The Landscape of Centralization in Endovascular Care for Peripheral Arterial Disease: A National Cross-Sectional Study.

Abstract

IntroductionPeripheral arterial disease (PAD) is highly prevalent among cardiovascular diseases. However, the distribution and volume of endovascular diagnostic and therapeutic procedures among institutions have not been thoroughly investigated. This study aimed to determine the number and types of endovascular procedures performed in patients with PAD, both overall and by county, as well as to compare institutional volumes and procedural trends.MethodsWe analyzed interventions performed between 2017 and 2020, including the type of admission, diagnostic procedure group, procedure type, and institution. Institutions were categorized as high-volume if they performed more than 200 procedures annually.ResultsThere was a total of 13,533 procedures. Percutaneous transluminal angioplasty (PTA) with balloon and single-stent PTA with balloon were the most performed interventions. Routine inpatient procedures were more frequent than those performed in day hospitals and increased through 2019, followed by a decline in 2020. The mean annual number of interventions per institution was 96.73 in university hospitals and university hospital centers, 18.12 in general hospitals, and 52.75 in private hospitals. High-volume centers included University Hospital Merkur, Clinical Hospital Center Rijeka, Dubrava University Hospital, and University Hospital Centre Zagreb. The ratio of single-stent to multiple-stent procedures varied across institutions and over time. In general hospitals, single-stent procedures were performed 2.5 times more frequently than multiple-stent procedures. At Clinical Hospital Center Zagreb, this ratio was 6.4-fold higher compared with other university hospitals.ConclusionThe findings of this cross-sectional study suggest centralization of endovascular PAD interventions in higher-level institutions, with lower procedural volumes in smaller centers. Substantial variability in clinical practice patterns may indicate a lack of integrated care pathways, absence of cost-effectiveness frameworks, and limited use of standardized quality indicators.