Use of Atherectomy During Index Peripheral Vascular Interventions
Caitlin W Hicks1, Courtenay M Holscher2, Peiqi Wang2
1Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Physician use of atherectomy in femoropopliteal peripheral artery disease intervention varies widely. Guidelines are needed to prevent overuse, especially given high Medicare reimbursement for atherectomy procedures.
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.
Objectives:
The aim of this study was to describe physician practice patterns and examine physician-level factors associated with the use of atherectomy during index revascularization for patients with femoropopliteal peripheral artery disease.
Background:
There are minimal data to support the routine use of atherectomy over angioplasty and/or stenting for the endovascular treatment of peripheral artery disease.
Methods:
Medicare fee-for-service claims (January 1 to December 31, 2019) were used to identify all beneficiaries undergoing elective first-time femoropopliteal peripheral vascular intervention (PVI) for claudication or chronic limb-threatening ischemia. Hierarchical logistic regression was used to evaluate patient- and physician-level characteristics associated with atherectomy.
Results:
A total of 58,552 patients underwent index femoropopliteal PVI by 1,627 physicians. There was a wide distribution of physician practice patterns in the use of atherectomy, ranging from 0% to 100% (median 55.1%). Independent characteristics associated with atherectomy included treatment for claudication (vs. chronic limb-threatening ischemia; odds ratio [OR]: 1.51), patient diabetes (OR: 1.09), physician male sex (OR: 2.08), less time in practice (OR: 1.41 to 2.72), nonvascular surgery specialties (OR: 2.78 to 5.71), physicians with high volumes of femoropopliteal PVI (OR: 1.67 to 3.51), and physicians working primarily at ambulatory surgery centers or office-based laboratories (OR: 2.19 to 7.97) (p ≤ 0.03 for all). Overall, $266.8 million was reimbursed by Medicare for index femoropopliteal PVI in 2019. Of this, $240.6 million (90.2%) was reimbursed for atherectomy, which constituted 53.8% of cases.
Conclusions:
There is a wide distribution of physician practice patterns for the use of atherectomy during index PVI. There is a critical need for professional guidelines outlining the appropriate use of atherectomy in order to prevent overutilization of this technology, particularly in high-reimbursement settings.
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