Vascular surgeons have the highest market share and the lowest overall mortality and morbidity rates for peripheral arterial interventions (PAI), when compared to interventional cardiologists and interventional radiologists who also perform this procedure. Mohammad H. Eslami, MD, FACS, associate professor of vascular surgery at the University of Massachusetts Medical School in Worcester and his colleagues findings reported in the Nov. 2009 issue of the Journal of Vascular Surgery®, published by the Society for Vascular Surgery®.
"With all three specialties involved in PAI procedures, there has been a significant increase of PAI which in certain locations has led to significant 'turf wars' as to who should perform them and who should not," said Dr. Eslami.
"Using the Nationwide Inpatient Sample our research team reviewed 23,825 PAI cases (about 75 percent of the providers' specialties) from 1998 to 2005," add Dr. Eslami. "We found the market share for vascular surgeons increased from 27 percent to 43 percent, while the cardiologists' share rose from 10 to 29 percent. The radiologists, who previously almost exclusively used endovascular methods to treat patients with peripheral arterial disease (PAD), had their share decrease from 36 percent to 6 percent. A yearly percentage of unidentified providers remained relatively stable with a median value of 22 percent, and did not affect the market share trends."
The majority of all PAI procedures (52.3 percent) were performed at teaching hospitals, where trends were even more pronounced, showing that market shares for vascular surgeons and interventional cardiologist were higher, compared to the radiologists' share which again reflected a decline. In these settings the vascular surgeons' market share even had a more robust rise during the study period (18 percent to 48 percent).
Researchers noted that in-hospital mortality rates were highest for radiologists 2.1 percent vs. 1.2 percent for vascular surgeons and 0.6 percent for interventional cardiologists. When combing the overall post-procedure iatrogenic arterial injuries (IAI) and mortality, the vascular surgeon group was the lowest at 1.7 percent. The radiologists had 3.00 percent; cardiologists were at 3.04 percent. Compared with vascular surgeons, the mortality rate odds ratio was 1.62 times higher for the radiologist group's patients.