Trends in Utilization of Common Tests and Procedures in Treating Peripheral Arterial Disease in the Medicare...

This study investigated changes in utilization of diagnostic imaging-computed tomography (CT) angiography and magnetic resonance (MR) angiography-and treatments-stent placement, angioplasty, atherectomy, and bypass-in peripheral arterial disease (PAD) across different physician specialties and healthcare facilities from 2011 to 2021. Data were gathered from the 2011-2021 Physician/Supplier Procedure Summary files and tallied per 100,000 Medicare beneficiaries. Sites of service included inpatients, physician offices, and hospital outpatient departments. Physician specialties included interventional radiologists, interventional cardiologists, and vascular surgeons. From 2011 to 2021 and per 100,000 Medicare beneficiaries, CT angiography utilization rates grew (+14%), vascular ultrasound (US) utilization rates decreased (-17%), and MR angiography utilization rates decreased (-86%). Per 100,000, atherectomy utilization rates increased by 159% (from 37.7 to 55.1), and bypass grafting utilization rates decreased by 74% (from 40.7 to 10.5). Combined angioplasty, stent placement, stent placement with atherectomy, and atherectomy utilization rates increased (+16%), particularly in the office (angioplasty, +277%; atherectomy, +1036%). These data support that PAD management shifted toward endovascular procedures in office-based laboratories.