Index atherectomy peripheral vascular interventions performed for claudication are associated with more reinterventions than nonatherectomy interventions

5-Year Follow-Up of a Physician Performance Feedback Report Intervention to Reduce Overuse and Excess Cost: A National Cohort Study

“…[13][14][15] Hicks and colleagues identified a series of low-value practice patterns and highlighted the opportunity to re-evaluate the appropriateness of peripheral vascular interventions. 13,[16][17][18] Kaczmarski and colleagues 14 examined the surgeon re-excision rate among patients who underwent breast-conserving surgery, identifying a cohort of outliers who increased financial burden to the health care system and defining a quality metric associated with low-value care. Electronic health records-based interventions have been conducted in health care professionals and resulted in statistically significant reductions in inappropriate antibiotic prescribing.…”

Needle fenestration of popliteal artery covered stent graft to salvage inadvertent stent misdeployment

“… 7 Also, evidence is mounting that restenosis rates can be exacerbated by the misuse of atherectomy. 3 , 8 Because of concerns regarding restenosis and occlusion, which plague any endovascular intervention to the femoropopliteal segment, different strategies have been used, including covered stents, which theoretically only have a risk of restenosis and occlusion at the margins of the stent, because neointimal ingrowth cannot occur in the body of the stent graft itself. The use of covered stents has resulted in good success in limited series.…”

Device regulation and surveillance in vascular care: Challenges and opportunities

“…Patients undergoing atherectomy were also reported as frequently being treated early in their course for claudication. This contrasts with professional societal clinical guidelines and appropriate use criteria for intermittent claudication, which recommend medical and lifestyle management as the preferred initial strategy and found unclear benefit of atherectomy over alternative interventions when revascularization is warranted 31–40 . Fee schedules readily demonstrate higher physician reimbursement in the outpatient setting.…”

“…This contrasts with professional societal clinical guidelines and appropriate use criteria for intermittent claudication, which recommend medical and lifestyle management as the preferred initial strategy and found unclear benefit of atherectomy over alternative interventions when revascularization is warranted. [31][32][33][34][35][36][37][38][39][40] Fee schedules readily demonstrate higher physician reimbursement in the outpatient setting. Moreover, CMS Provider Utilization and Payment Data Public Use Files demonstrate a significant correlation between OBL utilization, OBL atherectomy, and change in payment, raised concerns that increases in atherectomy use in OBLs are related to higher reimbursements rather than patient need.…”