What to Do If Your Doctor Suggests Revascularization

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If you have pain or cramping in your legs from peripheral artery disease (PAD), even after trying drugs and exercise, your doctor may suggest a procedure called revascularization to restore blood flow.

Several types of minimally invasive revascularization techniques can be performed in settings other than hospitals, such as office-based clinics or outpatient facilities.

But some researchers are concerned that the choice of procedure — and subsequent outcome — might sometimes be driven more by Medicare reimbursements than by what’s best for patients.

In June 2017 a study of Medicare patients with PAD, published in the Journal of the American College of Cardiology: Cardiovascular Interventions found that those undergoing revascularizations in office settings had significantly higher rates of repeat procedures than hospital patients.

Office patients were also twice as likely to undergo atherectomy, an approach that restores blood flow by removing plaque from arteries, than two other revascularization techniques, angioplasty and stenting.

Limited evidence supports atherectomy over angioplasty and stenting. But atherectomy offers a higher Medicare reimbursement rate for clinicians and facilities than other revascularization procedures, which might influence procedure choice.

Outpatient procedures were associated with a lower risk of death and leg amputation than hospital-based procedures, perhaps because people with advanced illness likely made up a greater share of inpatient procedures. This could be why the inpatients’ outcomes were poorer than those with less advanced disease.

If your doctor suggests a revascularization approach, ask which procedure he or she recommends and what the other options are. At the same time, ask how long the outcome is expected to last, and what your doctor’s past results have been. Also ask what would happen if you decide not to undergo the procedure.

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