Dynamic Trends and Practice Patterns in Femoropopliteal Revascularization From 2016 Through 2023

Abstract

Section snippets

Data sources

The study included all Medicare fee-for-service beneficiaries aged ≥66 years who underwent femoropopliteal revascularization by International Classification of Diseases–10th Revision codes between January 1, 2016, and December 31, 2023. Patient comorbidities were identified using the Chronic Conditions Warehouse data, and procedural data were identified using claims codes.

Statistical analyses

Trends of femoropopliteal artery revascularization procedures were examined by quarter year from January 1. 2016, to

Results

During the study period, the number of endovascular revascularization procedures declined 38.2%; the number of surgical revascularization procedures declined 59.7%. PTA was the primary device (27.72%) used for endovascular revascularization before the onset of the paclitaxel-coated device safety concern (years 2016-2018), followed closely by DCB (24.91%). After the paclitaxel safety concern, the use of DCBs declined to a nadir of 17.89% by 2019, with a proportional increase in the use of

Discussion

In this analysis of >275,000 Medicare fee-for-service beneficiaries, we found a substantial decline in endovascular and surgical revascularizations. The paclitaxel safety concern sparked a rapid shift away from the use of paclitaxel-coated devices and toward the use of uncoated devices, particularly PTA. The use of DCBs has only recently regained some ground since its nadir in 2019, but their use remains remarkably low relative to PTA despite evidence supporting their superior efficacy and the

Conclusions

The onset of the paclitaxel safety concern is associated with a decrease in the use of drug-coated device use in femoropopliteal revascularization and is associated with increased mortality, exacerbated further after the onset of the COVID pandemic.

Funding Support and Author Disclosures

This research was sponsored by the Society for Cardiovascular Angiography and Interventions (SCAI) and supported by an educational grant from Abbott Vascular. The views presented here represent those of the authors and do not necessarily reflect the official views of SCAI or Abott Vascular. Dr Yeh has received research funding from Boston Scientific, Abbott, and Medtronic; and has been a consultant for Boston Scientific, Abbott, Medtronic, Edwards, CathWorks, and Shockwave. Dr Secemsky has