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Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative.

Publication ,  Journal Article
Mohan, S; Flahive, JM; Arous, EJ; Judelson, DR; Aiello, FA; Schanzer, A; Simons, JP; Vascular Quality Initiative,
Published in: J Vasc Surg
December 2018

OBJECTIVE: Peripheral atherectomy has been shown to have technical success in single-arm studies, but clinical advantages over angioplasty and stenting have not been demonstrated, leaving its role unclear. We sought to describe patterns of atherectomy use in a real-world U.S. cohort to understand how it is currently being applied. METHODS: The Vascular Quality Initiative was queried to identify all patients who underwent peripheral vascular intervention from January 2010 to September 2016. Descriptive statistics were performed to analyze demographics of the patients, comorbidities, indication, treatment modalities, and lesion characteristics. The intermittent claudication (IC) and critical limb ischemia (CLI) cohorts were analyzed separately. RESULTS: Of 85,605 limbs treated, treatment indication was IC in 51% (n = 43,506) and CLI in 49% (n = 42,099). Atherectomy was used in 15% (n = 13,092) of cases, equivalently for IC (15%; n = 6674) and CLI (15%; n = 6418). There was regional variation in use of atherectomy, ranging from a low of 0% in one region to a high of 32% in another region. During the study period, there was a significant increase in the proportion of cases that used atherectomy (11% in 2010 vs 18% in 2016; P < .0001). Compared with nonatherectomy cases, those with atherectomy use had higher incidence of prior peripheral vascular intervention (IC, 55% vs 43% [P < .0001]; CLI, 47% vs 41% [P < .0001]), greater mean number of arteries treated (IC, 1.8 vs 1.6 [P < .0001]; CLI, 2.1 vs 1.7 [P < .0001]), and lower proportion of prior leg bypass (IC, 10% vs 14% [P < .0001]; CLI, 11% vs 17% [P < .0001]). There was lower incidence of failure to cross the lesion (IC, 1% vs 4% [P < .0001]; CLI, 4% vs 7% [P < .0001]) but higher incidence of distal embolization (IC, 1.9% vs 0.8% [P < .0001]; CLI, 3.0% vs 1.4% [P < .0001]) and, in the CLI cohort, arterial perforation (1.4% vs 1.0%; P = .01). CONCLUSIONS: Despite a lack of evidence for atherectomy over angioplasty and stenting, its use has increased across the United States from 2010 to 2016. It is applied equally to IC and CLI populations, with no identifiable pattern of comorbidities or lesion characteristics, suggesting that indications are not clearly delineated or agreed on. This study places impetus on further understanding of the optimal role for atherectomy and its long-term clinical benefit in the management of peripheral arterial disease.

Duke Scholars

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

December 2018

Volume

68

Issue

6

Start / End Page

1806 / 1816

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Surgeons
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Practice Patterns, Physicians'
  • Peripheral Arterial Disease
  • Middle Aged
 

Citation

APA
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Mohan, S., Flahive, J. M., Arous, E. J., Judelson, D. R., Aiello, F. A., Schanzer, A., … Vascular Quality Initiative, . (2018). Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative. J Vasc Surg, 68(6), 1806–1816. https://doi.org/10.1016/j.jvs.2018.03.417
Mohan, Sathish, Julie M. Flahive, Edward J. Arous, Dejah R. Judelson, Francesco A. Aiello, Andres Schanzer, Jessica P. Simons, and Jessica P. Vascular Quality Initiative. “Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative.J Vasc Surg 68, no. 6 (December 2018): 1806–16. https://doi.org/10.1016/j.jvs.2018.03.417.
Mohan S, Flahive JM, Arous EJ, Judelson DR, Aiello FA, Schanzer A, et al. Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative. J Vasc Surg. 2018 Dec;68(6):1806–16.
Mohan, Sathish, et al. “Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative.J Vasc Surg, vol. 68, no. 6, Dec. 2018, pp. 1806–16. Pubmed, doi:10.1016/j.jvs.2018.03.417.
Mohan S, Flahive JM, Arous EJ, Judelson DR, Aiello FA, Schanzer A, Simons JP, Vascular Quality Initiative. Peripheral atherectomy practice patterns in the United States from the Vascular Quality Initiative. J Vasc Surg. 2018 Dec;68(6):1806–1816.
Journal cover image

Published In

J Vasc Surg

DOI

EISSN

1097-6809

Publication Date

December 2018

Volume

68

Issue

6

Start / End Page

1806 / 1816

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Surgeons
  • Risk Factors
  • Retrospective Studies
  • Registries
  • Practice Patterns, Physicians'
  • Peripheral Arterial Disease
  • Middle Aged