Analyzing Trends of Lower Extremity Peripheral Vascular Interventions

Purpose: Considering the debatable indications for lower extremity peripheral vascular intervention (PVI) that resulted in multiple Department of Justice (DOJ) lawsuits in 2015, this project aims to evaluate trends in lower extremity PVIs with a focus on provider specialty and procedure setting.

Materials and Methods: A retrospective analysis was done using the Physicians Compare National Database File from the Center for Medicare Services database between 2012 and 2017. Procedures and settings were identified based on CPT code physicians use for billing iliac, femoral/popliteal, and tibial/peroneal interventions. Providers were grouped into vascular surgery, interventional cardiology, or interventional radiology.

Results: A total of 547,231 PVI procedures were analyzed. Iliac procedures accounted for 81,684, femoral/popliteal accounted for 305,924, and tibial/peroneal accounted for 159,623. Overall, there was a 37% increase in PVIs. Although iliac PVIs decreased by 14%, femoral/popliteal and tibial/peroneal procedures increased by 33% and 88%, respectively. Stratifying data by provider specialty showed that vascular surgery accounted for 65% of iliac PVIs, 53% of femoral/popliteal PVIs, and 49% of tibial/peroneal PVIs. Interventional cardiology accounted for 27% of iliac PVIs, 38% of femoral/popliteal PVIs, and 38% of tibial/peroneal PVIs. Interventional radiology accounted for 8% of iliac PVIs, 9% of femoral/popliteal PVIs, and 13% of tibial/peroneal PVIs. Data on facility-based procedures showed iliac PVIs decreased by 27%, femoral/popliteal PVIs decreased 16%, and tibial/peroneal PVIs increased 4%. For outpatient procedures, iliac PVIs increased 51.45%, femoral/popliteal PVIs increased 244%, and tibial/peroneal PVIs increased 300%.

Conclusions: Vascular surgeons continue to perform most of the lower extremity PVI procedures; interventional cardiologists come in second, and interventional radiologists are a distant third. Tibial/peroneal procedures are increasing the most, indicating that treatment of chronic life-threatening limb ischemia is becoming more common. Finally, analysis of procedure setting indicates there are a substantial increase in outpatient procedures and a decrease in facility procedures. Although outpatient settings are vital to reducing PVI costs, considering the 2015 lawsuits by the DOJ and the uncertainty for PVI indications, it is important to develop and adhere to better evidence-based guidelines and regulations.