Use of Atherectomy During Index Peripheral Vascular Interventions

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Health Services Research

Background:

• Limited data support routine atherectomy over angioplasty/stenting for femoropopliteal peripheral artery disease (PAD).
• Understanding current physician practice patterns is crucial for guiding future treatment strategies.

Purpose of the Study:

• To describe physician practice patterns for atherectomy use in femoropopliteal PAD.
• To examine physician-level factors associated with atherectomy utilization during index revascularization.

Main Methods:

• Analysis of Medicare fee-for-service claims from 2019 for patients undergoing elective femoropopliteal peripheral vascular intervention (PVI).
• Hierarchical logistic regression used to identify patient- and physician-level predictors of atherectomy use.

Main Results:

• 58,552 patients underwent PVI by 1,627 physicians; atherectomy use varied widely (median 55.1%).
• Physician factors like male sex, less experience, non-vascular specialty, high PVI volume, and practice setting (ASC/OBL) were associated with increased atherectomy use.
• Atherectomy accounted for 53.8% of cases and 90.2% of Medicare reimbursement ($240.6 million).

Conclusions:

• Significant variation exists in physician practice patterns for atherectomy in femoropopliteal PVI.
• Professional guidelines are essential to ensure appropriate use of atherectomy and prevent potential overutilization, particularly in lucrative settings.