An article in today’s The New York Times, “Medicare Payments Surge for Stents to Unblock Blood Vessels in Limbs,” focuses on increases in peripheral arterial stenting.
SCAI is concerned about several of the claims in the article. In particular, we question the journalists’ conclusions about the use of peripheral arterial procedures when it appears that the vast majority of the increase in procedures has occurred with venous procedures. We note in The Times chart “Number of Medicare-paid operations to open blood vessels” that the greatest increase over the 10-year period is in venous procedures, likely at least in part due to endovenous laser treatment (EVLT) procedures used to occlude (not stent) varicose veins. We will communicate our concerns and questions with The Times and The Advisory Board Company, whose analysis appears to have informed the article. If our concerns are justified, then the conclusions drawn about stenting do a disservice to the field of Interventional Cardiology.
We are also disappointed that the article understates the increasing prevalence of peripheral arterial disease (PAD) worldwide, public awareness of the condition and its impact on patients’ mortality, morbidity, and quality of life. According to recent data, PAD affects over 10 million people in the United States and 200 million people worldwide. Unfortunately, the majority of these people are unaware that they have PAD or the risks associated with having it. When patients with PAD do not seek medical attention, and ultimately develop critical limb ischemia, they may suffer limb loss and even death.
SCAI is committed to raising awareness of PAD and to supporting high-quality, evidence-based patient care. As The New York Times mentions, guidelines on revascularization “outside the heart” were issued within the past year. These treatment guidelines are the four-part expert consensus document series first developed by SCAI’s Peripheral Vascular Disease Committee, chaired by Drs. Michael R. Jaff and Bruce Gray. These documents assemble the best available evidence for revascularization in the aorto-iliac, femoral-popliteal, infrapopliteal and renal vascular beds. They are important for helping physicians determine optimal treatment options for patients who are at risk for gangrene, amputation and even death.
The Society understands that there is potential for abuse in our healthcare system. We have championed quality assurance processes, such as peer review and cath lab accreditation, to help ensure high-quality, appropriate care. We hope that readers of articles like this one realize that most physicians are not outliers.
Finally, SCAI also recognizes that, as treatment options evolve, there is important work still to be done to ensure these procedures are used for patients who will most benefit. The multi-societal PAD guidelines published in 2005 and updated in 2011, as well as SCAI’s expert consensus documents, have put us on the right path, and we will continue to update our standards of care as the evidence base matures. We will continue to apply the same evidence-based standards to all patients we treat. I look forward to working with all of you in advancing the treatment of patients with PAD.
Reach me at president@SCAI.org.
Charles Chambers, MD, FSCAI
SCAI President, 2014-15