Radiologists remain dominant specialty for key clot-busting procedure, with opportunity for expansion
Radiologists remain the dominant specialty delivering a key clot-busting procedure, with opportunity for expansion.
Between 2017 and 2022, all medical professions saw increases in thrombectomy procedures—a minimally invasive approach to removing blood clots from arteries or veins. Cardiologists recorded the biggest overall uptick in claims at roughly 185%, according to research published Thursday in the Journal of the American College of Radiology.
This likely reflects an increasing number of blood-clot patients being treated by interventional cardiologists and vascular medicine specialists, experts noted.
"Endovascular care is truly a shared space, and it is important to know what specialties are performing these procedures so all key players can be at the table," lead study author Julie C. Bulman, MD, an interventional radiologist with Beth Israel Deaconess Medical Center, Boston, said in a statement, noting this is especially important when it comes to establishing standards, guidelines, or reimbursement rates.
For the analysis, researchers used a 5% representative sample of Medicare claims, pinpointing billing codes related to thrombectomy procedures. Used to treat concerns such as pulmonary embolism and deep vein thrombosis, the approach involves inserting a catheter into the affected blood vessel via imaging guidance. Once inserted, various methods are then deployed to remove the clot and improve blood flow. Newer advances in technologies—such as stent retrievers and aspiration catheters—likely have fueled growth in this space, experts note.
Over a five-year period, thrombectomy claims climbed 38%, with vein-related procedures growing by 137% (or 19% per year), the analysis found. That’s compared to roughly 7% growth for thrombectomy procedures pertaining to the arteries. Radiologists were the dominant specialty for venous thrombectomy during the period, accounting for about 34% of Medicare claims, followed by vascular surgeons (29%) and cardiologists (20%). Meanwhile, vascular surgery led the way in arterial thrombectomy procedures at 41%, followed by cardiology (35%) and radiology (17%).
Cardiologists saw a 19% drop in their share of arterial procedures during the study period, while radiologists’ market share leapt 47%, demonstrating a change in who is performing the service, experts noted. Specific to certain conditions, claims for arterial thrombectomy to treat pulmonary embolism (PE) (clots in arteries of the lung) increased 712% during the study period, while use of venous thrombectomy for deep vein thrombosis (clots in deep veins of the body) climbed 137%.
“The growth of arterial thrombectomy for [pulmonary embolism] is reflective of the fact we now have very safe ways of endovascular treatment for PE that we did not have 10 years ago,” Bulman said in a statement from the Society of Interventional Radiology, which supported the study.
Outpatient facilities continue to account for the most common site of delivery for thrombectomies, at about 77% across both procedure types. Office-based labs are a growing option, but still only account for about 5% of Medicare claims. Meanwhile, most procedures were performed in the Southeast and Midwest regions of the U.S., together representing 62% of arterial and 57% of venous thrombectomies. However, these two geographies have the lowest known concentration of interventional radiologists and vascular surgeons in the country, the authors added.
“This suggests that the availability of vascular specialists does not account for the vast differences in regional thrombectomy practice,” they wrote. “Interestingly, however, prior studies have shown an increased rate of amputation in the southeastern region of the United States, with underutilization of revascularization compared with other regions, suggesting that peripheral arterial disease treatment and possibly [arterial thrombectomy] are still underutilized in these regions.”
Bulman and the Society of Interventional Radiology hope their findings help guide practice development, training, and efforts to address geographic IR care gaps.
"These devices can be expensive, so if you are trying to figure out how to offer this service in your workplace, partnering with other endovascular specialists in your hospital can help advocate for new technologies," Bulman said in the announcement.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.