Atherectomy in Peripheral Vascular Interventions

JACC: Use of Atherectomy During Index Peripheral Vascular Interventions

JACC: Atherectomy in Peripheral Vascular Interventions

Keywords

Cardiology, cardiac procedures, atherectomy; endovascular; femoropopliteal disease; peripheral artery disease; peripheral vascular interventions.

At a glance

Intro:

A large cohort study of 2019 Medicare fee-for-service claims from 58,552 patients treated by 1,627 physicians looks at procedural volumes, device choices and frequency of use of atherectomy in PVI (Peripheral Vascular Interventions).

Discussion:

  • Practice patterns and physician factors associated with use of atherectomy
  • The dramatic increase in the use of atherectomy from 22% in 2011 to ~50% in 2019
  • Lack of data to support the increased frequency of atherectomy
  • Significantly higher use of atherectomy by physicians working primarily in ASC (Ambulatory Surgical Centers) or OBL (Office-Based Laboratories) (∼8-fold higher), resulting in significantly higher Medicare costs.
  • Current professional guidelines from SCAI & ACC
  • OBL/ASC centers should be held to similarly high standards of care as inpatient facilities, with quality assurance metrics in place, including peer review for appropriateness of PVI and review of device selection/utilization.

Conclusion: 

The report concludes 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.

DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal news in the press. He also shares case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Atherectomy in Peripheral Vascular Interventions: Time to Follow the Guidelines?

Abstract:

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.

DISCLAIMER:Dr. Dalawari shares interesting and relevant medical-legal news in the press. He also shares case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Do you have questions about a medical case or need help understanding treatment plans and options?

Cardio Med Legal Dr. Jasdeep Dalawari

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References:

JACC Journals › JACC: Interventions › Archives › Vol. 14 No. 6

Use of Atherectomy During Index Peripheral Vascular Interventions

Caitlin W. Hicks, Courtenay M. Holscher, Peiqi Wang, Chen Dun, Christopher J. Abularrage, James H. Black, Kim J. Hodgson, and Martin A. Makary

J Am Coll Cardiol Intv. 2021 Mar, 14 (6) 678–688

About Jasdeep Dalawari MD

Experienced General and Specialist Physician with a demonstrated history of working in the medical practice industry. Skilled in Interventional, Endovascular, Vascular, and General Cardiovascular Medicine; Emergency Medicine; Healthcare Consulting, including Peer Review, Expert Witness, and Utilization Review; and Medical Education. Strong healthcare services professional with an MS focused in Health Administration from Virginia Commonwealth University.