Thrombectomy use increasing to treat VTE


The use of arterial and venous thrombectomy to treat blood clots has increased significantly over the past five years, according to research presented November 30 at the RSNA meeting.

Stephanie McNamara, PhD, of Harvard University in Cambridge, MA, presented a study that found procedure rates for venous thromboembolism (VTE) increased by 75% between 2017 and 2022. However, these rates remain low considering the total number of cases per year, McNamara said.

“The incidence of [venous thromboembolism] is expected to grow, creating opportunities to expand the use of these noninvasive procedures,” she noted in a poster presentation.

An estimated one million VTE events occur annually in the U.S., McNamara said. VTE occurs when blood clots form in the veins, usually in the deep veins of the legs, and then break loose. These clots can travel through the bloodstream and lodge in the lungs, causing pulmonary embolism, for instance.

While anticoagulant medications to prevent further clot formation is a primary treatment in nonemergency cases, the use endovascular procedures such as arterial and venous thrombectomy to treat more severe cases has become increasingly common, according to McNamara. These minimally invasive procedures involve inserting a catheter through a vein in the groin. The catheter is guided by x-ray to the site of the clot where it is then removed.

To shed light on current and anticipated claims trends, the researchers searched commercial and Medicare payer data on arterial and venous thrombectomy procedures performed to treat VTE between January 2017 and December 2021. They identified a total of 79,925 claims and calculated a 75% increase in procedures across all payers over the period.

Among the highlights of the findings were the following:

  • There were significantly more venous thrombectomy (VT) claims than arterial thrombectomy (AT) claims (64,258 vs. 15,667) and a greater five-year increase in AT claims compared with VT (5.5-fold vs. 1.8-fold).
  • AT was more often billed through commercial insurers (62.1%) than Medicare (37.9%), with the opposite true of VT (53.2% Medicare and 46.8% commercial).
  • Interventional radiology (IR) performed significantly more AT and VT procedures across all payers from 2017 to 2021 (IR: 46.7%; all cardiology: 23.1%; all surgery: 4.2%; vascular surgery: 25.9%).

“IR performed more AT and VT procedures than any other specialty over this five-year period,” McNamara said.

In addition, The Midwest and Southeast had the highest utilization of AT and VT, regardless of payer, and 61% of AT and 58% of VT procedures were performed in the outpatient hospital setting, according to the findings.

“The use of thrombectomy to treat VTE is growing rapidly. Nonetheless, it remains a small percentage of total VTEs occurring nationally each year,” McNamara concluded.

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