Cost Analysis of Venous Stent Reconstruction in the Treatment of Chronic Lower Extremity Venous Occlusive Disease

Cost Analysis of Venous Stent Reconstruction in the Treatment of Chronic Lower Extremity Venous Occlusive Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost Analysis of Venous Stent Reconstruction in the Treatment of Chronic Lower Extremity Venous Occlusive Disease Samir S. Jambhekar, Jacob J. Bundy, Spencer B. Lewis, Ravi N. Srinivasa, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7558747/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose: To quantify cost drivers of endovenous iliocaval stent reconstruction for chronic veno-occlusive disease based on time-driven activity-based costing. Materials and Methods: 31 iliocaval venous stent reconstruction procedures for iliocaval veno-occlusive disease were reviewed. Process model development began by constructing longitudinal process maps after interviews with representatives involved with iliocaval stent reconstructions. Subsequently, staff practical capacity rates and consumable equipment costs were analyzed using time-driven activity-based costing methods. Univariate and multivariate sensitivity analyses were conducted to identify the primary cost drivers of human labor and disposable materials.. Results: The mean procedure duration was 6.24 hours (5.75-7.15), and the base cost was $26,201.01. Multivariate sensitivity analyses yielded a cost range of $7,842.95 to $66,066.05. Using local salary information and negotiated prices for materials as parameters, the true base cost per case of iliocaval stent reconstruction was $25,750.33. Human personnel costs accounted for 16.8%, while disposable materials costs accounted for 83.2%. Univariate analysis demonstrated that the primary driver of human staffing costs was attending Anesthesiologist staffing time ($25,948.54 to $26,431.38). The predominant modifiable material cost drivers included the cost of venous stents ($17,801.01 to $34,811.01), their number ($19,326.01 to $29,326.01), the cost of catheters ($25,535.51 to $29,358.01), and their number ($24,961.01 to $27,441.01). Conclusion: Human labor, namely anesthesia staffing costs, and disposable material costs, namely stent and catheter selection, are large, potentially modifiable drivers of the overall cost for iliocaval stent reconstruction for chronic veno-occlusive disease. Additional studies are necessary to define an iliocaval venous reconstruction protocol that delivers cost savings without compromising outcomes. Figures Figure 1 Figure 2 Figure 3 Figure 4 Full Text Additional Declarations Tables 1 and 2 are available in the Supplementary Files section. Supplementary Files CVIREndovascularTable1.pdf CVIREndovascularTable2.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 10 Sep, 2025 Reviewers invited by journal 10 Sep, 2025 Editor assigned by journal 09 Sep, 2025 First submitted to journal 08 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7558747","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512927441,"identity":"0b386e3d-d5c2-45ed-b9c5-608ef1391196","order_by":0,"name":"Samir S. Jambhekar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYJCCAww8DAwGEgzMQLYNEDM2HiBFSxpISwNBLWAA1XIYaggeIN9+OvFwhYxdtLl082GDn3vO261tPwy0pcYmGqfhZ3I3HDzDk5y7c86x5MSeZ7eTt51JBGo5lpbbgEsLA1BLAw9z7oYbOcYHeA7cTjY7ANTC2HAYpxb5/rcgLfVALfmfD/45cC7Z7PxD/FoYboBtOQyyhTmZ58ABO7MbBGwxuAG25XjuzhlpxsYyB5ITzG4AbUnA4xf5/tzNHxt7qnO3SyQ/lnxzwM7e7Hz6wwcfamxwOwwEGHsQ7ESwygR8ysHgB4JpT1DxKBgFo2AUjDgAAIv9bg0uccQpAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0006-9008-8676","institution":"The Ohio State University Wexner Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Samir","middleName":"S.","lastName":"Jambhekar","suffix":""},{"id":512927442,"identity":"54a1c80b-e49b-464d-842b-733081ccd1a7","order_by":1,"name":"Jacob J. Bundy","email":"","orcid":"","institution":"Wake Forest University","correspondingAuthor":false,"prefix":"","firstName":"Jacob","middleName":"J.","lastName":"Bundy","suffix":""},{"id":512927443,"identity":"a4d14e4c-2873-4666-90cd-73e88a9a1979","order_by":2,"name":"Spencer B. Lewis","email":"","orcid":"","institution":"Providence Portland Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Spencer","middleName":"B.","lastName":"Lewis","suffix":""},{"id":512927444,"identity":"ececcf13-d1b4-421a-bba3-bf41f8e84c02","order_by":3,"name":"Ravi N. Srinivasa","email":"","orcid":"","institution":"UCLA Health","correspondingAuthor":false,"prefix":"","firstName":"Ravi","middleName":"N.","lastName":"Srinivasa","suffix":""},{"id":512927445,"identity":"f8ab43fb-a0f7-4450-8053-bbd299007721","order_by":4,"name":"Anthony N. Hage","email":"","orcid":"","institution":"Cooper University Health Care","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"N.","lastName":"Hage","suffix":""},{"id":512927446,"identity":"c9ffa2a3-7755-4f6b-9a6e-c060d4e1efb1","order_by":5,"name":"Eric J. Monroe","email":"","orcid":"","institution":"University of Wisconsin-Madison Department of Radiology","correspondingAuthor":false,"prefix":"","firstName":"Eric","middleName":"J.","lastName":"Monroe","suffix":""},{"id":512927447,"identity":"fa9f8c0d-b96d-444b-83bb-51d47fffc0ad","order_by":6,"name":"Jeffrey Forris Beecham Chick","email":"","orcid":"","institution":"USC Keck School of Medicine: University of Southern California Keck School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jeffrey","middleName":"Forris Beecham","lastName":"Chick","suffix":""},{"id":512927448,"identity":"54253a43-3f23-4203-ab99-8e6690fac734","order_by":7,"name":"David S. Shin","email":"","orcid":"","institution":"USC Keck School of Medicine: University of Southern California Keck School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"S.","lastName":"Shin","suffix":""},{"id":512927449,"identity":"4d2089cc-226d-4796-b5da-6b621883fe49","order_by":8,"name":"Matthew Abad-Santos","email":"","orcid":"","institution":"University of Washington Department of Radiology","correspondingAuthor":false,"prefix":"","firstName":"Matthew","middleName":"","lastName":"Abad-Santos","suffix":""},{"id":512927450,"identity":"18aae3e2-eff1-489a-9c63-ed4d6a0a5d0f","order_by":9,"name":"Mina S. Makary","email":"","orcid":"","institution":"The Ohio State University Wexner Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Mina","middleName":"S.","lastName":"Makary","suffix":""}],"badges":[],"createdAt":"2025-09-07 23:29:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7558747/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7558747/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91564491,"identity":"6a0c9af7-5b63-4ede-a5ef-8810b7aa551c","added_by":"auto","created_at":"2025-09-17 19:10:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":222307,"visible":true,"origin":"","legend":"\u003cp\u003e81-year-old female with TrapEase inferior vena cava filter-associated chronic bilateral iliocaval thrombosis. The patient presented with healed ulcerations of the left, greater than right, lower extremities and an inability to complete her one-mile daily walking routine due to lower extremity pain and fatigue. (A) Ascending venography, completed from a right common femoral vein approach, demonstrates complete chronic occlusion of the right common and external iliac veins. There was compensatory venous collateralization through the gonadal vein (solid black arrow). (B) Ascending venography, performed from a left common femoral vein approach, showed complete chronic occlusion of the left common and external iliac veins. Ascending lumbar (solid black arrow) and cross pelvic (black arrowhead) venous collaterals are seen. (C) Venous stent reconstruction was performed using a 22-mm Wallstent endoprosthesis within the inferior vena cava (dashed black arrow) and 16-mm “double barrel” common iliac venous Wallstents (solid black arrows). A decision was made to sequester, rather than remove, the TrapEase inferior vena cava filter (black arrowhead), given the patient’s age and potential trauma that may have occurred to the inferior vena cava during removal. (D) Completion of bilateral ascending iliocaval venography, performed after venous stent reconstruction, demonstrating brisk in-line flow through both iliac venous systems (solid black arrows) and inferior vena cava (dashed black arrow). The TrapEase inferior vena cava filter was sequestered (black arrowhead). The patient was able to resume her daily walking routine by one month. Healed ulcerations diminished by three months.\u003c/p\u003e","description":"","filename":"CVIREndovascularFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7558747/v1/1920eb138a798691ee3df52c.png"},{"id":91564490,"identity":"ef1e83dd-47e7-4644-a329-5b980b3f41ea","added_by":"auto","created_at":"2025-09-17 19:10:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":53801,"visible":true,"origin":"","legend":"\u003cp\u003eProcess map showing all decision points, staff, and resources involved in iliocaval stent reconstruction. This analysis focuses on costs incurred between the time the patient enters the procedure room and the time the patient exits the procedure room.\u003c/p\u003e","description":"","filename":"CVIREndovascularFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7558747/v1/68d61284f806b922740bf285.png"},{"id":91564488,"identity":"941b4f2e-f914-4aee-b5d9-006f900316e9","added_by":"auto","created_at":"2025-09-17 19:10:25","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":17891,"visible":true,"origin":"","legend":"\u003cp\u003eUnivariate sensitivity analysis of human labor factors related to the cost of iliocaval stent reconstruction per case. The central vertical line indicates the base case and corresponds to a cost of $26,201.01. Each variable is modeled as an uncertain variable, from minimum to maximum studied values around the base case value, with all other variables held static. Gray bars to the left of the vertical line represent the degree of total cost reduction, and the striped bars to the right of the vertical line represent the degree of total cost increase.\u003c/p\u003e","description":"","filename":"CVIREndovascularFigure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7558747/v1/c6934eaa9a6d295138318018.png"},{"id":91565164,"identity":"326c7195-51f5-4d61-851c-f8d6fcf936e3","added_by":"auto","created_at":"2025-09-17 19:18:25","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":12934,"visible":true,"origin":"","legend":"\u003cp\u003eUnivariate sensitivity analysis of material factors related to the cost of iliocaval stent reconstruction per case. The central vertical line indicates the base case and corresponds to a cost of $26,201.01. Each variable is modeled as an uncertain variable, from minimum to maximum studied values around the base case value, with all other variables held static. Gray bars to the left of the vertical line represent the degree of total cost reduction, and the striped bars to the right of the vertical line represent the degree of total cost increase.\u003c/p\u003e","description":"","filename":"CVIREndovascularFigure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7558747/v1/6e5c54031fcdb2f0970feba0.png"},{"id":91565750,"identity":"95eb6da9-327d-4794-a270-406ddc55af7b","added_by":"auto","created_at":"2025-09-17 19:26:28","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":493769,"visible":true,"origin":"","legend":"","description":"","filename":"CVIREndovascularManuscriptPDFFile2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7558747/v1_covered_a7719cca-d72c-4a82-8603-870bd9093cc5.pdf"},{"id":91564492,"identity":"042f4a95-0b94-4d08-80fc-d4b1fc3d185f","added_by":"auto","created_at":"2025-09-17 19:10:25","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":78727,"visible":true,"origin":"","legend":"","description":"","filename":"CVIREndovascularTable1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7558747/v1/ae21ddfb982117c75eed5c01.pdf"},{"id":91564496,"identity":"b60afc00-c682-4e11-89d6-8d3f8f540846","added_by":"auto","created_at":"2025-09-17 19:10:25","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":106496,"visible":true,"origin":"","legend":"","description":"","filename":"CVIREndovascularTable2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7558747/v1/19320aa4cef9f8e89d2790ad.pdf"}],"financialInterests":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"Cost Analysis of Venous Stent Reconstruction in the Treatment of Chronic Lower Extremity Venous Occlusive Disease","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7558747/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7558747/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e To quantify cost drivers of endovenous iliocaval stent reconstruction for chronic veno-occlusive disease based on time-driven activity-based costing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e 31 iliocaval venous stent reconstruction procedures for iliocaval veno-occlusive disease\u0026nbsp;were reviewed. Process model development began by constructing longitudinal process maps after interviews with representatives involved with iliocaval stent reconstructions. Subsequently, staff practical capacity rates and consumable equipment costs were analyzed using time-driven activity-based costing methods. Univariate and multivariate sensitivity analyses were conducted to identify the primary cost drivers of human labor and disposable materials..\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The mean procedure duration was 6.24 hours (5.75-7.15), and the base cost was $26,201.01.\u0026nbsp;Multivariate sensitivity analyses yielded a cost range of $7,842.95 to $66,066.05. Using local salary information and negotiated prices for materials as parameters, the\u0026nbsp;true\u0026nbsp;base cost per case of iliocaval stent reconstruction was $25,750.33. Human personnel costs accounted for 16.8%, while disposable materials costs accounted for 83.2%. Univariate analysis demonstrated that the primary driver of human staffing costs was attending Anesthesiologist staffing time ($25,948.54 to $26,431.38). The predominant modifiable material cost drivers included the cost of venous stents ($17,801.01 to $34,811.01), their number ($19,326.01 to $29,326.01), the cost of catheters ($25,535.51 to $29,358.01), and their number ($24,961.01 to $27,441.01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Human labor, namely anesthesia staffing costs, and disposable material costs, namely stent and catheter selection, are large, potentially modifiable drivers of the overall cost for iliocaval stent reconstruction for chronic veno-occlusive disease. Additional studies are necessary to define an iliocaval venous reconstruction protocol that delivers cost savings without compromising outcomes.\u003c/p\u003e","manuscriptTitle":"Cost Analysis of Venous Stent Reconstruction in the Treatment of Chronic Lower Extremity Venous Occlusive Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 19:10:21","doi":"10.21203/rs.3.rs-7558747/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-09-10T16:57:13+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-10T07:41:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-09T12:56:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"CVIR Endovascular","date":"2025-09-08T10:10:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dad0f269-82f3-44ce-a8c1-85cff1e3728c","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T11:41:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 19:10:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7558747","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7558747","identity":"rs-7558747","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}