG) 0% 0% 0.9% 0.8% Dysrhythmia 0% 1.2% 1.3% 2%

CHF 0% 1.2% 0.4% 0.6% Discharge Medications (excludes death in Antipaltelet+Statin 100% 95% 94.9% 92.2% hospital) Discharge Destination Home 100% 78.6% 87.3% 86.2% Rehab Unit 0% 19% 9.9% 8.6% Nursing Home 0% 0% 1.5% 3.3% Dead 0% 2.4% 1.3% 1.3%

20 SVS VQI 2018 Annual Report

VQI Best Practices Scorecard

Carotid Endarterectomy (CEA) VQI BEST PRACTICES DASHBOARD: Timeframe: July 1, 2017-June 30, 2018 2. Carotid Endarterectomy (CEA) Timeframe: July 1, 2017-June 30, 2018 In the table below,In the percentagestable below, percentages represent represent the rate the rate of casesof cases with with thethe noted noted outcome outcome or complication. or complication. If you performed procedures in more than one hospital, ‘Your Center’ shows the results for the hospital at If you performedwhich you procedures performed the in most more procedures. than one hospital, ‘Your Center’ shows the results for the hospital at which you performed the most procedures. Your results are highlighted in green if you are at or above the top 25th percentile among all VQI Your resultsphysicians, are highlighted and in red in if greenat or below if you the bottomare at 25th or above percentile. the Your top center’s 25th percentileresults are similarly among color all- VQI physicians, codedand inif they red fall if atabove or belowor below the the 75thbottom or 25th 25th percentiles percentile. among Your all VQI center’s centers. results are similarly color- coded if theyNote fall that above percentiles or beloware based the on 75ththe rates or 25thof individual percentiles physicians among or centers, all VQI so it centers.is possible for your rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) Note that percentilesbut still be above are the based 75th percentile on the acrossrates ofall physicians’individual or physicians centers’ individual or centers, rates. so it is possible for your rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) but stillNote be also above that percentages the 75th percentile are computed across only among all physicians’ cases with non or- missingcenters’ data individual for each outcome, rates. so it is possible to have rates for some outcomes but “No cases” for others. Note also that percentages are computed only among cases with non-missing data for each Regional data are suppressed if your region has fewer than 3 centers participating in this registry. outcome, so it is possible to have rates for some outcomes but “No cases” for others.

Regional data are suppressed if your region has fewer than 3 centers participating in this registry. Legend: Green = Top 25th percentile Red = Bottom 25th percentile Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data Number of cases reviewed 14 65 1583 16461 Median postop LOS (days) 1 1 1 1 Median total LOS (days) 1 2 1 1 Cranial Nerve Injury (at discharge) CNI 7.1% 9.2% 3.7% 2.8% Neurologic Events (at discharge) Any postop TIA or stroke 0% 0% 1.5% 1.8% Ips. ocular or cortical stroke 0% 0% 0.9% 0.9% Your Your Your VQI OtherCategory Events Outcome/Complication Results Center Region Overall (at discharge) MI (troponin only or EKG) 0% 3.1% 0.9% 0.8% IV meds for hypertension 7.1% 44.6% 18.8% 21.2%

IV meds for hypotension 28.6% 15.4% 14.5% 11.2% Postop CHF 0% 0% 0.3% 0.4% Postop dysrhythmia 0% 3.1% 2.1% 1.8% Reperfusion symptoms 0% 0% 0.3% 0.2% Wound infection 0% 0% 0% 0% RTOR 0% 4.6% 2.3% 2.1% RTOR for bleeding 0% 4.6% 1% 1.1% Discharge Meds (excludes death in Antiplatelet+Statin 100% 95.3% 94.2% 91% hospital) Discharge Destination In-hospital death 0% 0% 0.2% 0.3% 30-Day Outcomes (July 2015- Ips. ocular or cortical stroke 0% 0% 1.2% 1.1% June 2016) Any TIA or stroke 0% 0% 1.9% 2.2% 21 Death www.VQI.org0% 1.5% 0.7% 0.7% 1-Year Outcomes (July 2015- Ips. ocular or cortical stroke 0% 0% 1.8% 1.8% June 2016) CNI persisting at least 1 0% 0% 0.3% 0.2% year MI (troponin only or EKG) 0% 1.9% 1.1% 1.7% Ipsilateral restenosis >70% 0% 0% 1.6% 1.9% Redo CEA or CAS 0% 0% 0.1% 0.3% Death 0% 4.4% 3.6% 3.6%

VQI Best Practices Scorecard

VQI BESTTEVAR/Complex PRACTICES DASHBOARD: EVAR 3. TEVAR/Complex EVAR Timeframe: July 1, 2017-June 30, 2018 In the tableTimeframe: below, percentages July 1, 2017 represent-June the 30, rate 2018 of cases with the noted outcome or complication. If you performedIn the tableprocedures below, percentages in more representthan one the hospital, rate of cases ‘Your with Center’ the noted shows outcome the or complication.results for theIf hospital at whichyou you performed performed procedures the most in more procedures. than one hospital, ‘Your Center’ shows the results for the hospital at which you performed the most procedures.

Your resultsYour are results highlighted are highlighted in green in green if ifyou you are at at or orabove above the top the 25th top percentile 25th percentile among all VQI among all VQI physicians,physicians, and in andred in if red at ifor at belowor below the the bottombottom 25th 25th percentile. percentile. Your center’s Your center’sresults are resultssimilarly arecolor similarly- color- coded ifcoded they iffall they above fall above or orbelow below the 75th 75th or or25th 25th percentiles percentiles among allamong VQI centers. all VQI centers.

Note thatNote percentiles that percentiles are are based based on on the rates rates of individualof individual physicians physicians or centers, or so centers, it is possible so itfor is your possible for your rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) rate or yourbut still center’s be above rate the 75thto be percentile below across the overall all physicians’ VQI rate or centers’ across individual all procedures rates. (the “VQI Overall” column) but still be above the 75th percentile across all physicians’ or centers’ individual rates. Note also that percentages are computed only among cases with non-missing data for each outcome, so it Note alsois thatpossible percentages to have rates forare some computed outcomes butonly “No among cases” for cases others. with non-missing data for each Regional data are suppressed if your region has fewer than 3 centers participating in this registry. outcome, so it is possible to have rates for some outcomes but “No cases” for others. Regional data are suppressed if your region has fewer than 3 centers participating in this registry. Legend: Green = Top 25th percentile Red = Bottom 25th percentile Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data NA (<3 Number of cases reviewed 2 25 2084 centers) Median postop LOS (days) 5 5 4 Median total LOS (days) 5 5 6 Cerebrovascular Complications Any CV symptoms 0% 4% 3.3% TIA 0% 0% 0.4% Carotid stroke 0% 0% 0.3% VB stroke 0% 0% 0.9% Your Your Your VQI Category Outcome/ComplicationBilateral stroke 0% 4% 1.3% Results Center Region Overall Hemorrhagic stroke 0% 0% 0.5% Postop Spinal Ischemia Transient 0% 4% 1.5% Present at discharge 0% 4% 1.7%

Reintervention Any Re-intervention 0% 12% 7.9% Related to procedure 0% 12% 4.8% Unrelated to procedure 0% 0% 3.1% Reintervention Indication (reops related to Aorta/branch related No cases 66.7% 43.4% procedure) Access related No cases 0% 20.2% Other No cases 33.3% 40.4% Discharge status/destination Home 100% 68% 73.8% Rehab Unit 0% 12% 12.2% Nursing Home 0% 4% 6.7% Dead 0% 12% 5.1% Other Hospital 0% 4% 2.2% Homeless 0% 0% 0.1% 22

VQI Best Practices Scorecard

VQI BEST PRACTICES DASHBOARD: 4. Infra-inguinalInfra -Bypassinguinal (INFRA) BypassTimeframe: July (INFRA) 1, 2017-June 30, 2018 In the table below, percentages represent the rate of cases with the noted outcome or complication. If you performed procedures in more than one hospital, ‘Your Center’ shows the results for the hospital at whichTimeframe: you performed July the most1, 2017 procedures.-June 30, 2018 In the table below, percentages represent the rate of cases with the noted outcome or complication. If Your resultsyou areperformed highlighted procedures in greenin more thanif you one are hospital, at or ‘Your above Center’ the shows top 25ththe results percentile for the hospital among at all VQI physicians,which and you in performed red if at the or most below procedures. the bottom 25th percentile. Your center’s results are similarly color- coded ifYour they results fall above are highlighted or below in green the if 75th you are or at25th or above percentiles the top 25th among percentile all amongVQI centers. all VQI physicians, and in red if at or below the bottom 25th percentile. Your center’s results are similarly color- Note thatcoded percentiles if they fall aboveare based or below on the the 75th rates or 25th of percentiles individual among physicians all VQI centers. or centers, so it is possible for your rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) Notebut thatstill percentilesbe above are the based 75th on percentilethe rates of individual across physiciansall physicians’ or centers, or centers’ so it is possible individual for your rates. rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) but still be above the 75th percentile across all physicians’ or centers’ individual rates. Note also that percentages are computed only among cases with non-missing data for each outcome,Note so alsoit is thatpossible percentages to have are computedrates for only some among outcomes cases with but non “No-missing cases” data for for each others. outcome, Regional so it data are suppressedis possible if toyour have region rates for has some fewer outcomes than but 3 “Nocenters cases” participating for others. in this registry. Regional data are suppressed if your region has fewer than 3 centers participating in this registry.

Legend: Green = Top 25th percentile Red = Bottom 25th percentile Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data Number of cases reviewed 12 70 407 6581 Median postop LOS 3.5 5 4 4 Events at Discharge Any Transfusion 25% 22.9% 29.3% 28.5% Return to OR 16.7% 12.9% 14.7% 12.7% RTOR for Bleeding* 50% 33.3% 10% 11.1% RTOR for Thrombosis* 0% 33.3% 25% 23.8% RTOR for Infection* 0% 11.1% 8.3% 8.5% RTOR for Revision* 0% 11.1% 23.3% 16.2% MI (troponin only) 0% 2.9% 1.5% 1.2% MI (EKG) 8.3% 1.4% 1.5% 1.4% Your Your Your VQI Category Outcome/Complication Postop CHF Results0% Center2.9% Region2.5% Overall1.6% Dysrhythmia 0% 2.9% 4.2% 3.1% Surgical Site Infection 0% 2.9% 2.2% 2.6% Minor ipsilateral amputation 8.3% 7.1% 8.6% 8.9% BK/AK ipsilateral 0% 1.4% 2.2% 2% amputation Discharge Medications ASA or other antiplatelet 83.3% 95.7% 95.5% 93.9% Statin 83.3% 82.6% 88.2% 85.9% New anticoagulant** 0% 34.1% 17.5% 17.1% Discharge Destination Dead 0% 0% 0.7% 1.2% *Rate is among patients returned to the OR and is omitted if no patients were RTOR. **Rate is among patients not taking anticoagulant on admission.

23 SVS VQI 2018 Annual Report

VQI Best Practices Scorecard

VQI BEST PRACTICES DASHBOARD: Supra-inguinal Bypass (SUPRA) 5. Supra-inguinal Bypass (SUPRA) Timeframe: July 1, 2017-June 30, 2018 In the tableTimeframe: below, percentages July 1, 2017 represent-June the 30, rate 2018 of cases with the noted outcome or complication. If you performed procedures in more than one hospital, ‘Your Center’ shows the results for the hospital at which youIn performed the table below, the percentages most procedures. represent the rate of cases with the noted outcome or complication. If you performed procedures in more than one hospital, ‘Your Center’ shows the results for the hospital at which you performed the most procedures. Your results are highlighted in green if you are at or above the top 25th percentile among all VQI physicians,Your and results in redare highlighted if at or below in green the if you bottom are at or 25th above percentile. the top 25th Yourpercentile center’s among results all VQI are similarly color- coded ifphysicians, they fall aboveand in red or if belowat or below the the 75th bottom or 25th percentile. percentiles Your amongcenter’s results all VQI are centers. similarly color - coded if they fall above or below the 75th or 25th percentiles among all VQI centers.

Note thatNote percentiles that percentiles are are based based on on the rates rates of individualof individual physicians physicians or centers, or so centers, it is possible so itfor is your possible for your rate or yourrate orcenter’s your center’s rate rate to beto be below below the the overall overall VQI VQI rate acrossrate across all procedures all procedures (the “VQI Overall” (the “VQIcolumn) Overall” column) butbut still still be be above above the 75th the percentile 75th percentile across all physicians’ across all or physicians’centers’ individual or centers’ rates. individual rates.

Note also that percentages are computed only among cases with non-missing data for each outcome, so it Note alsois thatpossible percentages to have rates forare some computed outcomes butonly “No among cases” for cases others. with non-missing data for each outcome,R egionalso it is datapossible are suppressed to have if ratesyour region for some has fewer outcomes than 3 centers but “Noparticipating cases” in for this others. registry. Regional data are suppressed if your region has fewer than 3 centers participating in this registry.

Minor ipsilateral amputation 0% 0% 2.8% 1.3% BK/AK ipsilateral 0% 4.5% 2.1% 1.2% amputation Discharge Medications ASA or other antiplatelet 0% 90.9% 96.2% 93.3% Statin 100% 90.9% 89.2% 85.9% New anticoagulant** 0% 11.8% 10.4% 11.3% Discharge Destination Dead 0% 0% 4.2% 2.6% *Rate is among patients returned to the OR. **Rate is among patients not taking anticoagulant on admission.

24 www.VQI.org

VQI Best Practices Scorecard Peripheral Vascular Intervention (PVI) VQI BEST PRACTICES DASHBOARD: Timeframe: July 1, 2017-June 30, 2018 6. PeripheralIn Vascular the table below, Intervention percentages (PVI) represent Timeframe: the rate ofJuly cases 1, 2017-Junewith the noted 30, outcome 2018 or complication. If In the tableyou performedbelow, percentages procedures in more represent than one the hospital, rate ‘Your of cases Center’ with shows the the noted results foroutcome the hospital or at complication. If you performedwhich you performedprocedures the most in more procedures. than one hospital, ‘Your Center’ shows the results for the hospital at which you performed the most procedures. Your results are highlighted in green if you are at or above the top 25th percentile among all VQI physicians, and in red if at or below the bottom 25th percentile. Your center’s results are similarly color- Your resultscoded are if theyhighlighted fall above orin belowgreen the if 75th you or are 25th at percentiles or above among the alltop VQI 25th centers. percentile among all VQI physicians, and in red if at or below the bottom 25th percentile. Your center’s results are similarly color- coded ifNote they that fall percentiles above orare below based on the the 75th rates orof individual25th percentiles physicians oramong centers, all so VQIit is possible centers. for your rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) Note thatbut percentiles still be above arethe 75th based percentile on the across rates all physicians’of individual or centers’ physicians individual or rates. centers, so it is possible for your rate or yourNote center’s also that percentages rate to be are below computed the only overall among VQI cases rate wi thacross non-missing all procedures data for each (theoutcome, “VQI so Overall” it column) isbut possible still be to haveabove rates the for some75th outcomespercentile but “Noacross cases” all for physicians’ others. or centers’ individual rates. Regional data are suppressed if your region has fewer than 3 centers participating in this registry. Note also that percentages are computed only among cases with non-missing data for each outcome, so it is possible to have rates for some outcomes but “No cases” for others. Regional data are suppressedLegend: ifGreen your = region Top 25th has percentile fewer than Red =3 Bottom centers 25th participating percentile in this registry. Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data Number of cases reviewed 3 46 2466 28817 Hematoma Any Hematoma 0% 4.4% 4.2% 2.4% Moderate/Major Hematoma 0% 0% 0.7% 0.7% Discharge Medications (excludes death in Antiplatelet 100% 95.3% 96.1% 94.1% hospital) Statin 100% 93% 86.1% 82.3% Smoking in Claudicants Never 0% 0% 9.5% 11.4% Prior 0% 22.2% 56.7% 49.3% Current 100% 77.8% 33.8% 39.3% 9-Month Outcomes Your Your Your VQI Category Outcome/Complication (July 2015-June 2016 9-Month AFS* for CLI NoResults cases Center100% Region90.8% 87.4%***Overall with 9-month LTFU) 9-Month MALE** for CLI No cases 0% 13% 20.6%*** Long term follow-up (July 2015-June 2016) Long term follow-up rate No cases 87.5% 88.9% 71.4%

*Freedom from amputation in the ispilateral limb for at least 9 months among patients treated for critical limb ischemia. **Major adverse limb event (MALE) is defined as ipsilateral amputation or any reintervention within 9 months among patients treated for critical limb ischemia. ***Only 52% of PVI cases have complete data for these long-term follow-up outcomes, so the VQI benchmarks may be biased. The Vascular Quality Initiative is working to provide timely, relevant and individualized outcomes data to physicians caring for patients with vascular disease. We rely on diligent long-term follow-up data entry to provide this information to our members.

25 SVS VQI 2018 Annual Report

VQI Best Practices Scorecard

VQI BESTLower PRACTICES Extremity DASHBOARD: Amputation (LEAMP) 7. Lower Extremity Amputation (LEAMP) Timeframe: July 1, 2017-June 30, 2018 In the tableTimeframe: below, percentages July 1, 2017 represent-June the 30, rate 2018 of cases with the noted outcome or complication. If you performedIn the tableprocedures below, percentages in more representthan one the hospital, rate of cases ‘Your with Center’ the noted shows outcome the or complication.results for theIf hospital at whichyou you performed performed procedures the most in more procedures. than one hospital, ‘Your Center’ shows the results for the hospital at which you performed the most procedures.

Your resultsYour are results highlighted are highlighted in green in green if ifyou you are at at or orabove above the top the 25th top percentile 25th percentile among all VQI among all VQI physicians,physici andans, in andred in if red at ifor at belowor below the the bottombottom 25th 25th percentile. percentile. Your center’s Your center’sresults are resultssimilarly arecolor similarly- color- coded ifcoded they iffall they above fall above or orbelow below the 75th 75th or or25th 25th percentiles percentiles among allamong VQI centers. all VQI centers.

Note thatNote percentiles that percentiles are are based based on on the rates rates of individualof individual physician physicianss or centers, or so centers, it is possible so itfor is yourpossible for your rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) rate or yourbut still center’s be above rate the 75thto be percentile below across the overall all physicians’ VQI rate or centers’ across individual all procedures rates. (the “VQI Overall” column) but still be above the 75th percentile across all physicians’ or centers’ individual rates. Note also that percentages are computed only among cases with non-missing data for each outcome, so it Note alsois thatpossible percentages to have rates forare some computed outcomes butonly “No among cases” for cases others. with non-missing data for each Regional data are suppressed if your region has fewer than 3 centers participating in this registry. outcome, so it is possible to have rates for some outcomes but “No cases” for others. Regional data are suppressed if your region has fewer than 3 centers participating in this registry. Legend: Green = Top 25th percentile Red = Bottom 25th percentile Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data Number of cases reviewed 11 75 221 2952 Median postop LOS (days) 5 5 5 6 Median total LOS (days) 9 8 9 10 Amputation Indication (per limb) Number of limbs treated 11 75 221 3023 Ischemic Rest Pain 9.1% 5.3% 4.1% 4% Ischemic Tissue Loss 45.5% 42.7% 37.1% 45.7% Acute Ischemia 9.1% 2.7% 5.9% 8% Uncontrolled Infection 27.3% 38.7% 48% 38.8% Neuropathic Tissue Loss 0% 8% 3.2% 2.2% Other 9.1% 2.7% 1.8% 1.3% Your Your Your VQI AmputationCategory Level Outcome/Complication Results Center Region Overall TMA 36.4% 18.7% 25.8% 20.6% Hindfoot 0% 0% 1.4% 0.5% Ankle 0% 5.3% 2.3% 2.1% BKA 45.5% 49.3% 46.2% 43.5% TKA 0% 0% 0.5% 1.4% AKA 18.2% 26.7% 24% 31.5% Higher 0% 0% 0% 0.3% Complications Any Post-Op Complications 45.5% 24% 25.8% 18.7% Reoperation Return to OR for Revision 18.2% 13.3% 14.5% 9.5% Discharge Medications (excludes death in Antipaltelet+Statin 100% 80.3% 75.2% 61.8% hospital) Discharge Status Home 9.1% 22.7% 32.1% 32.3% Rehab Unit 81.8% 73.3% 63.3% 34.9% Nursing Home 0% 1.3% 1.4% 26.8% Dead 9.1% 2.7% 2.3% 3.8% Other Hospital 0% 0% 0.5% 2% Homeless 0% 0% 0.5% 0.2% 26 www.VQI.org

VQI BESTVQI PRACTICES Best DASHBOARD: Practices Scorecard

8. Hemodialysis Access (AVACCESS) Timeframe: July 1, 2017-June 30, 2018 In the tableHemodialysis below, percentages Access represent the (AVACCESS) rate of cases with the noted outcome or complication. If you performed procedures in more than one hospital, ‘Your Center’ shows the results for the hospital at whichTimeframe: you performed July the most1, 2017 procedures.-June 30, 2018 In the table below, percentages represent the rate of cases with the noted outcome or complication. If Your resultsyou areperformed highlighted procedures in greenin more thanif you one are hospital, at or ‘Your above Center’ the shows top 25ththe results percentile for the hospital among at all VQI physicians,which and you in performed red if at the or most below procedures. the bottom 25th percentile. Your center’s results are similarly color- coded ifYour they results fall above are highlighted or below in green the if 75th you are or at25th or above percentiles the top 25th among percentile all amongVQI centers. all VQI physicians, and in red if at or below the bottom 25th percentile. Your center’s results are similarly color- Note thatcoded percentiles if they fall aboveare based or below on the the 75th rates or 25th of percentiles individual among physicians all VQI centers. or centers, so it is possible for your rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) Notebut thatstill percebe aboventiles are the based 75th on percentilethe rates of individual across physiciansall physicians’ or centers, or centers’ so it is possible individual for your rates. rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) but still be above the 75th percentile across all physicians’ or centers’ individual rates. Note also that percentages are computed only among cases with non-missing data for each outcome,Note so alsoit is thatpossible percentages to have are computedrates for only some among outcomes cases with but non “No-missing cases” data for for each others. outcome, Regional so it data are suppressedis possible if toyour have region rates for has some fewer outcomes than but 3 “Nocenters cases” participating for others. in this registry. Regional data are suppressed if your region has fewer than 3 centers participating in this registry.

Legend: Green = Top 25th percentile Red = Bottom 25th percentile Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data Number of cases reviewed 50 120 372 6934 Median postop LOS (days) 0 0 0 0 Median total LOS (days) 0 0 0 0 Preop Measures Ultrasound vein mapping 64% 60% 75% 87.2% Procedure Measures Fistula vs. graft* 95.1% 82.6% 85.7% 82% Reason Not Autogenous Number not autogenous 5 26 77 1598 Need acute access 0% 7.7% 3.9% 6.2% Vein not available 100% 88.5% 70.1% 77.9% Other, documented 0% 0% 6.5% 8% Not specified 0% 3.8% 19.5% 7.8% *Excludes previous access in same arm.

27 www.VQI.org VQI Best Practices Scorecard

VQI BEST PRACTICES DASHBOARD:

9. InferiorInferior Vena Cava VenaFilter (IVCF) Cava Timeframe: Filter July (IVCF)1, 2017-June 30, 2018 In the table below, percentages represent the rate of cases with the noted outcome or complication. If you performedTimeframe: procedures July 1,in more2017 than-June one 30, hospital, 2018 ‘Your Center’ shows the results for the hospital at which youIn performed the table below, the percentages most procedures. represent the rate of cases with the noted outcome or complication. If you performed procedures in more than one hospital, ‘Your Center’ shows the results for the hospital at Your resultswhich are you highlighted performed the in most green procedures. if you are at or above the top 25th percentile among all VQI physicians, and in red if at or below the bottom 25th percentile. Your center’s results are similarly color- coded ifYour they results fall above are highlighted or below in green the if 75th you are or at25th or above percentiles the top 25th among percentile all amongVQI centers. all VQI physicians, and in red if at or below the bottom 25th percentile. Your center’s results are similarly color- coded if they fall above or below the 75th or 25th percentiles among all VQI centers. Note that percentiles are based on the rates of individual physicians or centers, so it is possible for your rate or yourNote center’s that percentiles rate areto bebased below on the the rates overall of individual VQI physiciansrate across or centers, all procedures so it is possible (the for “VQI your Overall” column) ratebut or still your be center’s above rate the to be75th below percentile the overall VQIacross rate allacross physicians’ all procedures or centers’ (the “VQI Overall”individual column) rates. but still be above the 75th percentile across all physicians’ or centers’ individual rates.

Note alsoNote that also percentages that percentages are are computed computed only only among among cases withcases non -withmissing non-missing data for each data outcome, for soeach it outcome,is sopossible it is possible to have rates to havefor some rates outcomes for some but “No outcomes cases” for others. but “No cases” for others. Regional data are suppressedRegional ifdata your are region suppressed has if feweryour region than has 3 fewercenters than participating 3 centers participating in this in registry. this registry.

Legend: Green = Top 25th percentile Red = Bottom 25th percentile Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data Number of cases reviewed 13 42 199 2314 Preop Indications Prophylactic 15.4% 35.7% 22.1% 22.1% PE 7.7% 7.1% 9% 13.8% DVT 76.9% 54.8% 34.2% 41.3% PE+DVT 0% 2.4% 34.7% 22.8% Planned Duration Temporary 100% 97.6% 86.9% 82.8% Permanent 0% 2.4% 13.1% 17.2% Follow up Scorecard Your Your Your VQI Category Outcome/ComplicationAt least one visit 69.2% 85.7% 79.9% 47.4% Results Center Region Overall No FU or no retrieval data 30.8% 16.7% 33.7% 65.3% Any follow up imaging 15.4% 21.4% 44.2% 23.1% Filter ret. or attempt made 61.5% 81% 61.3% 26.3%

Median days to retrieval 84.5 63 75.5 94 Reasons Not Removed Visits with reason recorded 1 1 14 179 Not clinically indicated* 100% 100% 100% 70.4% Patient declined* 0% 0% 0% 20.4% Lost to follow-up* 0% 0% 0% 7.9% Too late for removal* 0% 0% 0% 1.3% New DVT/PE New DVT 0% 0% 3.8% 3.4% IVC 1.5% 1% Iliac 0% 0.7% Femoral 1.5% 1.2% Infrainguinal 0.8% 0.4% New PE 0% 0% 0% 0.1% Follow-Up Complications 28

Any complication www.VQI.org0% 0% 2.3% 4% Filter angle** 0% 24.1% Migration: Cephalad only** 0% 6.9% Migration: Caudal only** 0% 3.4% Migration: Both** 0% 0% Filter fracture** 0% 10.3% Vein thrombosis** 66.7% 34.5% Filter thrombosis** 100% 51.7% Filter fragments** 0% 3.4% Filter vein perforation** 0% 10.3% *Rate is among patients with filter not removed and reason recorded. **Rate is among patients with any complication.

Your Your Your VQI Category Outcome/Complication Results Center Region Overall

Any follow up imaging 15.4% 21.4% 44.2% 23.1% Filter ret. or attempt made 61.5% 81% 61.3% 26.3% Median days to retrieval 84.5 63 75.5 94 Reasons Not Removed Visits with reason recorded 1 1 14 179 Not clinically indicated* 100% 100% 100% 70.4% Patient declined* 0% 0% 0% 20.4% Lost to follow-up* 0% 0% 0% 7.9% Too late for removal* 0% 0% 0% 1.3% New DVT/PE New DVT 0% 0% 3.8% 3.4% IVC 1.5% 1% Iliac 0% 0.7% Femoral 1.5% 1.2% Infrainguinal 0.8% 0.4% New PE 0% 0% 0% 0.1% Follow-Up Complications Any complication 0% 0% 2.3% 4% Filter angle** 0% 24.1% Migration: Cephalad only** 0% 6.9% Migration: Caudal only** 0% 3.4% Migration: Both** 0% 0% Filter fracture** 0% 10.3% Vein thrombosis** 66.7% 34.5% Filter thrombosis** 100% 51.7% Filter fragments** 0% 3.4% Filter vein perforation** 0% 10.3% *Rate is among patients with filter not removed and reason recorded. **Rate is among patients with any complication.

29 SVS VQI 2018 Annual Report VQI Best Practices Scorecard

VQI BESTVaricose PRACTICES DASHBOARD: Vein (VV)

10. VaricoseTimeframe: Vein (VV) Timeframe: July 1, 2017 July -1,June 2017-June 30, 2018 30, 2018 In the tableIn the below, table below, percentages percentages represent represent the the rate rate of cases of cases with the with noted the outcome noted or outcomecomplication. or If youcomplication. If you performedperformed proceduresprocedures in more in more than one than hospital, one ‘Yourhospital, Center’ ‘Your shows Center’ the results shows for the the hospital results at whichfor the hospital at whichyou you performed performed the most the procedures. most procedures.

Your results are highlighted in green if you are at or above the top 25th percentile among all VQI Your resultsphysicians, are highlighted and in red if inat orgreen below ifthe you bottom are 25th at or percentile. above Your the center’stop 25th results percentile are similarly among color- all VQI physicians,coded and if they in red fall aboveif at or or below th ethe 75th bottom or 25th percentiles 25th percentile. among all YourVQI centers. center’s results are similarly color- coded if they fall above or below the 75th or 25th percentiles among all VQI centers. Note that percentiles are based on the rates of individual physicians or centers, so it is possible for your Note thatrate percentiles or your center’s are rate based to be belowon the the rates overall of VQI individual rate across physicians all procedures or (the centers, “VQI Over so all”it is column) possible for your but still be above the 75th percentile across all physicians’ or centers’ individual rates. rate or your center’s rate to be below the overall VQI rate across all procedures (the “VQI Overall” column) but still be above the 75th percentile across all physicians’ or centers’ individual rates. Note also that percentages are computed only among cases with non-missing data for each outcome, so it is possible to have rates for some outcomes but “No cases” for others. Note also that percentages are computed only among cases with non-missing data for each outcome,Regional so it is datapossible are suppressed to have if ratesyour region for some has fewer outcomes than 3 centers but “Noparticipating cases” in for this others. registry. Regional data are suppressed if your region has fewer than 3 centers participating in this registry.

Legend: Green = Top 25th percentile Red = Bottom 25th percentile Your Your Your VQI Category Outcome/Complication Results Center Region Overall Case Data NA (<3 Number of cases reviewed 34 242 7662 centers) Pre-Operative Measures CEAP (% captured) 100% 100% 99.5% VCSS (% captured) 100% 100% 97.1% PRO (% captured) 100% 99.6% 89.5% Venous Duplex 91.2% 91.7% 96.7% Any Postop Complications All procedures 0% 0% 0.2% Ablation only 0% 0% 0.1% Your Your Your VQI Category Outcome/ComplicationSclerotherapy only 0% 0% 0.3% Results Center Region Overall Phlebectomy only 0% 0% 0.2% Combination treatment 0% 0% 0.1% Follow-Up Measures

(Jan -Dec 2017 cases) CEAP within 90 days 75% 51.9% 44.1% CEAP at any follow-up 75% 63% 46.9% VCSS within 90 days 75% 48.1% 43.7% VCSS at any follow-up 75% 59.3% 46.5% PRO within 90 days 37.5% 33.3% 41.2% PRO at any follow-up 37.5% 44.4% 44.5% Early Follow-Up Complications (within 14 days Any Complications 0% 8.3% 3% postop among those with DVT 0% 0% 0.5% FU) EHIT 0% 0% 1.1% Wound Infection 0% 0% 0.1% Paresthesia 0% 0% 0.5% Pigmentation 0% 0% 0.1%

Superficial phlebitis 0% 4.2% 0.5% 30 Any Follow-Up Complications www.VQI.org (at any follow-up) Any Complications 0% 12.5% 9% DVT 0% 0% 0.9% EHIT 0% 0% 2% Wound Infection 0% 0% 0.3% Paresthesia 0% 0% 2.4% Pigmentation 0% 4.2% 1% Superficial phlebitis 0% 4.2% 1.4% Overall Follow Up Early 87.5% 85.2% 48.6% Late 12.5% 18.5% 12.6%

Your Your Your VQI Category Outcome/Complication Results Center Region Overall

Combination treatment 0% 0% 0.1% Follow-Up Measures (Jan -Dec 2017 cases) CEAP within 90 days 75% 51.9% 44.1% CEAP at any follow-up 75% 63% 46.9% VCSS within 90 days 75% 48.1% 43.7% VCSS at any follow-up 75% 59.3% 46.5% PRO within 90 days 37.5% 33.3% 41.2% PRO at any follow-up 37.5% 44.4% 44.5% Early Follow-Up Complications (within 14 days Any Complications 0% 8.3% 3% postop among those with DVT 0% 0% 0.5% FU) EHIT 0% 0% 1.1% Wound Infection 0% 0% 0.1% Paresthesia 0% 0% 0.5% Pigmentation 0% 0% 0.1% Superficial phlebitis 0% 4.2% 0.5% Any Follow-Up Complications (at any follow-up) Any Complications 0% 12.5% 9% DVT 0% 0% 0.9% EHIT 0% 0% 2% Wound Infection 0% 0% 0.3% Paresthesia 0% 0% 2.4% Pigmentation 0% 4.2% 1% Superficial phlebitis 0% 4.2% 1.4% Overall Follow Up Early 87.5% 85.2% 48.6% Late 12.5% 18.5% 12.6%

31 SVS VQI 2018 Annual Report APPENDIX E – SAMPLE CENTER OPPORTUNITY PROFILE FOR IMPROVEMENT (COPI) REPORT AND BEST PRACTICES DASHBOARD (CENTER-LEVEL)

VQI COPI Report Elective EVAR: Percentage of Patients with Length of Stay > 2 Days (2011-May 2014 compared to 2015-2017)

Excludes patients with symptomatic and ruptured EVAR, patients with prior aortic surgery, patients who died in the hospital with LOS<3 days, patients who were not admitted the same day of the procedure and patients who had surgery on the weekend. Note: In all tables and graphics, regional data are not shown for regions with <3 centers participating in the registry.

In our continuing effort to improve vascular health, the Vascular Quality Initiative (VQI) is pleased to provide you with this Center Opportunity for Improvement (COPI) report concerning length of stay (LOS) after elective endovascular aneurysm repair (EVAR). The SVS PSO previously issued a COPI report on LOS after elective EVAR in 2014. This report compares rates of LOS>2 days before (January 2011-May 2014) and since (2015-2017) the original report was issued.

“*" indicates the two rates are significantly different. The observed rates on the left are among only patients with complete data for the risk model, while observed rates on the right are among all patients.

SUMMARY

32 www.VQI.org VQI COPI Report Elective EVAR: Percentage of Patients with Length of Stay > 2 Days (2011-May 2014 compared to 2015-2017)

SUMMARY

Your center's Your region's Your center's current rate of Your region's current rate Nationally, the VQI rate of observed rate of observed rate of LOS>2 days is of LOS>2 days is LOS>2 days is LOS>2 days is LOS>2 days is not significantly not significantly different significantly lower than its significantly lower than the significantly higher different from from its previous rate (2011- previous rate (2011-May previous rate (2011-May than expected. expected. May 2014). 2014). 2014).

Most patients who undergo elective EVAR were discharged by the second post-operative day, but across all VQI centers in 2017, 13% of patients undergoing elective EVAR and admitted the same day of the procedure have post-operative LOS > 2 days. Since EVAR is one of the most frequently performed vascular operations, this can have significant impact. This report compares the rate of LOS>2 days (post-procedure to discharge) from 2015 to 2017 to the rate from January 2011 to May 2014, the time frame studied in the original COPI report concerning elective EVAR LOS that was issued in 2014. Graphics A and B below show the variation in the percentage of patients with LOS > 2 days after elective EVAR across VQI centers in these two time periods. The OBSERVED percentage of patients with LOS > 2 days is shown for each center (blue dots, sorted from low to high), with your center indicated by a yellow square. As you can see, some centers have very few patients who stay > 2 days, while in other centers, nearly all patients stay > 2 days after elective EVAR. The EXPECTED percentage of patients with LOS > 2 days is shown by the red line, which corrects for differences in patients between centers in factors that influence LOS. Many of these factors are listed in the COPI table presented immediately after these graphics. We also corrected for other factors – such as race and BMI, family history of AAA, preop meds, and maximum AAA diameter – that are not listed in the table because their effects on LOS were found to be minimal.

33 SVS VQI 2018 Annual Report To determine which factors are associated with prolonged LOS, we performed multivariate logistic regression regarding patient characteristics, procedure details and postop complications. Because the EVAR registry was revised in December 2014, we used data from 2015 to 2017 to create this model, which updates the model presented in the original 2014 COPI report. The Center Opportunity Profile for Improvement (COPI) report below lists each risk factor that contributes to LOS > 2 days after elective EVAR and compares your center with all VQI centers. The COPI report lists risk factors independently associated with LOS > 2 days, along with the percentage of patients at your center with that risk factor. Factors are highlighted in red if your center was above the 75th percentile for all centers (indicating a potential opportunity to reduce LOS) and in green if your center was below the 25th percentile (indicating that your center has more patients with a lower risk of having a longer LOS). The report also contains the odds ratio (OR) for each risk factor. This shows how much each risk factor contributes to LOS > 2 days. An OR of 2 means patients with this risk factor have twice the odds of LOS > 2 days compared to a risk factor with an OR of 1. Thus, ORs are a way to rank the risk factor’s impact on longer LOS (larger ORs have a larger impact). Patient characteristics that increase LOS can usually not be modified, but can help direct earlier efforts at discharge planning. Procedure details are potentially modifiable and represent opportunities to reduce LOS. Post-operative complications have a very large influence on LOS, and represent the greatest opportunity for improvement. If you would like further information or have questions about your report, contact Dan Neal, VQI Director of Analytics, at [email protected]. Jens Jorgensen, SVS PSO Medical Director Salvatore Scali, MD, EVAR Registry Committee Chair Your Center Opportunity Profile for Improvement (COPI) Legend: Green: <= 25 percentile Red: >= 75 percentile Excludes patients with symptomatic and ruptured EVAR, patients with prior aortic surgery, patients who died in the hospital within 2 days, patients who were not admitted the same day of the procedure, and patients who had surgery on the weekend.

Risk factors for LOS>2 days after elective EVAR % Patients with risk factor, 2015-2017

Odds ratio Your center Your region VQI

Patient Characteristics Female Gender (vs. Male) 1.7 4.8% 20.3% 18.2% Age 80 or above (vs. <70) 1.7 23.8% 26.1% 24.2% COPD On Meds (vs. No) 1.4 33.3% 23% 19.5% COPD On Home Oxygen (vs. No) 1.6 0% 3.9% 4.9% EGFR Class 3 (vs. class 1) 1.3 28.6% 31.2% 30.6% EGFR Class 4 (vs. class 1) 1.8 0% 2.2% 1.9% EGFR Class 5 (vs. class 1) 2.4 0% 0.9% 1.2% Functional Status with Light Work (vs. Full) 1.5 42.9% 13.7% 16.8% Functional Status with Self Care (vs. Full) 1.6 23.8% 7.2% 10.4% Functional Status with assisted care/bed bound (vs. full) 1.9 0% 1.9% 2.1% Unfit for Open AAA Repair (vs. No) 1.4 19% 16.3% 11.9% Procedure Characteristics PRBC (in OR or Preop) > 0 unit (vs. =0) 3.3 0% 3.5% 3.6% Total Procedure Time 121-180 Minutes (vs. <=120) 1.5 28.6% 31.1% 26.8% Total Procedure Time >180 Minutes (vs. <=120) 4.0 57.1% 17.6% 14.1% Any Femoral-femoral Bypass (vs. None) 4.7 0% 1.9% 1.7% Any Iliac Artery Injury with Stent-Graft (vs. None) 2.0 0% 0.6% 1.2% Surgery Performed on Friday (vs. T-TH) 1.6 9.5% 17.7% 16.1% Post-Op Complications Myocardial Infarction (vs. None) 14.3 0% 0.7% 0.6% Dysrhythmia (vs. No) 10.3 0% 0.8% 1.5% Post-Op CHF (vs. No) 16.2 0% 0.3% 0.5% Respiratory (vs. None) 15.7 0% 0.9% 0.9% Re-operation (vs. No) 14.6 0% 1.3% 1.3% IV BP Support Post-Op <4 hrs (vs. No) 1.9 4.8% 1.8% 2% IV BP Support Post-Op 4-24 hrs (vs. No) 3.0 4.8% 1.7% 1.5% IV BP Support Post-Op >24 hrs (vs. No) 18.4 0% 0.8% 0.8% 34 www.VQI.org Detailed Results: LOS>2 Days After Elective EVAR, 2011-May 2014 vs. 2015- 2017

The tables below show your center’s average and median LOS after elective EVAR in the two time periods and compare your center’s statistics with those of other centers in your region and in VQI. In addition, your center’s observed and expected percentage of patients with LOS > 2 days are shown, with a statistical calculation of whether this percentage is lower or higher than expected based on the characteristics of patients in your center. Detailed results for 2011-May 2014

The tables below show the number EVAR procedures meeting the inclusion criteria that were in the VQI as of January 31, 2018, and the percentage of those cases in which the patient’s length of stay was greater than 2 days after surgery.

Your Center Your Region VQI Overall Number of procedures meeting inclusion criteria 17 2055 8724 Number of procedures included in analysis* 17 1997 8045 Mean (SD) [Median] post-op length of stay 2.4 (1.5) [2] 2.2 (3) [2] 2.3 (3.7) [1] Observed percentage of cases with LOS>2 days 29.4% 22.3% 21.9% Expected percentage of cases with LOS>2 days 28.3% 23.8% NA P-value for O/E comparision 1 0.11 NA

*Because the multivariate model presented in the COPI table is used to calculate expected rates of LOS>2 days, any patients missing data on any factors in that model must be excluded from the analysis.

Detailed results for 2015-2017

Your Center Your Region VQI Overall Number of procedures meeting inclusion criteria 21 1568 14444 Number of procedures included in analysis* 21 1491 13754 Mean (SD) [Median] post-op length of stay 2.5 (1.7) [2] 2.2 (8.8) [1] 1.9 (4.6) [1] Observed percentage of cases with LOS>2 days 42.9% 14.7% 14.4% Expected percentage of cases with LOS>2 days 20.8% 15.3% NA P-value for O/E comparision 0.03 0.56 NA P-value for comparison of 2011-May 2014 vs. 2015-2017 observed rates <.01 <.01

35 SVS VQI 2018 Annual Report Graphics C and D show the center-to-center variation in LOS>2 days across your region before and since the publication of the original COPI report in 2014. The bars give the observed rate for each center, which should be compared to the expected rate for each center, shown by the red dots.

“*" indicates center’s observed rate differs significantly from its expected rate. Graphics E and F show the region-to-region variation in LOS>2 days across VQI before and since the publication of the original COPI report in 2014. The bars give the observed rate for each region, which should be compared to the expected rate for each region, shown by the red dots.

“Others” indicates centers that do not belong to a regional group. *Indicates region’s rate is significantly different (p<.05) from VQI rate.

Graphic G below shows the percentage of patients with LOS > 2 days after elective EVAR in your center over time, compared with centers in your region and all VQI centers. As you can see, the overall VQI rate has been declining steadily since 2011, from 28% to 13%, which is a statistically significant trend over time, as indicated by the askterisk in the graphic legend (“VQI Overall*”). If an asterisk appears in the legend for your center (“Your Center*”), it indicates that your center’s trend over time is also statisically significant. If there is no askterisk, it indicates that your center’s rate has not changed significantly over time.

36 “*" indicates indicates a significant trend over time. www.VQI.org APPENDIX F – REGIONAL QUALITY GROUPS AND LEADERSHIP

Canadian Vascular Quality Initiative Southeastern Vascular Study Group Dr. Graham Roche-Nagle Dr. Yazan Duwayri Toronto General Hospital Emory University Hospital

Carolinas Vascular Quality Group Southern California Vascular Outcomes Dr. Thomas Brothers Improvement Collaborative Medical University of South Carolina Dr. Ahmed Abou-ZamZam Dr. Leila Mureebe Loma Linda University Medical Center University Duke University Medical Center Medical Center

Great Lakes Vascular Study Group Southern Vascular Outcomes Network Dr. Jean Starr Dr. Dennis Gable Ohio State University Medical Center Baylor University Medical Center at Dallas

Michigan Vascular Study Group Upper Midwest Vascular Network Dr. Ashraf Mansour Dr. Randall DeMartino Spectrum Health Mayo Clinic

Mid-America Vascular Study Group Vascular Study Group of Greater New York Dr. David Chew Dr. Apostolos Tassiopoulos Iowa Heart Center at Mercy Medical Center at Stony Brook University Hospital Mercy Medical Center Dr. James Ebaugh Vascular Study Group of New England Iowa Heart Center at Mercy Medical Center at Dr. Philip Goodney Mercy Medical Center Dartmouth-Hitchcock Medical Center

Mid-Atlantic Vascular Study Group Virginias Vascular Study Group Dr. Grace Wang Dr. William Robinson Hospital of the University of Pennsylvania University of Virginia

Mid-South Vascular Study Group Dr. H. Edward Garrett, Jr. Baptist Memorial Hospital

Midwest Vascular Collaborative Dr. Gary Lemmon Indiana University Health System

Northern California Vascular Study Group Dr. Matthew Mell University of California at Davis

Pacific Northwest Vascular Study Group Dr. Stephen Murray Providence Sacred Heart Medical Center

Rocky Mountain Vascular Quality Initiative Dr. Scott Berman Carondelet Heart & Vascular Institute

37 SVS VQI 2018 Annual Report APPENDIX G – LIST OF QUALITY IMPROVEMENT ABSTRACTS 2017/2018 (ALPHABETICAL BY CENTER) Atrium Health (Charlotte, NC) Stony Brook Medicine (Stony Brook, NY) Improvement Project: Reducing Infection Related The Benefits of a Nurse Practitioner (NP) Lead Vascular Readmissions Venous Thromboembolism (VTE) Team

Carle Foundation (Urbana, IL) University of Alberta - Grey Nuns Hospital Achieve 100% Compliance in PVI Data (Edmonton AB, CAN) Submission Improving Critical Discharge Medication Adherence: A Vascular Quality Initiative (VQI) Henry Ford Health System (Detroit, MI) Cross-Clamp Location and Peri-operative University of Pittsburgh Medical Center (UPMC), Outcomes after Open Abdominal Aortic Heart and Vascular Institute, UPP Vascular Surgery Aneurysm Surgery (Pittsburgh, PA) Successful Continuation of EVAR Patient Indiana University Health (Indianapolis, IN) Compliance Utilizing VQI for Long Term Follow-Up Improvement in Carotid Stent Embolic Protection Device Usage University of Rochester (Rochester, NY) Integration of VQI and SVS Wifi into an EMR Indiana University Health-Methodist Hospital Population Health Registry (Indianapolis, IN) Peripheral Vascular Intervention (PVI) Discharge Toronto General Hospital (Toronto, ON, Canada) Acute and Chronic Renal Dysfunction Post Open Jobst Vascular Institute, ProMedica (Toledo, OH) and Endovascular Abdominal Aortic Aneurysm Improving Long Term Follow-Up for CEA Patients Repair

Jobst Vascular Institute, ProMedica (Toledo, OH) UCSF Health (San Francisco, CA) Using VQI as a Tool to Drive Improvement in IVC Improving Data Accuracy & Efficiency by Filter Follow-Up and Retrieval Implementing VQI-specific Brief Op Notes

New York Presbyterian Hospital - Weill Cornell University of Utah (Salt Lake City, UT) Medicine (New York City, NY, and Cornell, NY) Utilization & Usability Assessment of VQI-Specific Implementation of a Structured Protocol to Electronic Medical Record Brief Operative Notes Improve Rates of VQI Registry Vascular Patient at 1-Year Post Implementation Follow-Up

University of Kansas Health System (Kansas City, KS) Increasing Compliance with Discharge Medications

University of Kansas Health System (Kansas City, KS) PVI for New Data Managers

Toronto General Hospital (Toronto ON, Canada) Smoking Cessation Rates among Patients Undergoing Vascular Surgery in a Canadian Center

38 www.VQI.org APPENDIX H – NATIONAL APPROVED PROJECTS LIST, 2017/2018 (ALPHABETICAL BY TITLE) 1. Adherence to Instructions for Use for Peripheral 12. Comparison of Access Types for Ruptured Arterial Devices in Real World Practice, Daniel Abdominal Aortic Aneurysms., Jeffrey Siracuse, MD, Bertges, MD, VQI SVS PSO and Maine Medical Center, Boston University/Boston Medical Center, April 2018. December 2017. 13. Comparison of Complications in Selective 2. Analysis of Multi-Vessel Tibial Revascularization in Ultrasound Guided Percutaneous Access for Peripheral Patients with Critical Limb Ischemia, Matthew Mell, MD, Endovascular Procedures, Mark Stoner, MD, Mark Stanford University, December 2017. Balceniuk, MD, University of Rochester Medical Center, June 2018. 3. Anemia as an Independent Predictor of Adverse Outcomes after Carotid Revascularization, Mahmoud 14. Comparison of Long-term mortality between the Malas, MD, Johns Hopkins Hospital, August 2018. Nellix Endovascular Aneurysm Sealing System and Traditional Endovascular Aneurysm Repair, Marc 4. Aneurysm Sac Expansion and Late Mortality after Schermerhorn, MD, Thomas O’Donnell, MD, Beth-Israel Fenestrated EVAR (FEVAR) TEVAR, Virendra Patel, MD, Deaconess Medical Center, February 2018. Columbia University, April 2018. 15. Comparison of Outcomes and Prevalence of 5. Association between Anemia and Outcomes use of Flared Iliac Limb versus Iliac Branch Device in Patients undergoing hemodialysis using AVF or in Treatment of Simultaneous Abdominal Aorta and AVG, Mahmoud Malas, MD, Johns Hopkins Hospital, Common i, Mohammed Eslami, MD, UPMC, April 2018. December 2017. 16. A Comparison of Outcomes in Non-Ambulatory 6. The Association between Aortic Aneurysm Diameter Patients Treated with Peripheral Vascular Intervention, Indexed to Patient’s Height and Rupture Presentation, Lower Extremity Bypass or Amputation, Mahmoud Postoperative and 5-Year Mortality, Mahmoud Malas, Malas, MD, John Hopkins University, August 2018. MD, Johns Hopkins Bayview Medical Center, June 2018. 17. Comparison of Outcomes of Patients Treated for 7. Association between Frailty and Outcome of Iliac Artery Aneurysms by Iliac Branch Endografts Ambulatory Vascular Surgery Procedures, Mark or Coiling and Coverage of the Internal Iliac Artery, Conrad, MD, Massachusetts General Hospital, Randall DeMartino, MD, Bernardo Mendes, MD, Mayo December 2017. Clinic, June 2018.

8. Association of Left Vertebral Artery Status with 18. Comparison of Patient Demographics and Left Arm Ischemia after TEVAR with Coverage of Outcomes following Open and Endovascular Left Subclavian Artery without Revascularisation, Abdominal Aortic Aneurysm Repair between Multiple Sashi Inkollu, MD, Samantha Minc, MD, West Virginia National Databases, Marc Schermerhorn, MD, Nicholas University Morgantown, August 2018. Swerdlow, MD, Beth Israel Deaconess Medical Center, June 2018. 9. A Case-matched Linking of One-year Outcomes in the VQI with 30-day Outcomes from NSQIP, Eric 19. Contemporary Outcomes after Axillobifemoral Endean, MD, University of Kentucky, December 2017. vs Axillounifemoral Bypass, Jeffrey Kalish, MD, Boston Medical Center, December 2017. 10. Comparative Outcomes of Thoracic Endovascular Aortic Repair in Octogenarians vs. Younger Patients in 20. Contemporary Outcomes and Regional Variation the Vascular Quality Initiative, Mahmoud Malas, MD, in Polytetrafluoroethylene and Autologous Great Ali Azizzadeh, MD, Johns Hopkins Hospital/Cedar Sinai Saphenous Vein Grafts for Femoropopliteal Bypass, Hospital, August 2018. Douglas Jones, MD, Jeffrey Siracuse, MD, Boston Medical Center, February 2018. 11. Comparison in Outcomes between Percutaneous versus Open Femoral Cutdown Access for Ruptured 21. Correlation of Truncal Vein Diameter with Venous Endovascular Repair of Abdominal Aortic Aneurysm, Clinical Severity Scores and Patient-reported Shelley Maithel, MD, Roy Fujitani, MD, University of Outcome Measures within the Vascular Quality California, Irvine, August 2018. Initiative, Judith Lin, MD, Henry Ford Health System, October 2017.

39 SVS VQI 2018 Annual Report 22. Determination of the Influence of Gender on Frailty 34. Examination of potential Racial Disparities in the and Outcomes of Elective AAA Repair, Sarah Barbey, Choice of Conduit for Lower Extremity Bypass, Luke University of Florida, December 2017. Stewart, MD, Emily Spangler, MD, University of Alabama - Birmingham, October 2017. 23. Discharge Prescription Patterns for Anti-Platelet Therapy Following Lower Extremity Peripheral Vascular 35. Examination of Racial Disparities in Length of Stay Intervention, Parveen Garg, MD, Gregory Magee, in Lower Extremity Bypass Surgery, Emily Spangler, MD, MD, University of Southern California Keck School of University of Alabama - Birmingham, December 2017. Medicine, June 2018. 36. Examining Radiation Exposure during Endovascular 24. Durability of Autogenous Venous Biografts Versus Aneurysm Repair, Nicholas Osborne, MD, University of Prosthetic Grafts in Hemodialysis Vascular Access., Michigan, December 2017. Mahmoud Malas, MD, Johns Hopkins Hospital, December 2017. 37. Examining Radiation Exposure during Endovascular Infrainguinal Peripheral Vascular Interventions, Nicholas 25. Effect of Anemia on Postoperative Outcomes of Osborne, MD, Elizabeth Andraska, MD, University of Endovascular Repair of Thoracic Aneurysms (TEVAR), Michigan, April 2018. Mahmoud Malas, MD, Johns Hopkins University School of Medicine, April 2018. 38. Examining Repeated/Subsequent Procedures among Patients within the VQI VVR, Nicholas 26. The Effect of Anticoagulant Medications on Osborne, MD, University of Michigan, December Outcomes for Axillary-femoral and Femoral-femoral 2017. Bypass, Bjoern Suckow, MD, Peter Bartline, MD, Dartmouth-Hitchcock Medical Center, April 2018 39. Factors Associated with In-Hospital 27. Effect of Late Smoking Cessation on Postoperative Complications Following EVAR in Elderly Patients Outcomes in Vascular Surgery, Nkiruka Arinze, MD, and Effect of Complications on Long-Term Boston Medical Center, October 2017. Survival, Marc Schermerhorn, MD, Rens Varkevisser, MD, Beth-Israel Deaconess Medical Center, 28. The Effect of Procedure Day on Outcomes for February 2018. Patients Undergoing Elective Lower Extremity Bypass, Jeffrey Siracuse, MD, Gheorghe Doros, MD, Boston 40. Identification of Frailty Index, Relationship University/Boston Medical Center, April 2018. between lesion length/plaque size and Frailty, and Role of Frailty on Outcomes Following 29. Effects of Statin and Antiplatelet Therapy Noncompliance on Patient Outcomes following Carotid Artery, Mahmoud Malas, MD, Johns Vascular Surgery, Adam Beck, MD, Johnston Moore, Hopkins Hospital, June 2018. MD, University of Alabama - Birmingham, June 2018. 41. Impact of ‘Distressed Communities Index’ on 30. Effects of Surgeon Experience on Patient Selection, Outcomes after Infrainguinal Bypass in a National Procedure Type and Outcomes in the Treatment of Cohort, Robert Hawkins, MD, Margaret Tracci, MD, AAA and PAD within the VQI, Salvatore Scali, MD, University of Virginia, August 2018. University of Florida, July 2018. 42. Impact of Dual Antiplatelet Therapy on Lower 31. Evaluation of Individual and System Contributions Extremity Revascularization Outcomes in Patients to Race Disparities in Treatment of AAA, Mark Conrad, MD, Massachusetts General Hospital, December 2017. with Critical Limb Ischemia, Bala Ramanan, MD, UT Southwestern Medical Center, June 2018. 32. Evaluation of Individual and System Contributions to Race Disparities in Treatment of AAA, Mark Conrad, 43. Impact of Gender on Outcomes following MD, Laura Boitano, MD, Massachusetts General Abdominal Aortic Aneurysm Repair, Mahmoud Hospital, August 2018. Malas, MD, Johns Hopkins Hospital, August 2018.

33. Evaluation of the Temporal Incidence of 44. The Impact of Loss to Follow-up of Patients Post-Operative Myocardial Infarction in Patients Undergoing Peripheral Vascular Intervention Undergoing Vascular Surgery Interventions, Adam in the Vascular Quality Initiative, Grace Wang, Beck, MD, John Axley, MD, University of Alabama at Birmingham, February 2018. MD, Hospital of the University of Pennsylvania, October 2017.

40 www.VQI.org 45. The Impact of Pre-Operative Chronic Kidney 55. Life after Lower Extremity Bypass: What the Disease Stage on Short Term and Long-Term Medicare Linked Vascular Quality Initiative MACE and MALE following Lower Extremity Database Can Tell Us, Jessica Simons, MD, Endovascular Intervention, William Robinson, MD, University of Massachusetts, February 2018. University of Virginia, December 2017. 56. National Update on the Use of Completion 46. The Impact of Race on Vascular Care and Neuroimaging after Carotid Endarterectomy, Long-term Outcomes after Lower Extremity Mahmoud Malas, MD, Johns Hopkins Medical Revascularization for Peripheral Artery Disease, Institutions, June 2018. William Robinson, MD, Alexander Shannon, MD, University of Virginia, April 2018. 57. Outcomes and Efficacy of Cyanoacrylate Closure (CAC) Compared to Endovenous 47. Impact of Reoperation on Clinical Outcomes Thermal Ablation (EVTA) Methods in Treatment in Elderly Patients undergoing Lower Extremity of Incompetent Saphenous Vein, Joseph Ricotta, Bypass, Tze-Woei Tan/Scott Berman, Banner MD, Ahmed Ghamraoui, MD, Delray Medical University Medical Center/ University of Arizona, Center/Florida Atlantic University, August 2018. June 2018. 58. Outcomes following Eversion vs. Conventional 48. Impact of Rural Residence on the Risk of Endarterectomy in the Vascular Quality Initiative Amputation, Samantha Minc, MD, West Virginia Database, Mahmoud Malas, MD, Johns Hopkins University, June 2018. Medical Institutions, June 2018.

49. Impact of Spinal Drainage in Thoracic 59. Outcomes Following Lower Extremity Bypass Endovascular Aortic Repair, James Black, MD, for Patients on Dialysis., Mark Stoner, MD, University Johns Hopkins University, April 2018. of Rochester Medical Center, June 2018.

50. Impact of Time to Intervention for 60. Outcomes of Endovascular Infrarenal AAA Symptomatic and Ruptured Abdominal Aortic Repairs in Patients with Marfans and Ehlers- Aneurysms on Patient Outcomes in the Vascular Danlos, Alfio Carroccio, MD, Lenox Hill Hospital, Quality Initiative, Frank Davis, MD, Nicholas December 2017. Osborne, MD, The University of Michigan, February 2018. 61. Outcomes of Peripheral Vascular Interventions in Kidney Transplant Recipients Compared to 51. Impact of Timing of Carotid Revascularization Dialysis-Dependent Patients, Ryan King, MD, after Preprocedural Stroke in Symptomatic Medical University of South Carolina, December Patients, Marc Schermerhorn, MD, Beth-Israel 2017. Deaconess Medical Center, October 2017. 62. Outcomes of Routine Shunt Placement during 52. Individual-Level Risk Model to Optimize Carotid Endarterectomy after Acute Stroke, Selection of Carotid Revascularization Approach, Jeffrey Siracuse, MD, Scott Levin, MD, Boston James Burke, MD, Nicholas Osborne, MD, Medical Center, June 2018. University of Michigan, February 2018. 63. Outcomes of Transcarotid Arterial 53. Influence of Hospital Volume on Outcomes Revascularization (TCAR): Local vs. General after Carotid Revascularization, Marc Anesthesia, Dipankar Mukherjee, MD, Inova Schermerhorn, MD, Beth-Israel Deaconess Fairfax Medical Campus, August 2018. Medical Center, February 2018. 64. Patient Selection and Stroke in Isolated 54. Influence of Surgeon and Hospital Volume CEA and Concomitant CEA/CABG in Vascular on Outcomes after Carotid Revascularization, Quality Initiative (VQI), William Darrin Clouse, MD, Marc Schermerhorn, MD, Beth-Israel Deaconess Massachusetts General Hospital, December 2017. Medical Center, June 2018.

41 SVS VQI 2018 Annual Report 65. Predictors of Discharge Destination following 76. Risk Factors and Outcomes for Bowel Ischemia Open and Endovascular Abdominal Aortic after Abdominal Aortic Aneurysm Repair, Aneurysm, Mark Conrad, MD, Massachusetts Mahmoud Malas, MD, Johns Hopkins Hospital, General Hospital, December 2017. December 2017.

66. Predictors of False Lumen Thrombosis after 77. Risk Factors for Delayed Discharge after TEVAR for Type B Dissection, Mahmoud Malas, MD, Carotid Endarterectomy, William Shutze, MD, Johns Hopkins Hospital, August 2018. Salvatore Scali, MD, The Heart Hospital Baylor Plano, June 2018. 67. Predictors of One-year Ambulation After Major Lower Extremity Amputation Using the Vascular 78. Risk Factors for Upper Extremity Arteriovenous Quality Initiative Lower Extremity Database, Graft Infection and its Complications, Jeffrey Jessica Simons, MD, Grace Wang, MD, University Siracuse, MD, Scott Levin, MD, Boston Medical of Massachusetts Medical School/ Hospital of the Center, June 2018. University of Pennsylvania, August 2018. 79. Risk Model for 5 Year Survival following EVAR, 68. Predictors of Renal Complications after Marc Schermerhorn, MD, Beth-Israel Deaconess Branched and Fenestrated EVAR, Virendra Patel, Medical Center, October 2017. MD, Columbia University, June 2018. 80. Role of EndoAnchors in Patients with Hostile 69. Preoperative Predictors of Discharge to Aortic Neck undergoing Endovascular Repair., Rehab or Skilled Nursing Facility following Mahmoud Malas, MD, Johns Hopkins Hospital, Carotid Endarterectomy for Symptomatic and February 2018. Asymptomatic Patients, Mark Conrad, MD, Massachusetts General Hospital, December 2017. 81. Safety Determinants of Insertion and Retrieval of Inferior Vena Cava Filters, Mahmoud Malas, 70. Procedural Characteristics and Risk of MD, Johns Hopkins Hospital, December 2017. Perioperative Stroke following Endovascular Aortic Interventions, Marc Schermerhorn, MD, 82. Sex Differences in Access Complications Nicholas Swerdlow, MD, Beth Israel Deaconess following EVAR, Virendra Patel, MD, Columbia Medical Center, August 2018. University, June 2018.

71. Proximal Neck Characteristics on Outcomes 83. Sex Differences in Access Complications of EVAR, Virendra Patel, MD, Columbia University, following TEVAR and FEVAR, Virendra Patel, MD, April 2018. Columbia University, June 2018.

72. Racial and Gender Disparity in Aortoiliac 84. Small Abdominal Aortic Aneurysm Study, Brian Disease Supra-Inguinal Open Revascularization Nolan, MD, Maine Medical Center, December Procedures, Mahmoud Malas, MD, Johns Hopkins 2017. Hospital, February 2018. 85. Staged Repair for Extensive Aortic Disease 73. Reintervention for Endoleak following EVAR and Spinal Cord Ischemia: Risk Factors, Optimal for Patients on Anticoagulation, Michael Stoner, Timing, and Other Perioperative Outcomes, MD, University of Rochester Medical Center, Ryan King, MD, Matthew Wooster, MD, Medical December 2017. University of South Carolina, April 2018.

74. Relation between Wound Complications 86. Temporal Trends in Perioperative Outcomes and Early Graft Failure, Leila Mureebe, MD, Duke and Risk Factors for Aortofemoral Bypass Versus University, December 2017. Iliac Stenting for Aorto-Iliac Occlusive Disease, Ryan King, MD, Thomas Brothers, MD, Medical 75. Renal Artery Coverage During EVAR for University of South Carolina, April 2018. Ruptured AAA, Adam Tanious, MD, Mark Conrad, MD, Massachusetts General Hospital, June 2018.

42 www.VQI.org 87. The Impact of a Negative Preoperative Stress 96. The Volume-Outcome Relationship for Open Test on the Likelihood of Postoperative Cardiac AAA Repair in the Modern Era: Guiding Volume Events in the Vascular Quality Initiative, Jesse Thresholds with “Real World” Practice Patterns, Colombo, MD, David Stone, MD, Dartmouth- Michael Belkin, MD, Tufts University School of Hitchcock Medical Center, February 2018. Medicine / Maine Medical Center, December 2017. 88. Trends in Utilization and Outcomes for Lower Extremity Revascularization Using Transradial 97. The Weekend Effect in Vascular Surgery and Its Arterial Access, Abhisekh Mohapatra, MD, Change over Time, Marc Schermerhorn, MD, Beth- Mohammad Eslami, MD, University of Pittsburgh Israel Deaconess Medical Center, December Medical Center, June 2018. 2017.

89. Ultrasound-guided Access in Percutaneous 98. The Weekend Effect in Vascular Surgery, Marc Endovascular Aneurysm Repair, Marc Schermerhorn, MD, Thomas O’Donnell, MD, Beth- Schermerhorn, MD, Beth-Israel Deaconess Israel Deaconess Medical Center, February 2018. Medical Center, December 2017. 99. Wound Infection and Preoperative 90. Use of Intravascular Ultrasound (IVUs) During Hemoglobin A1c Level following Lower Extremity Peripheral Vascular Intervention and its Impact Bypass, Tze Woei Tan, MD, Scott Berman, MD, on Stent Use, Danielle Sutzko, MD, University of University of Arizona/Carondelet St. Mary’s Michigan, December 2017. Hospital, February 2018.

91. The Use of Intravascular Ultrasound in the Treatment of Type B Dissection with TEVAR and Implications on Outcomes, Grace Wang, MD, Nathaniel Belkin, MD, Hospital of the University of Pennsylvania, August 2018.

92. Use of P2Y12 Antagonists and the Impact on In-stent Thrombosis: Observations from the VQI, (The), Gilbert Upchurch, MD, University of Virginia, October 2017.

93. Utility of Varicose Vein VQI Registry for Evaluation of Treatments for CEAP C6 Venous Disease, Nasim Hedayati, MD, University of California, Davis, June 2018.

94. Utilization of Preoperative Duplex Ultrasound (DUS) and Computed Tomographic Angiography (CTA) in Carotid Endarterectomy and Its Outcomes, Mujtaba Ali, MD, UT Southwest, October 2017.

95. Validation of Frailty Indices as an Accurate Predictor of Outcome and Need for Revision to a Higher Level in Patients Undergoing Below Knee Amputation, Ahmed Abou-Zamzam, MD, Loma Linda University Medical Center University, December 2017.

43 SVS VQI 2018 Annual Report APPENDIX I – NATIONAL AND REGIONAL PUBLICATIONS 2017/2018

1. Aggressive Infrainguinal Revascularization in 7. Carotid Artery Revascularization in Patients Renal Transplant Patients Is Justifiable., Craig- with Contralateral Carotid Artery Occlusion: Schapiro R, Nejim B, Arhuidese I, Malas MB., Am J Stent or Endarterectomy? Nejim B, Dakour Aridi H, Transplant. 2018 Jul;18(7):1718-1725. doi: 10.1111/ Locham S, Arhuidese I, Hicks C, Malas MB., J Vasc ajt.14636. Epub 2018 Jan 24. Surg. 2017 Dec;66(6):1735-1748.e1. doi: 10.1016/j. jvs.2017.04.055. Epub 2017 Jun 27. 2. Analysis of Patients Undergoing Major Lower Extremity Amputation in the Vascular Quality 8. Carotid Endarterectomy Performed before the Initiative., Gabel J, Jabo B, Patel S, Kiang S, Bianchi Weekend is Associated with Increased Length C, Chiriano J, Teruya T, Abou-Zamzam AM Jr; of Stay., Cheng TW, Farber A, Kalish JA, Jones Vascular Quality Initiative, Ann Vasc Surg. 2018 DW, Castagne M, Rybin D, Raulli SJ, Siracuse JJ; Jan;46:75-82. doi: 10.1016/j.avsg.2017.07.034. Vascular Quality Initiative., Ann Vasc Surg. 2018 Epub 2017 Sep 6. Apr;48:119-126. doi: 10.1016/j.avsg.2017.09.028. Epub 2017 Dec 5. 3. Anesthetic Type and Hospital Outcomes after Carotid Endarterectomy from the Vascular 9. Clinical Outcomes after Varicose Vein Quality Initiative database., Dakour Aridi H, Procedures in Octogenarians within the Vascular Paracha N, Nejim B, Locham S, Malas MB., J Vasc Quality Initiative Varicose Vein Registry., Sutzko Surg. 2018 May;67(5):1419-1428. doi: 10.1016/j. DC, Obi AT, Kimball AS, Smith ME, Wakefield jvs.2017.09.028. Epub 2017 Dec 11. TW, Osborne NH., J Vasc Surg Venous Lymphat Disord. 2018 Jul;6(4):464-470. doi: 10.1016/j. 4. Association between Medicare High- jvsv.2018.02.008. Epub 2018 May 8. risk Criteria and Outcomes after Carotid Revascularization Procedures., Hicks CW, Nejim 10. Comparable Perioperative Mortality B, Locham S, Aridi HD, Schermerhorn ML, Malas Outcomes in Younger Patients Undergoing MB., J Vasc Surg. 2018 Jun;67(6):1752-1761.e2. doi: Elective Open and Endovascular Abdominal 10.1016/j.jvs.2017.10.066. Epub 2018 Feb 1. Aortic Aneurysm Repair., Liang NL, Reitz KM, Makaroun MS, Malas MB, Tzeng E., J Vasc Surg. 5. Association of Left Subclavian Artery 2018 May;67(5):1404-1409.e2. doi: 10.1016/j. Coverage without Revascularization and jvs.2017.08.057. Epub 2017 Oct 31. Spinal Cord Ischemia in Patients Undergoing Thoracic Endovascular Aortic Repair: A Vascular 11. A Comparative Analysis of Long-term Mortality Quality Initiative Analysis., Teixeira PG, Woo after Carotid Endarterectomy and Carotid K, Beck AW, Scali ST, Weaver FA; Society for Stenting, Columbo JA, Martinez-Camblor P, Vascular Surgery, Vascular Quality Initiative MacKenzie TA, Kang R, Trooboff SW, Goodney PP, (VQI), Vascular. 2017 Dec;25(6):587-597. doi: O’Malley AJ., J Vasc Surg. 2018 Jun 15. pii: S0741- 10.1177/1708538116681910. Epub 2017 Oct 12. 5214(18)31015-2. doi: 10.1016/j.jvs.2018.03.432. [Epub ahead of print]. 6. Black Patients Present with More Severe Vascular Disease and a Greater Burden of Risk 12. Comparing the Efficacy of Shunting Factors than White Patients at Time of Major Approaches and Cerebral Monitoring during Vascular Intervention., Soden PA, Zettervall SL, Carotid Endarterectomy using a National Deery SE, Hughes K, Stoner MC, Goodney PP, Database, Wiske C, Arhuidese I, Malas M, Vouyouka AG, Schermerhorn ML; Society for Patterson R., J Vasc Surg. 2018 Aug;68(2):416-425. Vascular Surgery Vascular Quality Initiative., J Vasc doi: 10.1016/j.jvs.2017.11.077. Epub 2018 Mar 20. Surg. 2018 Feb;67(2):549-556.e3. doi: 10.1016/j. jvs.2017.06.089. Epub 2017 Sep 23.

44 www.VQI.org 13. Comparison of Access Type on Perioperative 20. Estimating Risk of Adverse Cardiac Event after Outcomes after Endovascular Aortic Aneurysm Vascular Surgery Using Currently Available Online Repair, Siracuse JJ, Farber A, Kalish JA, Jones Calculators., Moses DA, Johnston LE, Tracci MC, DW, Rybin D, Doros G, Scali ST, Schermerhorn Robinson WP 3rd, Cherry KJ, Kern JA, Upchurch ML; Vascular Quality Initiative, J Vasc Surg. 2018 GR Jr., J Vasc Surg. 2018 Jan;67(1):272-278. doi: Jul;68(1):91-99. doi: 10.1016/j.jvs.2017.10.075. Epub 10.1016/j.jvs.2017.06.105. Epub 2017 Oct 21. 2018 Jan 17. 21. External Validation of a Rapid Ruptured 14. Comparison of Devices Used in Carotid Artery Abdominal Aortic Aneurysm Score., Neilson M, Stenting: A Vascular Quality Initiative Analysis Healey C, Clark D, Nolan B., Ann Vasc Surg. 2018 of Commonly Used Carotid Stents and Embolic Jan;46:162-167. doi: 10.1016/j.avsg.2017.08.016. Protection Devices., Dhillon AS, Li S, Lewinger JP, Epub 2017 Sep 6. Shavelle DM, Matthews RV, Clavijo LC, Weaver FA, Garg P., Catheter Cardiovasc Interv. 2018 Jul 18. 22. External Validation of Vascular Study Group of doi: 10.1002/ccd.27646. [Epub ahead of print] New England Risk Predictive Model of Mortality after Elective Abdominal Aorta Aneurysm Repair 15. Comparison of Direct and Less Invasive in the Vascular Quality Initiative and Comparison Techniques for the Treatment of Severe Aorto- against Established Models., Eslami MH, Rybin DV, Iliac Occlusive Disease, Zamor KC, Hoel AW, Doros G, Siracuse JJ, Farber A, J Vasc Surg. 2018 Helenowski IB, Beck AW, Schneider JR, Ho KJ., Ann Jan;67(1):143-150. doi: 10.1016/j.jvs.2017.05.087. Vasc Surg. 2018 Jan;46:226-233. doi: 10.1016/j. Epub 2017 Aug 12. avsg.2017.07.002. Epub 2017 Jul 21. 23. Factors Affecting Operative Time and 16. A Comparison of Reintervention Rates after Outcome of Carotid Endarterectomy in the Endovascular Aneurysm Repair between the Vascular Quality Initiative., Perri JL, Nolan BW, Vascular Quality Initiative Registry, Medicare Goodney PP, DeMartino RR, Brooke BS, Arya S, Claims, and Chart Review., Columbo JA, Kang R, Conrad MF, Cronenwett JL., J Vasc Surg. 2017 Hoel AW, Kang J, Leinweber KA, Tauber KS, Hila R, Oct;66(4):1100-1108. doi: 10.1016/j.jvs.2017.03.426. Ramkumar N, Sedrakyan A, Goodney PP., J Vasc Epub 2017 Jul 14. Surg. 2018 Jun 15. pii: S0741-5214(18)30916-9. doi: 10.1016/j.jvs.2018.03.423. [Epub ahead of print] 24. Fluoroscopy Time Is Not Accurate as a Surrogate for Radiation Exposure., Skripochnik 17. Comparison of Virtual Visit Versus Traditional E, Loh SA., Vascular. 2017 Oct;25(5):466-471. doi: Clinic for Management of Varicose Veins., Lin JC, 10.1177/1708538117698342. Epub 2017 Mar 17. Mclaughlin D, Zurawski D, Kennedy N, Kabbani L., J Telemed Telecare. 2018 Sep 20:1357633X18797181. 25. Guidelines for Hospital Privileges in Vascular doi: 10.1177/1357633X18797181. [Epub ahead of Surgery and Endovascular Interventions: print] Recommendations of the Society for Vascular Surgery., Calligaro KD, Amankwah KS, D’Ayala 18. Current Experience and Midterm Follow-up of M, Brown OW, Collins PS, Eslami MH, Jain KM, Immediate-Access Arteriovenous Grafts., Wagner Kassavin DS, Propper B, Sarac TP, Shutze WP, Webb JK, Truong S, Chaer R, Dillavou E, Hager E, Yuo T, TH., J Vasc Surg. 2018 May;67(5):1337-1344. doi: Makaroun M, Avgerinos ED., Ann Vasc Surg. 2018 10.1016/j.jvs.2018.02.008. Aug 13. pii: S0890-5096(18)30487-4. doi: 10.1016/j. avsg.2018.04.036. [Epub ahead of print] 26. Hemodialysis Patients Have Worse Outcomes after Infrageniculate Revascularization 19. Episode-based Cost Reduction for Procedures., Hicks CW, Canner JK, Kirkland Endovascular Aneurysm Repair., Itoga NK, Tang K, Malas MB, Black JH 3rd, Abularrage CJ., J N, Patterson D, Ohkuma R, Lew R, Mell MW, Surg Res. 2018 Jun;226:72-81. doi: 10.1016/j. Dalman RL., J Vasc Surg. 2018 Jun 28. pii: S0741- jss.2018.01.019. Epub 2018 Feb 22. 5214(18)31023-1. doi: 10.1016/j.jvs.2018.04.043. [Epub ahead of print]

45 SVS VQI 2018 Annual Report 27. The Impact of Current Smoking on Outcomes 34. Outcomes of Familial Abdominal Aortic after Infrainguinal Bypass for Claudication., Aneurysm Repair in the Vascular Quality Initiative., Kalbaugh CA, Gonzalez NJ, Luckett DJ, Fine Ryer EJ, Garvin RP, Zhou Y, Sun H, Pham A, Orlova J, Brothers TE, Farber MA, Beck AW, Hallett JW K, Elmore JR, J Vasc Surg. 2018 Jul 28. pii: S0741- Jr, Marston WA, Vallabhaneni R., J Vasc Surg. 5214(18)31343-0. doi: 10.1016/j.jvs.2018.04.070. 2018 Aug;68(2):495-502.e1. doi: 10.1016/j. [Epub ahead of print] jvs.2017.10.091. Epub 2018 Mar 2. 35. Outcomes of Primary and Secondary Carotid 28. The Impact of Race on Outcomes after Artery Stenting., Arhuidese IJ, Rizwan M, Nejim B, Carotid Endarterectomy in the United States., Malas M., Stroke. 2017 Nov;48(11):3086-3092. doi: Pothof AB, Soden PA, Deery SE, O’Donnell TFX, 10.1161/STROKEAHA.117.016963. Epub 2017 Oct 3. Wang GJ, Hughes K, de Borst GJ, Schermerhorn ML; Society for Vascular Surgery Vascular Quality 36. Outcomes of Thoracic Endovascular Aortic Initiative., J Vasc Surg. 2018 Aug;68(2):426-435. doi: Repair for Chronic Aortic Dissections., Conway 10.1016/j.jvs.2017.11.087. Epub 2018 Feb 23. AM, Qato K, Mondry LR, Stoffels GJ, Giangola G, Carroccio A., J Vasc Surg. 2018 May;67(5):1345- 29. Local Anesthesia for Percutaneous 1352. doi: 10.1016/j.jvs.2017.08.098. Epub 2017 Nov Endovascular Abdominal Aortic Aneurysm 20. Repair Is Associated with Fewer Pulmonary Complications., Van Orden K, Farber A, 37. Patients with End-stage Renal Disease Have Schermerhorn ML, Goodney PP, Kalish JA, Jones Poor Outcomes after Endovascular Abdominal DW, Rybin D, Siracuse JJ; Vascular Quality Aortic Aneurysm Repair., Komshian S, Farber A, Initiative., J Vasc Surg. 2018 Oct;68(4):1023-1029. Patel VI, Goodney PP, Schermerhorn ML, Blazick e2. doi: 10.1016/j.jvs.2017.12.064. Epub 2018 Mar EA, Jones DW, Rybin D, Doros G, Siracuse JJ, J Vasc 27. Surg. 2018 Jun 23. pii: S0741-5214(18)30989-3. doi: 10.1016/j.jvs.2018.04.031. [Epub ahead of print] 30. Men Present with Higher Clinical Class of Chronic Venous Disease before Endovenous 38. Peripheral Atherectomy Practice Patterns Catheter Ablation., Kavousi Y, Al Adas Z, in the United States from the Vascular Quality Karamanos E, Kennedy N, Kabbani LS, Lin JC., Initiative, Mohan S, Flahive JM, Arous EJ, J Vasc Surg Venous Lymphat Disord. 2018 Jul Judelson DR, Aiello FA, Schanzer A, Simons JP; 28. pii: S2213-333X(18)30250-6. doi: 10.1016/j. Vascular Quality Initiative., J Vasc Surg. 2018 Jun jvsv.2018.05.024. [Epub ahead of print] 21. pii: S0741-5214(18)30910-8. doi: 10.1016/j. jvs.2018.03.417. [Epub ahead of print] 31. A National Vascular Quality Initiative Database Comparison of Hybrid and Open 39. Phenylephrine Infusion Impact on Surgical Site Repair for Aortoiliac-femoral Occlusive Infections after Lower Extremity Bypass Surgery., Disease., Zavatta M, Mell MW., J Vasc Surg. 2018 Curry C, Eldrup-Jorgensen J, Richard J, Siciliano Jan;67(1):199-205.e1. doi: 10.1016/j.jvs.2017.06.098. MC, Craig WY., J Vasc Surg. 2018 Jan;67(1):287-293. Epub 2017 Aug 16. doi: 10.1016/j.jvs.2017.05.130. Epub 2017 Aug 16.

32. Open and Endovascular Aneurysm Repair 40. Practical Guide to Surgical Data Sets: Society in the Society for Vascular Surgery Vascular for Vascular Surgery Vascular Quality Initiative Quality Initiative., Spangler EL, Beck AW., Surgery. (SVS VQI), Desai SS, Kaji AH, Upchurch G Jr., JAMA 2017 Dec;162(6):1195-1206. doi: 10.1016/j. Surg. 2018 Apr 4. doi: 10.1001/jamasurg.2018.0498. surg.2017.06.008. Epub 2017 Jul 31. [Epub ahead of print] No abstract available.

33. Outcomes after Elective Abdominal Aortic 41. Predictors of Acute Kidney Injury after Aneurysm Repair in Obese versus Nonobese Infrarenal Abdominal Aortic Aneurysm Repair in Patients., Locham S, Rizwan M, Dakour-Aridi H, Octogenarians, Dang T, Dakour-Aridi H, Rizwan Faateh M, Nejim B, Malas M., J Vasc Surg. 2018 M, Nejim B, Malas M., J Vasc Surg. 2018 Aug Jun 7. pii: S0741-5214(18)30907-8. doi: 10.1016/j. 25. pii: S0741-5214(18)31641-0. doi: 10.1016/j. jvs.2018.03.414. [Epub ahead of print] jvs.2018.05.227. [Epub ahead of print]

46 www.VQI.org 42. Preoperative Dementia Is Associated with 49. Routine Use of Ultrasound Guidance in Increased Cost and Complications after Vascular Femoral Arterial Access for Peripheral Vascular Surgery, Mehaffey JH, Hawkins RB, Tracci MC, Intervention Decreases Groin Hematoma Rates Robinson WP, Cherry KJ, Kern JA, Upchurch GR in High-Volume Surgeons, Inagaki E, Farber A, Jr., J Vasc Surg. 2018 Oct;68(4):1203-1208. doi: Siracuse JJ, Mell MW, Rybin DV, Doros G, Kalish J; 10.1016/j.jvs.2018.01.032. Epub 2018 Mar 30. Vascular Quality Initiative., Ann Vasc Surg. 2018 Aug;51:1-7. doi: 10.1016/j.avsg.2018.02.008. Epub 43. Preoperative Frailty Assessment Predicts 2018 Apr 13. Loss of Independence after Vascular Surgery, Donald GW, Ghaffarian AA, Isaac F, Kraiss LW, 50. Sex-Based Assessment of Patient Presentation, Griffin CL, Smith BK, Sarfati MR, Beckstrom JL, Lesion Characteristics, and Treatment Modalities Brooke BS., J Vasc Surg. 2018 May 14. pii: S0741- in Patients Undergoing Peripheral Vascular 5214(18)30822-X. doi: 10.1016/j.jvs.2018.02.044. Intervention, Ramkumar N, Suckow BD, Brown JR, [Epub ahead of print] Sedrakyan A, Cronenwett JL, Goodney PP., Circ Cardiovasc Interv. 2018 Jan;11(1):e005749. doi: 44. Racial Disparities in Outcomes after Intact 10.1161/CIRCINTERVENTIONS.117.005749. Abdominal Aortic Aneurysm Repair, Deery SE, O’Donnell TFX, Shean KE, Darling JD, Soden PA, 51. Smoking Cessation Rates among Patients Hughes K, Wang GJ, Schermerhorn ML; Society for Undergoing Vascular Surgery in a Canadian Vascular Surgery Vascular Quality Initiative., J Vasc Center, McHugh SM, Eisenberg N, Montbriand J, Surg. 2018 Apr;67(4):1059-1067. doi: 10.1016/j. Roche-Nagle G., Ann Vasc Surg. 2017 Nov;45:138- jvs.2017.07.138. Epub 2017 Oct 23. 143. doi: 10.1016/j.avsg.2017.06.048. Epub 2017 Jun 22. 45. Regarding “Increased Risk of Mortality after Lower Extremity Bypass in Individuals with Acute 52. Smoking Habits of Patients Undergoing Kidney Injury in the Vascular Quality Initiative”, Treatment for Intermittent Claudication in the Liu YY, Xue FS, Li HX, Yang GZ., J Vasc Surg. 2017 Vascular Quality Initiative, Gabel J, Jabo B, Patel Dec;66(6):1917-1918. doi: 10.1016/j.jvs.2017.07.144. S, Kiang S, Bianchi C, Chiriano J, Teruya T, Abou- No abstract available. Zamzam AM Jr; Vascular Quality Initiative., Ann Vasc Surg. 2017 Oct;44:261-268. doi: 10.1016/j. 46. Regional Variation in Patient Outcomes avsg.2017.04.046. Epub 2017 May 15. in Carotid Artery Disease Treatment in the Vascular Quality Initiative, Shean KE, O’Donnell 53. The Society for Vascular Surgery Practice TFX, Deery SE, Pothof AB, Schneider JR, Rockman Guidelines on the Care of Patients with an CB, Nolan BW, Schermerhorn ML; Society for Abdominal Aortic aneurysm, Chaikof EL, Dalman Vascular Surgery Vascular Quality Initiative., J RL, Eskandari MK, Jackson BM, Lee WA, Mansour Vasc Surg. 2018 Sep;68(3):749-759. doi: 10.1016/j. MA, Mastracci TM, Mell M, Murad MH, Nguyen LL, jvs.2017.11.080. Epub 2018 Mar 20. Oderich GS, Patel MS, Schermerhorn ML, Starnes BW., J Vasc Surg. 2018 Jan;67(1):2-77.e2. doi: 47. Regional Variation in Racial Disparities among 10.1016/j.jvs.2017.10.044. Patients with Peripheral Artery Disease, O’Donnell TFX, Powell C, Deery SE, Darling JD, Hughes K, Giles 54. Statin Therapy is Associated with Higher KA, Wang GJ, Schermerhorn ML., J Vasc Surg. 2018 Long-term but Not Perioperative Survival after Aug;68(2):519-526. doi: 10.1016/j.jvs.2017.10.090. Abdominal Aortic Aneurysm Repair, O’Donnell Epub 2018 Feb 16. TFX, Deery SE, Shean KE, Mittleman MA, Darling JD, Eslami MH, DeMartino RR, Schermerhorn ML., J 48. Retrograde Popliteal Access to Treat Vasc Surg. 2018 Aug;68(2):392-399. doi: 10.1016/j. Femoropopliteal Artery Occlusive Disease, jvs.2017.11.084. Epub 2018 Mar 23. Komshian S, Cheng TW, Farber A, Schermerhorn ML, Kalish JA, Rybin D, Jones DW, Siracuse JJ; Vascular Quality Initiative., J Vasc Surg. 2018 Jul;68(1):161-167. doi: 10.1016/j.jvs.2017.12.022. Epub 2018 Mar 1.

47 SVS VQI 2018 Annual Report 55. Surgeon, not Institution, Case Volume Is 62. Variation in Transfusion Practices and the Associated with Limb Outcomes after Lower Association with Perioperative Adverse Events Extremity Bypass for Critical Limb Ischemia in the in Patients Undergoing Open Abdominal Aortic Vascular Quality Initiative, Johnston LE, Tracci Aneurysm Repair and Lower Extremity Arterial MC, Kern JA, Cherry KJ, Kron IL, Upchurch GR Jr, Bypass in the Vascular Quality Initiative, Osborne Robinson WP., J Vasc Surg. 2017 Nov;66(5):1457- Z, Hanson K, Brooke BS, Schermerhorn M, Henke 1463. doi: 10.1016/j.jvs.2017.03.434. Epub 2017 P, Faizer R, Schanzer A, Goodney P, Bower T, May 27. DeMartino RR; Vascular Quality Initiative., Ann Vasc Surg. 2018 Jan;46:1-16. doi: 10.1016/j. 56. Timing of Carotid Endarterectomy After avsg.2017.06.154. Epub 2017 Jul 8. Stroke: Retrospective Review of Prospectively Collected National Database, Tanious A, Pothof 63. The Weekend Effect in AAA Repair, O’Donnell AB, Boitano LT, Pendleton AA, Wang LJ, de Borst TFX, Li C, Swerdlow NJ, Liang P, Pothof AB, Patel VI, GJ, Rattner DW, Schermerhorn ML, Eslami MH, Giles KA, Malas MB, Schermerhorn ML., Ann Surg. Malas MB, Eagleton MJ, Clouse WD, Conrad MF., 2018 Apr 18. doi: 10.1097/SLA.0000000000002773. Ann Surg. 2018 Sep;268(3):449-456. doi: 10.1097/ [Epub ahead of print] SLA.0000000000002933.

57. Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting in the Society for Vascular Surgery Vascular Quality Initiative, Malas MB, Dakour-Aridi H, Wang GJ, Kashyap VS, Motaganahalli RL, Eldrup-Jorgensen J, Cronenwett JL, Schermerhorn ML., J Vasc Surg. 2018 Jun 13. pii: S0741-5214(18)31054-1. doi: 10.1016/j.jvs.2018.05.011. [Epub ahead of print]

58. Treating Peripheral Artery Disease in the Wake of Rising Costs and Protracted Length of Stay, Wang GJ, Jackson BM, Foley PJ 3rd, Damrauer SM, Kalapatapu V, Golden MA, Fairman RM., Ann Vasc Surg. 2017 Oct;44:253-260. doi: 10.1016/j. avsg.2017.01.027. Epub 2017 May 4.

59. Underutilization of Antiplatelet and Statin Therapy after Postoperative Myocardial Infarction Following Vascular Surgery, Steely AM, Callas PW, Hohl PK, Schneider DJ, De Martino RR, Bertges DJ., J Vasc Surg. 2018 Jan;67(1):279-286.e2. doi: 10.1016/j.jvs.2017.06.093. Epub 2017 Aug 19.

60. Use of a Primary Carotid Stenting Technique Does Not Affect Perioperative Outcomes, Hicks CW, Nejim B, Obeid T, Locham SS, Malas MB., J Vasc Surg. 2018 Jun;67(6):1736-1743.e1. doi: 10.1016/j.jvs.2017.09.056. Epub 2018 Feb 2.

61. Variation in Hospital Costs and Reimbursement for Endovascular Aneurysm Repair: A Vascular Quality Initiative pilot project, Lemmon GW, Neal D, DeMartino RR, Schneider JR, Singh T, Kraiss L, Scali S, Tassiopoulos A, Hoel A, Cronenwett JL., J Vasc Surg. 2017 Oct;66(4):1073-1082. doi: 10.1016/j.jvs.2017.02.039. Epub 2017 May 11.

48 www.VQI.org APPENDIX J: VQI COUNCILS AND COMMITTEES

Governing Council Evan Lipsitz, MD, Greater New York Region (Montefiore Fred Weaver, MD, Chair (Keck Hospital of USC) Medical Center)

Michael Dalsing, MD, Vice-Chair (IU Health – Methodist) Ashraf Mansour, MD, Michigan Region (Spectrum Health) Ahmed Abou-Zamzam, MD, Southern California Region (Loma Linda University Medical Center) Robert McLafferty, MD, American Venous Forum (Oregon Health & Science University) Jose Almeida, MD, Ex-Officio, Venous Quality Council, Chair (Miami Vein Center) Matthew Mell, MD, N. California Region (UC Davis)

Herbert Aronow, MD, Society for Vascular Medicine (Rhode Joseph Mills, MD, Society for Vascular Surgery (Baylor College Island Hospital – Lifespan) of Medicine)

Adam Beck, MD, Ex-Officio, Arterial Quality Council, Chair Sanjay Misra, MD, Society of Interventional Radiologists (University of Alabama at Birmingham Hospital.) (Mayo Clinic Hospital – Rochester)

Scott Berman, MD, Rocky Mountains Region (Carondelet Leila Mureebe, MD, Carolinas Region (Duke University) Heart & Vascular Institute) Stephen Murray, MD, Pacific Northwest Region (Providence Thomas Brothers, MD, Carolinas Region (Medical University of Sacred Heart) South Carolina) William Robinson, MD, Virginias Region (University of Virginia Kelly Byrnes, Society for Vascular Ultrasound (Norton Health System) Healthcare) Graham Roche-Nagle, MD, Canadian Region (Toronto Elliot Chalkof, MD, Society for Vascular Surgery (Beth-Israel General Hospital) Deaconess Medical Center) Jean Starr, MD, Great Lakes Region (Ohio State University David Chew, MD, Mid-America Region (Iowa Heart Center at Medical Center) Mercy Medical Center) Apostolos Tassiopoulos, MD, Greater New York (Stony Brook David Dawson, MD, Society for Vascular Ultrasound (Baylor Medicine) Scott & White) Grace Wang, MD, Mid-Atlantic Region (Hospital of the Randall DeMartino, MD, Upper Midwest Region (Mayo Clinic University of Pennsylvania) Arizona)

Yazan Duwayri, MD, Southeastern Region (The Emory Clinic)

James Ebaugh, MD, Mid-America Region (Iowa Heart Center at Mercy Medical Center)

Jens Eldrup-Jorgensen, MD, SVS PSO Medical Director (Maine Medical Center)

Dennis Gable, MD, Southern Region (Baylor Jack and Jane Hamilton Heart and Vascular Hospital)

H. Edward Garrett, Jr., MD, Mid-South Region (Baptist Memorial Hospital)

Philip Goodney, MD, VSGNE and Ex-Officio Chair, Research Advisory Council (Dartmouth-Hitchcock Medical Center)

Peter Henke, MD, American Venous Forum (University of Michigan)

Gary Lemmon, MD, Midwest Region (IU Health)

49 SVS VQI 2018 Annual Report Executive Committee Daniel Bertges, MD, Peripheral Vascular intervention, Chair, Fred Weaver, MD, Chair (Keck Hospital of USC) Ex-Officio (University of Vermont Medical Center) Michael Dalsing, MD, Vice-Chair (IU Health – Methodist) Benjamin Brooke, MD, Rocky Mountain Region (University of Jose Almeida, MD, Chair, VQC (Miami Vein Center) Utah)

Adam Beck, MD, Chair, AQC, (Univ. of Alabama at Ankur Chandra, MD, SoCal VOICe (Scripps Health) Birmingham) Randall DeMartino, MD, Carotid Endarterectomy Chair, Ex- Scott Berman, MD, Community Practice Representative Officio (Mayo Clinic) (Carondelet Heart & Vascular Institute) Yazan Duwayri, MD, Southeastern Region (The Emory Clinic) Robert Molnar, MD, Office-based Laboratory Representative (Michigan Vascular Center) Jens Eldrup-Jorgensen, MD (SVS PSO Medical Director, Ex- Officio) Leila Mureebe, MD, At Large Representative (Duke University) Rumi Faizer, MD, Open AAA Chair (University of Minnesota Ronald Dalman, MD, SVS Executive Board Medical) (Stanford University) Philip Goodney, MD, New England Region (Dartmouth- Randall DeMartino, MD, At Large Representative (Mayo Hitchcock Medical Center) Clinic) Naomi Hamburg, MD, Society for Vascular Medicine (Boston Philip Goodney, MD, Chair, RAC (Dartmouth-Hitchcock University) Medical Center) Charles Kiell, MD, Midwest Region (St. Francis Heart Center) Jens Eldrup-Jorgensen, MD, SVS PSO Medical Director (Maine Medical Center) Angela Kokkosis, MD, Greater New York Region (Stony Brook Medicine) Alex Shepard, MD, At Large Representative (Henry Ford Hospital- Detroit MI) Mary McDonald, MD, Canadian Region (Toronto General Hospital) Kenneth Slaw, Ex-Officio, SVS Staff Liaison John Moawad, MD, Great Lakes Region (Summa Health SVS PSO Staff and Liaisons: System) Jim Wadzinski, SVS PSO Senior Director

Carrie Bosela, SVS PSO Director of Clinical Operations

Cheryl Jackson, SVS PSO Quality Director

Dan Neal, SVS PSO Director of Analytics

Nancy Heatley, SVS PSO Education and Research Projects Manager

Melissa McElroy, Inter-Society and PSO Specialist

Yuanyuan Zhao, SVS PSO Analyst

Arterial Quality Council Adam Beck, MD, Chair (University of Alabama at Birmingham Hospital)

Edouard Abouian, MD, Northern California Region (Palo Alto Medical Foundation)

Ahmed Abou-Zamzam, MD, Lower Extremity Amputation Chair, Ex-Officio (Loma Linda University Medical Center)

Joshua Beckman, MD, Society for Vascular Medicine (Vanderbilt Health)

50 www.VQI.org Arterial Quality Council (Cont’d) Venous Quality Council Leila Mureebe, MD, Carolinas (Duke University) Jose Almeida, MD, Chair (Miami Vein Center)

Constantino Pena, MD, Society of Interventional Radiology Marc Passman, MD, Vice-Chair (University of Alabama Representative (Baptist Hospital of Miami) Medical Center)

Patrick Ryan, MD, Mid-South Region (National Vein and Olamide Alabi, MD Southeastern Region (Emory University) Vascular Institute) Faisal Aziz, MD, Mid-Atlantic Region (Penn State Andres Schanzer, MD, Society for Vascular Surgery/LEB Chair Milton S. Hershey Medical Center) (UMass Memorial Health Care) Sabah Butty, MD, Midwest Region (IU Health - Ball Memorial Marc Schermerhorn, MD, Society for Vascular Surgery (Beth- Hospital) Israel Deaconess Medical Center) Sheila Coogan, MD, Southern Region (Memorial Hermann Jessica Simons, MD, New England Region (UMass Memorial Southeast Hospital) Health Care) Antonios Gasparis, MD, American Venous Forum (Stony Brook Bruce Tjaden, MD, Southern Region (Memorial Hermann Medicine) Southeast Hospital) Ravi Hasanadka, MD, Mid-America Region (SIU Medicine) Margaret Tracci, MD, Virginias Region (University of Virginia) Nasim Hedayati, MD, Northern California Region (UC Davis Nam Tran, MD, Pacific Northwest Region (Harborview Health System) Medical Center - UW Medicine) Glenn Jacobowitz, MD, Greater New York Region (New York Grace Wang, MD, Mid-Atlantic Region/Chair, Carotid Artery University) Stent (Hospital at the University of Pennsylvania) Isabella Kuo, MD, SoCAL VOICe (The University of California Mitchell Weaver, MD, Michigan Region (Henry Ford Health Irvine) System) Timothy Liem, MD, Pacific Northwest Region (Oregon Health Karen Woo, MD, Southern California Region (UCLA Ronald & Science University) Reagan Medical Center) Fedor Lurie, MD, Great Lakes Region (ProMedica Toledo Hospital)

William Marston, MD, Carolinas Region (University of North Carolina Hospitals)

Mark Meissner, MD, Society for Vascular Surgery (Harborview Medical Center)

Gregory Piazza, MD, Society for Vascular Medicine (Brigham and Women’s Hospital)

Joseph Raffetto, MD, American Venous Forum (Brigham and Women’s Hospital)

Brigitte Smith, MD, Rocky Mountain Region (University of Utah Hospital and Clinics)

David Spinosa, MD, Virginias Region (Inova Alexandria Hospital)

Thomas Wakefield, MD, Ex-Officio Varicose Vein Registry (University of Michigan)

Jennifer Watson, MD, Michigan Region (Spectrum Health)

51 SVS VQI 2018 Annual Report Research Advisory Council Wayne Zhang, MD, Pacific Northwest Region (University of Philip Goodney, MD, Chair (Dartmouth-Hitchcock Medical Washington) Center) Communication Committee Grace Wang, MD, Vice-Chair (Hospital at the University of Glenn Jacobowitz, MD, Chair (NYU Lagone Health) Pennsylvania) Faisal Aziz, MD (Penn State Milton S. Hershey Medical Center) Shipra Arya, MD, Northern California Region (Stanford University) Gary Lemmon, MD (Indiana University Health System)

Faisal Aziz, MD, Mid-Atlantic Region (Penn State Milton S. Carlos Mena, MD (Yale New Haven Hospital) Hershey Medical) Leila Mureebe, MD (Duke University) Adam Beck, MD, Southeastern Region (University of Alabama at Birmingham Hospital) Ravi Rajani, MD (Grady Memorial Hospital)

Benjamin Brooke, MD, Rocky Mountain Region (University of Jeffrey Siracuse, MD (Boston Medical Center) Utah) Brant Ullery, MD (Providence Portland Medical Center) Mohammed Eslami, MD, Great Lakes Region (University of Pittsburgh Medical Center)

Douglas Jones, MD, New England Region (Boston Medical Center)

Corey Kalbaugh, PhD, Carolinas Region (University of North Carolina Hospitals)

Issam Koleilat, MD, Greater New York Region (Montefiore Hospital)

Gregory Magee, MD, S. California Region (Keck Medical Center of USC)

Michael McNally, MD, Mid-South Region (University of Tennessee)

Mark Mewissen, MD, Upper Midwest Region (Aurora St. Luke’s Medical Center)

Raghu Motaganahlli, MD, Midwest Region (IU Health – Methodist)

Albeir Mousa, MD, Virginias Region (Charleston Area Medical Center)

Ryan N. Nolte, MD, Mid-America Region (OSF Saint Francis Medical Center)

Nicholas Osborne, MD, Michigan Region (University of Michigan)

William Robinson, MD, Virginias Region (University of Virginia)

Graham Roche-Nagle, MD, Canadian Region (Toronto General Hospital)

Marc Schermerhorn, MD, New England Region (Beth-Israel Deaconess Medical Center)

William Schutze, MD, Southern Region (Baylor Scott White)

Jeffrey Siracuse, MD, New England Region (Boston Medical Center)

Brant Ullery, MD, Pacific Northwest Region (Providence Portland Medical Center) 52 www.VQI.org REGISTRY COMMITTEES AND CHAIRS Lower Extremity Bypass (Supra- and Open AAA Repair Infra-inguinal) Rumi Faizer, MD, Chair (University of Minnesota Medical Andres Schanzer, MD, Chair (UMass Memorial Health Care) Center) Jessica Simons, MD, Vice-Chair (UMass Memorial Health Mohammed Eslami, MD, Vice Chair (UPP Vascular Surgery) Care)

Mark Conrad, MD (Massachusetts General Hospital) Roan Glocker, MD (University of Rochester)

Ralph Ierardi, MD (Christiana Care) Andrew Hoel, MD (Northwestern Memorial Hospital) Christopher Smolock, MD (Cleveland Clinic) Erica Mitchell, MD (Oregon Health & Science University) Nam Tran, MD (University of Washington) Nicholas Osborne, MD (University of Michigan) Endovascular AAA Repair Salvatore Scali, MD, Chair (University of Florida at Gainesville) Eva Rzucidlo, MD (Dartmouth-Hitchcock Medical Center)

Marc Schermerhorn, MD, Vice Chair (Beth-Israel Deaconess Ageliki Vouyouka, MD, (Mount Sinai Hospital) Medical Center) Lower Extremity Amputation Jim Black, MD (Johns Hopkins Bayview Medical Center) Ahmed Abou-Zamzam, MD, Chair (Loma Linda University Medical Center) Alfio Carroccio, MD (Lenox Hill Hospital) Ageliki Vouyouka, MD, Vice-Chair (Mount Sinai Hospital) Yazan Duwayri, MD (The Emory Clinic) Ochoa Christian, MD (University of Southern California) Omid Jazaeri, MD (University of Colorado, Denver) Mark Nehler, MD (University of Colorado, Denver) Mike Singh, MD (UPP Vascular Surgery) Carotid Artery Stenting Brant Ullery, MD (Providence Portland Medical Center) Grace Wang, MD, Chair (Hospital at the University of Pennsylvania) Thoracic and Complex EVAR Richard Cambria, MD, Chair (St. Elizabeth’s Hospital) Magdiel Trinidad-Hernandez, MD, Vice Chair (Memorial Hospital Central) Adam Beck, MD, (University of Alabama at Birmingham Hospital) Mohammed Eslami, MD (UPP Vascular Surgery)

Allen Hamden, MD (Beth-Israel Deaconess Medical Center) Mark Fleming, MD (Mayo Clinic)

Sukgu Han, MD (University of Southern California) Donald Heck, MD, Society of NeuroInterventional Surgery (Novant Health Forsyth Medical Center) Gregory Magee, MD (Keck Hospital of USC) Roger Laham, MD (Beth-Israel Deaconess Medical Center) Virendra Patel, MD (Columbia University) Wei Zhou, MD (Stanford University) Graham Roche-Nagle, MD (University Health Network Toronto)

Salvatore Scali, MD, Vice Chair (University of Florida)

Michael Verta, MD (Central DuPage Hospital)

Grace Wang, MD, (Hospital at the University of Pennsylvania)

53 SVS VQI 2018 Annual Report Carotid Endarterectomy IVC Access Benjamin Brooke, MD, Chair (University of Utah) Anthony Gasparis, MD Chair (Stony Brook Medicine)

Shipra Ayra, MD, Vice-Chair (Stanford Hospital & Clinics) Mark H. Meissner, MD, Vice-Chair (University of Washington)

Faisal Aziz, MD (Penn State Milton S. Hershey Medical Center) Robert Feezor, MD (University of Florida)

Mark Conrad, MD (Massachusetts General Hospital) Paul Lajos, MD (Mount Sinai Hospital)

Randall DeMartino, MD (Mayo Clinic) Ross Milner, MD (University of Chicago)

Sapan Desai, MD (Southern Illinois Medical Center) Varicose Vein Thomas Wakefield, MD, Chair (University of Michigan) Patrick Ryan, MD (Nashville Vascular and Vein Institute) Lowell Kabnick, MD, Vice Chair (NYU Langone Medical Gilford Vincent, MD (Mount Carmel St. Ann’s Hospital) Center)

Peripheral Vascular Intervention Jose Almeida, MD (Miami Vein Center) Daniel Bertges, MD, Chair (University of Vermont Medical Center) Venkat Kalapatapu, MD (Penn State Hershey)

William Robinson, MD, Vice-Chair (University of Virginia) Judith Lin, MD (Henry Ford Hospital)

Christopher Abularrage, MD (Johns Hopkins Bayview Medical Sang Rhee, MD (Baystate Medical Center) Center) Ting Windsor, MD (Mount Sinai Hospital) Gary Ansel, MD (Ohio Health)

Paul Bloch, MD (Maine Medical Center)

Joseph Mills, MD (Baylor Medical Center)

Robert Hieb, MD (Froedtert Health)

Hemodialysis Access Karen Woo, MD, Chair (UCLA Ronald Reagan Medical Center)

John Lucas III, MD, Vice Chair (The Practice of John Lucas III)

Oscar Grandas, MD (University of Tennessee Medical Center)

Gary Lemmon, MD (IU Health)

Michael McNally, MD (University of Tennessee Medical)

Charles Keith Ozaki, MD (Brigham and Women’s Hospital)

Brigitte Smith, MD (University of Utah)

Theodore Yuo, MD (UPP Vascular Surgery)

54 www.VQI.org 2018 Detailed Annual Report