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Abstract
The incidence and prevalence of peripheral vascular disease has been increasing. When coexistent with coronary artery disease (CAD), it has shown to predict higher mortality along with poorer quality-of-life consequently leading to a marked increase in healthcare costs. Broadly, there has been an increase in utilization of endovascular techniques in the management of peripheral vascular diseases. An inverse relation between volume and outcomes has been noted in these procedures. Additionally, improved resource utilization has also been noted with higher hospital and operator volumes. This has led to proposals to regionalize these procedures to high volume hospitals. There have also been calls to introduce the idea of having a set threshold of procedures for providers. This review presents an overview of published literature on the volume–outcome relationship affecting the outcomes of peripheral endovascular procedures.
As the number of centers that offer endovascular options for management of peripheral arterial disease (PAD) continue to expand, it becomes imperative to monitor procedural outcomes in these centers for quality control and best patient care.
One of the important predictors of procedural outcomes has been operator and hospital volume.
In a recently published study, an increasing hospital volume quartile was independently predictive of lower in-hospital mortality as well as lower composite end point of mortality and post-procedural complications following lower extremity endovascular (both angioplasty and stenting) interventions.
IVUS utilization was associated with significantly lower rates of amputation as well as post-procedural complications.
In a contemporary study by Badheka et al., the authors analyzed a total of 13,564 (weighted n = 67,344) CAS procedures from the NIS and demonstrated annual operator volume to be associated with significantly lower rate of mortality and complications.
A higher hospital volume is also associated with improved outcomes following renal artery stenting in terms of lower in-hospital mortality, shorter length of stay as well as lower hospitalization costs.
Given the strong volume–outcome relationship established by a majority of studies for utilization of endovascular technique in peripheral vascular diseases, there have been debates on regionalization of procedures in high-volume centers.
Further studies would be needed to set actual volume thresholds for the various peripheral endovascular procedures.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.