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Journal of Vascular Surgery Sep 2022Small, older studies have suggested that the use of atherectomy devices has become common in peripheral vascular interventions (PVIs) despite the paucity of strong...
OBJECTIVE
Small, older studies have suggested that the use of atherectomy devices has become common in peripheral vascular interventions (PVIs) despite the paucity of strong clinical guidelines. We analyzed the 10-year trends in the use of atherectomy for PVIs across the United States and identified the main predictors of atherectomy use.
METHODS
Using the Vascular Quality Initiative registry, we identified all patients who had undergone endovascular PVIs for occlusive lower extremity arterial disease from 2010 to 2019. Procedures in which an atherectomy device had been used as the primary or secondary device were classified as the atherectomy group. We calculated the frequency of atherectomy use over time and across geographic regions. Using regression modeling, we identified the factors that were independently associated with atherectomy use.
RESULTS
A total of 205,377 PVIs had been performed for 152,693 unique patients. During the 10-year period, 16.6% of the PVI procedures had used atherectomy, increasing from 8.5% in 2010 to 19.7% in 2019 (P < .0001). Across 17 geographic regions, we found a significant difference in the prevalence of atherectomy use, ranging from 8.2% to 29%. The strongest predictor of atherectomy use was performance of PVI in an office setting (odds ratio [OR], 10.08; 95% confidence interval [CI], 9.17-11.09) or ambulatory center (OR, 4.0; 95% CI, 3.65-4.39) vs a hospital setting. The presence of severe (OR, 2.6; 95% CI, 2.4-2.85) or moderate (OR, 1.5; 95% CI, 1.4-1.69) lesion calcification was also predictive of atherectomy use. Other predictive factors included elective status, insurance provider, lesion length, prior PVI, claudication symptoms, and diabetes mellitus.
CONCLUSIONS
Atherectomy use in PVI significantly increased from 2010 to 2019. We found wide regional variability in the use of atherectomy that seemed to be driven more strongly by nonclinical factors.
Topics: Atherectomy; Databases, Factual; Humans; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United States
PubMed: 35367566
DOI: 10.1016/j.jvs.2022.03.864 -
Journal of Vascular Surgery Feb 2017The purpose of this study was to evaluate the trends in procedure volume, clinical sites of care, and Medicare expenditure for peripheral vascular interventions (PVIs)...
OBJECTIVE
The purpose of this study was to evaluate the trends in procedure volume, clinical sites of care, and Medicare expenditure for peripheral vascular interventions (PVIs) for lower extremity occlusive disease since the Centers for Medicare and Medicaid Services instituted reimbursement policy changes that broadened payment for procedures performed in physician-owned office-based laboratories (OBLs).
METHODS
We analyzed fee-for-service Medicare claims data from 2011 to 2014 to obtain the frequency of use of PVI by type, care setting, and physician specialty. We also assessed changes in the total Medicare cost for PVI by setting.
RESULTS
There was a 60% increase in atherectomy cases among Medicare beneficiaries between 2011 and 2014. During the same period, OBLs experienced a 298% increase in atherectomy volume vs a 27% increase in hospital outpatient settings and an 11% decrease for inpatient hospital settings. In 2014, OBLs were the most common setting for atherectomy. Nonatherectomy PVIs grew more modestly at just 3% but also experienced site of care shifts. Vascular surgeons and cardiologists accounted for the majority of office-based PVIs in 2014. Total Medicare costs for PVIs increased 18% from 2011 to 2014. Hospital inpatient costs declined 1%, whereas costs for hospital outpatient PVIs increased by 41% and physician office costs increased by 258%.
CONCLUSIONS
The migration of revascularization procedures for lower extremity peripheral arterial occlusive disease continues from the inpatient to the outpatient setting and especially to OBLs. Increased use of atherectomy in all segments of the lower extremity arterial system has been observed, particularly in OBLs, without substantial evidence in the literature of increased efficacy compared with standard angioplasty with or without stenting. Generous Medicare reimbursement for in-office atherectomy procedures is likely contributing to the volume shifts observed.
Topics: Ambulatory Care; Ambulatory Surgical Procedures; Atherectomy; Databases, Factual; Health Care Costs; Health Expenditures; Health Services Needs and Demand; Humans; Lower Extremity; Medicare; Office Visits; Peripheral Arterial Disease; Practice Patterns, Physicians'; Process Assessment, Health Care; Time Factors; United States; Workload
PubMed: 27986487
DOI: 10.1016/j.jvs.2016.08.112 -
Cardiovascular Revascularization... Aug 2023Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of...
BACKGROUND
Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS.
METHODS
The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data.
RESULTS
Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 %, 2.3 %, and 9.1 % were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts ($34,340.77 in OA, $32,306.2 in non-OA) as compared to the PCI-only cohort ($23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI.
CONCLUSIONS
This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.
Topics: Humans; Percutaneous Coronary Intervention; Inpatients; Treatment Outcome; Vascular Calcification; Atherectomy, Coronary; Coronary Artery Disease; Atherectomy; Aortic Valve Stenosis; Coronary Angiography
PubMed: 36997465
DOI: 10.1016/j.carrev.2023.03.008 -
Journal of Vascular and Interventional... Oct 2022To describe national trends in the utilization of endovascular approaches (including balloon angioplasty, atherectomy, and stent placement) for the management of...
PURPOSE
To describe national trends in the utilization of endovascular approaches (including balloon angioplasty, atherectomy, and stent placement) for the management of femoropopliteal peripheral arterial disease (PAD).
MATERIALS AND METHODS
The Medicare Physician/Supplier Procedure Summary dataset containing 100% of Part B claims was interrogated for years 2011-2019. The Current Procedural Terminology codes specific for femoropopliteal angioplasty, stent placement, and atherectomy were used to create summary statistics for utilization by year, place of service (hospital inpatient, hospital outpatient, and office-based laboratory), and provider specialty (cardiology, radiology, and surgery).
RESULTS
The use of atherectomy increased from 34,732 (33%) procedures in 2011 to 75,435 (53%) procedures in 2019, and atherectomy became the dominant treatment strategy for femoropopliteal PAD. The relative utilization of stent placement (36,793 [35%] to 28,899 [20%]) and angioplasty only (34,398 [32%] to 38,228 [27%]) decreased concomitantly from 2011 to 2019. By 2019, the use of atherectomy was twofold higher in office-based laboratories than in the outpatient hospital setting (44,767 and 20,901, respectively). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925 [43%]), whereas radiologists used angioplasty alone (5,928 [6%]) and surgeons stented (18,009 [37%]) most frequently. By 2019, all specialties utilized atherectomy most frequently (29,564 [59%] for cardiology, 10,912 [58%] radiology, and 33,649 [47%] surgery).
CONCLUSIONS
The national approach to endovascular management of femoropopliteal PAD has changed since 2011 toward an implant-free strategy, including a multifold increase in the use of atherectomy. Discordant rates of atherectomy use between the ambulatory hospital and office-based settings highlight the need for comparative effectiveness studies to guide management.
Topics: Aged; Angioplasty, Balloon; Atherectomy; Femoral Artery; Humans; Medicare; Peripheral Arterial Disease; Treatment Outcome; United States
PubMed: 35764287
DOI: 10.1016/j.jvir.2022.03.607 -
Atherectomy followed by drug-coated balloon angioplasty for below knee lesions in diabetic patients.Cirugia Y Cirujanos 2022The aim of this study was to compare the long-term outcomes of below the knee revascularization with percutaneous atherectomy followed by drug-coated balloon and...
OBJECTIVE
The aim of this study was to compare the long-term outcomes of below the knee revascularization with percutaneous atherectomy followed by drug-coated balloon and revascularization with drug-coated balloon alone for symptomatic diabetic patients with peripheral arterial disease.
PATIENTS AND METHODS
Between April 2015 and January 2020, total of 128 patients and 228 below the knee procedures were enrolled into this retrospective study. Sixty-five patients were treated with atherectomy followed by drug-coated balloon and 63 patients were treated solely with drug-coated balloon.
RESULTS
Technical success rates were similar in the AT+DCB group and DCB group. Target lesion revascularization (TLR) was found similar in both groups at 6-month follow-up. Clinically, driven repeat endovascular and surgical limb revascularization rates were also significantly lower at 12 and 24 months.
CONCLUSION
Combined usage of rotational atherectomy and drug-coated balloons for the treatment of diabetic patients with below-the knee arterial lesions and critical limb ischemia is associated with reduced long-term TLR rates and improved the long-term outcomes.
Topics: Humans; Angioplasty, Balloon; Atherectomy; Diabetes Mellitus; Retrospective Studies
PubMed: 36480761
DOI: 10.24875/CIRU.22000131 -
The Journal of Invasive Cardiology May 2020There is paucity of data regarding the temporal trends and outcomes of coronary atherectomy in the United States.
BACKGROUND
There is paucity of data regarding the temporal trends and outcomes of coronary atherectomy in the United States.
METHODS
We queried the National Inpatient Sample database (2011-2016) for hospitalizations of patients undergoing coronary atherectomy procedures. We also compared outcomes of non-orbital vs orbital coronary atherectomy in a more contemporary cohort.
RESULTS
Our analysis included 2,990,223 hospitalizations with PCI, of which 114,462 (3.8%) included an atherectomy procedure. A significant increase in coronary atherectomy procedures was observed over time (0.66% in 2011 vs 8.9% in 2016; Ptrend=.04). There was an increase in in-hospital mortality associated with atherectomy procedures from 3.2% in 2011 to 4.7% in 2016 (Ptrend=.04), which paralleled the increase in patient comorbidities, use of mechanical circulatory devices (Ptrend<.001), and procedural complications. While several predictors of increased mortality after an atherectomy procedure were identified, the use of intravascular ultrasound (IVUS) was associated with lower mortality during atherectomy procedures (adjusted odds ratio [OR] = 0.61; 95% confidence interval [CI], 0.42-0.89), although its overall use was low (10.4%). Compared with other atherectomy procedures, orbital atherectomy was associated with lower in-hospital mortality (3.2% vs 4.7%; adjusted OR = 0.50; 95% CI, 0.30-0.81).
CONCLUSION
Our large national database analysis demonstrates an increase in the number of coronary atherectomy procedures and in their in-hospital mortality and complications over time. Orbital atherectomy appears to be associated with favorable outcomes compared with non-orbital atherectomy, and IVUS use was associated with lower mortality during atherectomy procedures. These associations do not necessarily imply causality and need to be confirmed in future randomized clinical trials.
Topics: Atherectomy; Atherectomy, Coronary; Coronary Artery Disease; Humans; Percutaneous Coronary Intervention; Treatment Outcome; United States; Vascular Calcification
PubMed: 32357132
DOI: No ID Found -
Deutsche Medizinische Wochenschrift... Oct 2023In addition to conservative therapy with intensive walking training, endovascular revascularisation and open vascular surgical revascularisation are of high importance...
In addition to conservative therapy with intensive walking training, endovascular revascularisation and open vascular surgical revascularisation are of high importance in the treatment of peripheral arterial disease. Over the past decades, endovascular therapy has developed considerably and is now the treatment of choice for most vascular segments. The use of different devices has been shown to be beneficial for different vessel segments. Primary stent angioplasty has been shown to be superior to balloon angioplasty with secondary stent implantation for the treatment of iliac lesions. Femoropopliteal, the use of paclitaxel-eluting balloon angioplasty is recommended. A mortality signal shown in a meta-analysis was not confirmed. With directional atherectomy and intravascular lithotripsy, different options for plaque modification are available. The cytostatic drug sirolimus as another antirestenotic substance still has to be investigated in large, randomised trials. A final assessment of the effectiveness and safety is not yet possible. Infrapopliteal balloon angioplasty remains the standard treatment. After interventional therapy, regular follow-up is recommended.
Topics: Humans; Peripheral Arterial Disease; Angioplasty, Balloon; Femoral Artery; Atherectomy; Stents; Treatment Outcome; Popliteal Artery; Coated Materials, Biocompatible
PubMed: 37757890
DOI: 10.1055/a-2017-7786 -
Giornale Italiano Di Cardiologia (2006) Nov 2020Coronary artery calcification enhances percutaneous treatment complexity, increasing the likelihood of procedural failure and complications and affecting acute and... (Review)
Review
Coronary artery calcification enhances percutaneous treatment complexity, increasing the likelihood of procedural failure and complications and affecting acute and long-term outcomes. In order to deal with such lesions, several devices and technologies, including balloons, atherectomy and intravascular lithotripsy, have been developed. The combination of the aforementioned technologies and the guidance of intracoronary imaging can help skilled interventional cardiologists in achieving better acute and long-term results in this setting. The purpose of the present review is to provide an appraisal of the devices dedicated to the treatment of calcified lesions, including the description of components and function and how to integrate them into a practical, standardized approach.
Topics: Atherectomy, Coronary; Coronary Angiography; Coronary Artery Disease; Humans; Percutaneous Coronary Intervention; Treatment Outcome; Vascular Calcification
PubMed: 33295335
DOI: 10.1714/3487.34673 -
JACC. Cardiovascular Interventions Jun 2021
Topics: Atherectomy, Coronary; Humans; Treatment Outcome; Vascular Calcification
PubMed: 34167674
DOI: 10.1016/j.jcin.2021.05.008 -
Catheterization and Cardiovascular... Apr 2017Rotational atherectomy is performed infrequently (∼3.5%) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) for two indications: treatment...
Rotational atherectomy is performed infrequently (∼3.5%) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) for two indications: treatment of balloon uncrossable and balloon undilatable lesions. Use of rotational atherectomy in CTO PCI was associated with high success and acceptable complication rates. Rotational atherectomy remains a "must have" device for interventional cardiologists performing complex PCI.
Topics: Angioplasty, Balloon, Coronary; Atherectomy, Coronary; Chronic Disease; Coronary Angiography; Coronary Occlusion; Humans; Percutaneous Coronary Intervention; Treatment Outcome
PubMed: 28419791
DOI: 10.1002/ccd.27052