4:12 PM Abstract No. 316 Variations in endovascular management of infrapopliteal arterial disease: national trends from the Medicare procedure database

Abstract

Growing evidence for the efficacy of endovascular interventions for infrapopliteal atherosclerotic arterial disease has led to increased utilization of these procedures. We aim to characterize developing national trends in use of balloon angioplasty (PTA), stenting, and atherectomy across clinical settings and provider specialties. The Medicare Physician/Supplier Procedure Summary data were used to quantify endovascular interventions performed for infrapopliteal arterial disease between 2011 and 2017 based upon submitted current procedural terminology (CPT) codes. Enrollment-adjusted results were stratified by year and analyzed by provider specialty (cardiology, radiology, and surgery) and clinical setting (office-based lab (OBL), hospital outpatient, and hospital inpatient). Between 2011 and 2017 there was a shift in treatment strategy of infrapopliteal disease, from PTA alone (59.8% to 48.4% of interventions) to substantially increased use of atherectomy (32.4% to 47.8%). Cardiologists were the first to adopt atherectomy as primary therapy (52.8% of interventions). By 2017, radiologists used PTA-only and atherectomy equally (49.3% atherectomy) and surgeons still performed more PTA-only than atherectomy (43.2% atherectomy). Stenting was consistent across specialties, accounting for 8% of cases in 2011 and 4% of cases in 2017. Clinical location impacted the intervention performed, with increasing use of atherectomy in the OBL setting compared to the hospital outpatient setting (58.9% OBL and 31.2% outpatient in 2011, 74.2% OBL and 32.8% outpatient in 2017). Hospital inpatient atherectomy was infrequently used (27.2% in 2011 and 25.3% in 2017). Endovascular treatment of infrapopliteal disease has shifted in recent years to predominant use of atherectomy. Cardiologists were early adopters of atherectomy, followed by radiologists, with surgeons still performing comparatively more PTA-only procedures. Atherectomy is much more prevalent in OBL than the hospital outpatient setting, suggesting possible inappropriate use. Stenting rates remained low and continued to decline, suggesting decreasing bailout for complications of other interventions.