Cardiologists self-refer peripheral interventions

Interventional radiologists' procedure volumes in the field of percutaneous peripheral arterial interventions were significantly outpaced by those of cardiologists in the period between 1997 and 2002. Cardiologists' self-referral accounts for their higher volumes of these procedures, according to a study conducted at Thomas Jefferson University.

While radiologists continue to maintain a strong presence in the discipline, they saw their share of the market decline from more than two-thirds in 1997 to less than half in 2002.

Cardiologists increased their share from 25% to 36% during those years, while vascular surgeons claimed 10% of peripheral vascular interventions, up from 4% in 1997.

"The slope of cardiologists' utilization is rising much more rapidly than radiologists'. The biggest reason for this is self-referral," lead author Dr. David Levin told Diagnostic Imaging.

Levin and colleagues examined Medicare Part B databases for CPT-4 surgical procedure codes for percutaneous transluminal angioplasty of noncardiac peripheral arteries, transcatheter placement of noncardiac intravascular stents, and endovascular aortic stent-graft placement. The group presented its findings at the 2004 RSNA meeting.

Total procedure volumes increased by 95%, with radiologists performing more than 72,000 procedures in 2002, cardiologists more than 62,000, and vascular surgeons nearly 18,000. The percentage rate of increase was 29% among radiologists, 181% among cardiologists, and 398% among vascular surgeons.

While total volumes increased for radiologists, cardiologists' proximity to the peripheral vessels during typical procedures and their close relationship with patients who require these types of interventions make the continued erosion of radiology's share inevitable, said Dr. Alan Kaye, chair of radiology at Bridgeport Hospital in Connecticut.

Levin, emeritus radiology chair at Jefferson, summed up the problem succinctly: drive-by angiograms.

"Cardiologists may start out doing a heart catheterization, and while they are putting the catheter up the right iliac artery, they may find a plaque. They pull the catheter out, do a renal angiogram, find a stenosis, and then go ahead and dilate the vessel," he said.

Dilating arteries unnecessarily involves a risk of damaging the artery or of converting a stable atherosclerotic plaque into an unstable lesion.

"Hospital credential committees and administrators should be taking steps to ensure that procedures like these are performed only by the best trained doctors," Levin said.

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Other physicians: 19,666

Radiologists: 72,657

Vascular surgeons: 17,895

Cardiologists: 62,901

Total number of percutaneous transluminal angioplasties of noncardiac peripheral arteries and transcatheter placements of intravascular stents performed in 2002.