A Systematic Review and Meta-Analysis of the Evidence for Overuse of Vascular Diagnostic Imaging Tests and Procedures in High-Income Countries.

Authors

Aidan M Kirkham, Emma E Sypes, Chen Chen Xu, Sudhir K Nagpal, Daniel J Niven, Mamas A Mamas, Daniel I McIsaac, Risa Shorr, Ian D Graham, Henry T Stelfox, Jeremy M Grimshaw, Derek J Roberts

Published in

Annals of vascular surgery. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

We sought to synthesize and evaluate evidence for the overuse of vascular diagnostic imaging tests and procedures in high-income countries as they may be overused in asymptomatic, minimally symptomatic, and/or high-risk patients with limited life expectancy.
After protocol registration (CRD42021257490), we searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews (January 1st, 2010-May 14th, 2025) for English-language studies that reported the incidence/prevalence of overuse of vascular diagnostic imaging tests and/or procedures in high-income countries; adjusted predictors of overuse; or adjusted associations between overuse and outcomes. Three investigators independently reviewed titles/abstracts and full-texts, extracted data, and assessed risk of bias. Data were pooled using random-effects models. GRADE was used to assess estimate certainty.
Among 11,748 citations, we included 14 studies (n=16,706,904 patients) that examined two unique vascular diagnostic imaging tests and eight unique procedures. The most frequently overused vascular imaging tests included carotid (pooled-cumulative incidence=19%; 95% confidence interval [CI]=10-30%; moderate-certainty) and venous duplex (cumulative incidence=46%; 95% CI=43-48%; moderate-certainty). The most frequently overused vascular procedures included renal artery angioplasty (pooled-cumulative incidence=92%; 95% CI=85-97%; low-certainty) and inferior vena cava filter placement (pooled-cumulative incidence=72%; 95% CI=0-100%; low-certainty). Adjusted-risk factors for carotid duplex overuse included increasing age and higher median neighborhood income quartile. Adjusted risk factors for overuse of endovascular intervention for claudication included ever smoking and end-stage renal disease. Overuse was associated with increased healthcare costs in all studies examining this outcome.
Overuse of vascular diagnostic imaging tests and procedures may be common in high-income countries and associated with increased healthcare costs. However, because the included studies had important limitations, our findings should be confirmed before methods to reduce the above overuse are developed.

PMID:
42567310
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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