Peripheral arterial disease (PAD) is an indicator for coronary and carotid arterial disease and carries inherent risks of claudication and amputation. PAD screening has increased dramatically, particularly among cardiologists, while vascular surgery has demonstrated the greatest growth in revascularization procedures treating PAD, according to research being presented at the 2011 American Roentgen Ray Society's annual meeting.
The study was performed at Rhode Island Hospital in Providence, RI. CPT codes were extracted for lower extremity vascular noninvasive physiologic studies and for peripheral arterial stent placement and transluminal angioplasty. Six years of data were examined from the Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary Master files over an eight year span from 2000 -- 2007.
Regarding non-invasive physiologic testing, cardiology has demonstrated nearly twice the compounded annual growth rate of vascular surgery and radiology. However, in endovascular therapy for PAD, vascular surgery has shown the greatest increase, with compounded growth rates more than twice that of cardiology. In contrast, radiology has experienced a net decline in endovascular PAD therapy.
"There has been a marked increase in volume of non-invasive physiologic testing, particularly within cardiology, a self-referring specialty, and this has been associated with tremendous growth in endovascular therapy for peripheral arterial disease," said Tyler Harris, MD, lead author of the study.
"Prior work has shown the majority of peripheral arterial stenting and angioplasty is performed for patients with intermittent claudication, particularly when performed by cardiologists," said Harris.
"However, non-invasive therapies such as supervised exercise programs have shown equivalent outcomes versus stenting and angioplasty in this population across multiple trials. Additionally, this growth has occurred in the absence of any major advance in the understanding of morbidity and mortality of peripheral arterial disease," he said.
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