Abstract No. 38 Trends in Diagnosis and Treatment of Peripheral Arterial Disease in the Medicare Population from 2011 to 2021

There have been recent advances in endovascular treatments of peripheral arterial disease (PAD), specifically atherectomy. We sought to assess whether there was any impact on the utilization of diagnostic imaging—CT angiography (CTA) and MR angiography (MRA)—and treatments—stenting, angioplasty, atherectomy, and bypass—in PAD both generally and across different physician specialties and healthcare facilities. Data were gathered from the 2011-2021 Physician/Supplier Procedure Summary files and tallied per 100,000 Medicare beneficiaries. Starting in 2019, only physicians with 11 or greater cases of a given CPT code were recorded. For consistency, entries with fewer than 11 cases from 2011-2018 were excluded. Global and professional fees were aggregated. Sites of service included inpatients, physician offices, and hospital outpatient departments (HOPDs). Physician specialties evaluated included interventional radiologists and vascular surgeons. From 2011 to 2021, CTA rates slightly grew (+14%) and MRA greatly decreased (-86%). Combined, imaging volumes are down 25%. Angioplasty rates decreased (-13%). Stenting without atherectomy declined 60% (-89% interventional radiologists, -26% for vascular surgeons), while stenting with atherectomy increased by 150% (+980% for interventional radiologists, +338% for vascular surgeons). Atherectomy alone increased by 159% (1129% for interventional radiologists, 238% for vascular surgeons). Bypass rates greatly decreased (-74%). Overall endovascular procedure volumes have increased (+16%). Endovascular procedure volumes shifted to the office, with angioplasty up 277% and atherectomy up 1036%. HOPDs had reductions in angioplasty (-26%) and atherectomy (-37%). Similarly, inpatients had reductions in angioplasty (-32%) and atherectomy (-64%). Interestingly, despite the use of noninvasive diagnostic imaging decreasing, minimally invasive procedure rates have increased. Atherectomy uptake is especially high, with interventional radiology a key reason for its growth. These data support the pattern that advances in endovascular techniques have continued the shift away from open procedures. Sites of service have also shifted away from the hospital setting and toward physician offices, typically designated as office-based labs.