The changing roles of radiologists, cardiologists, and vascular surgeons in percutaneous peripheral arterial interventions during a recent five-year interval

Abstract

This study aimed to determine the relative roles of radiologists, cardiologists, vascular surgeons, and other physicians in performing percutaneous peripheral arterial interventions and how these roles have changed over a recent 5-year period. The authors reviewed the Medicare Part B fee-for-service databases between 1997 and 2002 for the Current Procedural Terminology (4th ed.) (CPT-4) surgical procedure codes for percutaneous transluminal angioplasty (PTA) of noncardiac peripheral arteries (six codes), the transcatheter placement of noncardiac intravascular stents (two codes), and endovascular aortic stent graft placement (six codes). Using the Medicare physician specialty codes, procedure volume in each CPT-4 code was determined for radiologists, cardiologists, vascular surgeons, and other physicians. Percentage changes from 1997 to 2002 were calculated for PTA and intravascular stent placement procedures. Between 1997 and 2002, the total Medicare procedure volume in the eight procedure codes relating to PTA and stent placement increased by 95%. In 2002, radiologists performed 72,657 of these procedures, cardiologists 62,901, vascular surgeons 17,895, and other physicians 19,666. Over the 5-year interval, procedure volume among radiologists increased 29%, among cardiologists by 181%, among vascular surgeons by 398%, and among other physicians by 195%. Radiologists' share in the total pool of procedures in 2002 was 42.0% (down from 63.3% in 1997), cardiologists' 36.3% (up from 25.2% in 1997), vascular surgeons' 10.3% (up from 4.0% in 1997), and other physicians' 11.4% (up from 7.5% in 1997). Trend data were not available for endovascular aortic stent graft procedures. Between 1997 and 2002, procedure volume in percutaneous peripheral arterial interventions grew at faster rates among cardiologists, vascular surgeons, and other physicians than it did among radiologists. As a result, radiologists' share of this market declined during the interval. However, procedure volume among radiologists continued to grow over the 5 years, and in 2002, they still had the largest share among the four physician specialty groups. Thus, despite the erosion, interventional radiologists still maintain a strong position in this rapidly growing field.