By: James Pitt  Aug. 15, 2018
Peripheral artery disease (PAD) is a common condition in which narrowed blood vessels reduce blood flow to the limbs. Calcium buildups on the vessel walls frequently complicate treatment. Rocha-Singh et. al write “The prevalence of VC [vascular calcification] in lower extremity PAD is inadequately defined, but data extrapolated from other vascular beds provide evidence that 30-50% of patients may manifest some degree of VC.”
A variety of atherectomy devices can cut away calcium on vessel walls, but their safety is poorly understood. A recent approach is the Shockwave Medical Lithoplasty System, an endovascular catheter that uses ultrasound pulses to break up calcium deposits. This approach is intended to minimize complications and vessel injury.
The FDA cleared the device for sale under substantial equivalence, and a trial to compare the Lithoplasty System against standard balloon angioplasty is ongoing.
To estimate the burden of complications in PAD, Dexur analysts examined the case mix of peripheral vascular disorders, a slightly broader category, at 77 hospitals in Texas. On average, 30% of patients with peripheral vascular disorders had major complications, 49% had non-major complications, and 21% had no complications.
Fort Worth is a useful representative example:
Peripheral Vascular Disease, Fort Worth Hospitals
Plaza Medical Center | Baylor Scott & White All Saints | Texas Health Harris Methodist | Texas Health Harris Methodist Southwest | |
---|---|---|---|---|
% major complications | 22.10% | 22.80% | 23.60% | 34.10% |
% complications | 51.90% | 64.00% | 51.40% | 46.30% |
% no complications | 26.00% | 13.20% | 25.00% | 19.60% |
In Fort Worth, the highest proportion of PVD discharges with complications was at Plaza Medical Center, where 26% of PVD discharges had no complications. The highest proportion of non-major complications was 64%, at Baylor Scott & White All Saints Medical Center; and the highest proportion of major complications was 34.1%, at Texas Health Harris Methodist Southwest. Therefore, of these Fort Worth hospitals, Texas Health Harris Methodist Southwest and Baylor Scott & White All Saints may have the most demand for a solution that reduces complications in PVD.
For diagnosis-related groups DRG 299, DRG 300, and DRG 301, at the following hospitals:
And
For all hospitals that reported 11 or more Medicare-eligible inpatient discharges in all three PVD DRGs, in the following Texas cities: