In patients with peripheral arterial disease (PAD) and accompanying severe calcification, atherectomy is an adjunctive treatment option that is associated with reduced in-hospital mortality, low rates of adverse events, and decreased lengths of hospital stay, according to an analysis of the 2012–2014 National Inpatient Sample (NIS) data set published in Vascular.
“Percutaneous revascularization for patients with PAD has become a treatment of choice for many symptomatic patients,” the researchers wrote. “The presence of severe arterial calcification presents many challenges for successful revascularization. Atherectomy is an adjunctive treatment option for patients with severe calcification undergoing percutaneous intervention.”
Data on patients with lower extremity PAD who were scheduled to undergo percutaneous revascularization were extracted from the NIS. The study investigators compared patients who were not treated with atherectomy (n = 51,037) vs those who were treated with atherectomy (n = 11,408). A propensity score-matched analysis that adjusted for differences at baseline yielded a total of 11,037 patients in each group. The primary outcomes of interest included the effects of atherectomy on in-hospital outcomes, length of hospital stay, and costs associated with the percutaneous treatment of PAD.
Atherectomy was associated with a significantly lower rate of in-hospital mortality compared with no atherectomy (2% vs 1.4%, respectively; p=0.0006). Except for acute renal failure, all secondary outcomes were lower in patients underwent atherectomy. The researchers also found a lower length of hospital stay among the atherectomy group vs the no-atherectomy group (7.2 vs. 7.0 days, respectively; p=0.0494). While atherectomy was associated with more favorable outcomes, the median cost of the procedure in this cohort was significantly higher ($21,589 vs $24,060; p=<0.0001).
“Though cost associated with atherectomy use is increased, this is offset by decreased in-hospital adverse outcomes,” the investigators concluded. “Appropriate use of atherectomy devices is an important tool in revascularization of PAD in select patients.”
Doshi R, Shlofmitz E, Meraj P. Utilization and in-hospital outcomes associated with atherectomy in the treatment of peripheral vascular disease: An observational analysis from the National Inpatient Sample. Vascular. 2018;26(5):464-471.