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. 2021 Mar 22;14(6):678-688.
doi: 10.1016/j.jcin.2021.01.004.

Use of Atherectomy During Index Peripheral Vascular Interventions

Caitlin W Hicks  1 , Courtenay M Holscher  2 , Peiqi Wang  2 , Chen Dun  2 , Christopher J Abularrage  3 , James H Black 3rd  3 , Kim J Hodgson  4 , Martin A Makary  5
Affiliations

Use of Atherectomy During Index Peripheral Vascular Interventions

Caitlin W Hicks et al. JACC Cardiovasc Interv. .

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.

Keywords: atherectomy; endovascular; femoropopliteal disease; peripheral artery disease; peripheral vascular interventions.

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Conflict of interest statement

FUNDING SUPPORT AND Author Disclosures Dr. Hicks is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant 1K23DK124515. The sponsor had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. National distribution of physicians by their atherectomy rate for index femoropopliteal peripheral vascular interventions (PVI) in 2019.
The 1,627 physicians included in the analysis had a wide distribution of use of femoropopliteal atherectomy during index PVI, ranging from 0% (i.e. never used atherectomy as the initial procedure) to 100% (always used atherectomy as the initial procedure).
Central Illustration
Central Illustration
Based on 2019 Medicare data, we found a wide distribution of physician practice patterns for use of atherectomy during index peripheral vascular interventions. Atherectomy accounted for 90.2% of Medicare payments to physicians for index femoropopliteal PVI procedures in 2019, despite accounting for only 53.8% of cases. High rates of atherectomy were more common in patients with claudication and diabetes, and for procedures performed in ambulatory surgical centers (ASC) and office-based laboratories (OBL).
See this image and copyright information in PMC

Comment in

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