The Landscape of Centralization in Endovascular Care for Peripheral Arterial Disease: A National Cross-Sectional
Zrinka Biloglav1,2, Stipe Radoš3, Ivana Škrlec4
1Department of Medical Statistics, Epidemiology and Medical Informatics, School of Public Health Andrija Štampar, Zagreb, Croatia.
Insights
This study reveals that endovascular procedures for peripheral arterial disease (PAD) are concentrated in specialized centers, with significant variations in practice across different hospital types and institutions. Lower-volume centers may benefit from integrated care pathways and standardized quality indicators.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Peripheral arterial disease (PAD) is a common cardiovascular condition.
- The distribution and volume of endovascular procedures for PAD across institutions are not well understood.
Purpose of the Study:
- To determine the overall and county-specific number and types of endovascular procedures for PAD.
- To compare institutional volumes and procedural trends for PAD interventions.
Main Methods:
- Analysis of endovascular interventions performed between 2017 and 2020.
- Categorization of institutions based on annual procedure volume (>200 procedures/year defined high-volume centers).
Main Results:
- A total of 13,533 procedures were analyzed, with percutaneous transluminal angioplasty (PTA) being the most common intervention.
- University hospitals performed significantly more procedures annually than general hospitals.
- High-volume centers included University Hospital Merkur, Clinical Hospital Center Rijeka, Dubrava University Hospital, and University Hospital Centre Zagreb.
Conclusions:
- Endovascular PAD interventions are centralized in higher-level institutions, with lower volumes in smaller centers.
- Variability in practice patterns suggests potential gaps in integrated care, cost-effectiveness, and standardized quality indicators.
Abstract:
IntroductionPeripheral arterial disease (PAD) is highly prevalent among cardiovascular diseases. However, the distribution and volume of endovascular diagnostic and therapeutic procedures among institutions have not been thoroughly investigated. This study aimed to determine the number and types of endovascular procedures performed in patients with PAD, both overall and by county, as well as to compare institutional volumes and procedural trends.MethodsWe analyzed interventions performed between 2017 and 2020, including the type of admission, diagnostic procedure group, procedure type, and institution. Institutions were categorized as high-volume if they performed more than 200 procedures annually.ResultsThere was a total of 13,533 procedures. Percutaneous transluminal angioplasty (PTA) with balloon and single-stent PTA with balloon were the most performed interventions. Routine inpatient procedures were more frequent than those performed in day hospitals and increased through 2019, followed by a decline in 2020. The mean annual number of interventions per institution was 96.73 in university hospitals and university hospital centers, 18.12 in general hospitals, and 52.75 in private hospitals. High-volume centers included University Hospital Merkur, Clinical Hospital Center Rijeka, Dubrava University Hospital, and University Hospital Centre Zagreb. The ratio of single-stent to multiple-stent procedures varied across institutions and over time. In general hospitals, single-stent procedures were performed 2.5 times more frequently than multiple-stent procedures. At Clinical Hospital Center Zagreb, this ratio was 6.4-fold higher compared with other university hospitals.ConclusionThe findings of this cross-sectional study suggest centralization of endovascular PAD interventions in higher-level institutions, with lower procedural volumes in smaller centers. Substantial variability in clinical practice patterns may indicate a lack of integrated care pathways, absence of cost-effectiveness frameworks, and limited use of standardized quality indicators.
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