Yesterday the New York Times (NYT) published an article, ”Medicare Payments Surge for Stents to Unblock Blood Vessels in Limbs.” The article draws attention to the high volume of such procedures performed by a few individuals and should not be construed as implying a systemic problem among the broader community of interventional cardiologists.

The ACC has had clinical guidelines for peripheral artery disease (PAD) since 2006; an update was issued in 2011. The current guideline specifically recommends revascularization with a stent when the patient is at risk for losing a limb or after an exercise program and/or medication have failed to address lifestyle-limiting symptoms.  Smoking cessation and attention to other risk factors for heart disease and stroke are also emphasized.

The College, in partnership with other organizations, is currently in the process of re-updating the PAD guidelines and creating appropriate use criteria to provide additional guidance on specific types of treatments for individual patients. Further, to track the outcomes of patients with PAD undergoing revascularization procedures, the College launched the Peripheral Vascular Interventions Registry in 2014, which will serve as a platform for quality improvement and allow individuals and institutions the ability to compare their outcomes to national standards. As in other areas of cardiovascular medicine and surgery, decision-making will be guided by application of evidence-based guidelines at the point of care while accounting for individual patient preferences and values.

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