Variations in Practice Patterns for Peripheral Vascular Interventions Across Clinical Settings.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Health Services Research

Background:

• Peripheral vascular interventions (PVIs) for lower extremity peripheral artery disease are rising, especially in office-based settings.
• Understanding practice variations across different care sites is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate practice patterns for PVIs based on the site of service.
• To analyze patient demographics, comorbidities, procedural details, and outcomes across hospital and office-based settings.

Main Methods:

• Utilized the Vascular Quality Initiative PVI registry (2010-2021).
• Classified sites of service into hospital/inpatient, hospital/outpatient, and ambulatory/office-based centers.
• Analyzed patient characteristics, procedural indications, interventions used, and periprocedural complications.

Main Results:

• Ambulatory/office-based centers performed 6.4% of PVIs, treating older patients more often for claudication using atherectomy.
• Hospital settings (inpatient and outpatient) managed more complex cases with higher rates of coronary artery disease and chronic obstructive pulmonary disease.
• Atherectomy use was significantly higher in ambulatory settings (63.4%) compared to hospital settings (14.2%-19.4%), while stent graft use was lower.
• Periprocedural complication rates were low across all settings.

Conclusions:

• Significant variations exist in patient populations, indications, and interventions for PVIs across different care locations.
• Ambulatory/office-based PVI practices are distinct, focusing on claudication with increased atherectomy use and decreased stent graft utilization.
• Further research is needed to understand long-term outcomes of PVIs in the growing ambulatory setting.