Disparity in Clinical Presentation and Utilization of Atherectomy for Peripheral Arterial Disease: An Analysis of the OEIS National Registry

Vollständiger Abstract

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Background: Racial and socioeconomic disparities exist in patients with peripheral arterial disease (PAD) and their treatment. We examined factors that may affect utilization of atherectomy in an office-based setting using a national outpatient registry. Methods: Data were analyzed from the Outpatient Endovascular Interventional Society (OEIS) National Registry of 96 participating sites during a 6-year period of adults undergoing lower extremity endovascular procedures. Demographic, socioeconomic, and clinical variables were assessed for the primary outcome of which endovascular modality was utilized. Safety outcomes included technical success and complications. The Social Deprivation Index (SDI) was utilized to quantify socioeconomic status. Multinomial logistic regression was used to evaluate potential associations with endovascular treatment selection. Results: A total of 23 287 patients underwent 33 373 PAD procedures between January 3, 2017, and December 28, 2022. Their mean age was 73 ± 17 years, and 59% were male. They were 72% Caucasian, 15% African American, and 8% Hispanic. The most common indication for intervention was claudication in 52% of the patients, of which 79% were classified as having severe claudication. Endovascular interventions for PAD had a technical success rate of 98% with complications occurring in 1.9% of procedures and 0.8% requiring a hospital transfer. Patients presenting with tissue loss were twice as likely to be treated with atherectomy vs stenting (relative risk ratio [RRR] = 2.169 [95% confidence interval [CI] = 1.185-3.968]). African American patients were more likely to undergo atherectomy vs stenting (RRR = 1.531 [CI = 2.128-1.101]) while Hispanic patients were more likely to undergo balloon angioplasty (RRR = 1.794 [CI = 1.248-2.578]) and stenting (RRR = 1.823 [CI = 1.336-2.487]). Female patients were less likely compared to men to undergo atherectomy vs balloon angioplasty (RRR = 0.793 [CI = 0.631-0.996]) or stenting (RRR = 0.939 [CI = 0.769-1.148]). Greater socioeconomic deprivation was associated with greater utilization of atherectomy vs balloon angioplasty (RRR = 1.010 [CI = 1.017-1.007]) and stenting (RRR = 1.013 [CI = 1.017-1.009]). Conclusions: Outpatient PAD interventions were performed with high technical success and low complication rates. Atherectomy was more frequently used in African Americans and in socioeconomically disadvantaged patients, whereas women were less likely to undergo atherectomy interventions. Clinical Impact Endovascular procedures for peripheral arterial disease performed in office-based laboratories (OBLs) have a high success rate with low complications. Atherectomy procedures are more often performed on patients presenting with more severe disease and having lesions with a greater degree of calcification. Patients undergoing atherectomy are more likely to be African American and come from socioeconomically disadvantaged areas. Women were less likely to have an atherectomy procedure performed. Patients received advanced endovascular procedures for limb-salvage care in the OBL regardless of minority or socioeconomic status.