Commentary for CVIR on the Article Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018

Excerpt

First of all, one has to congratulate the authors for their approach to analyze trends and differences of endovascular, surgical and hybrid revascularization approaches and the impact of comorbidity on characteristics, costs and outcome of patients with peripheral artery disease (PAD) of the lower extremity [1]. Especially comparing two different 3-year periods from 2009–2011 and 2016–2018 with a gap of 4 years seems prone for major findings probably highlighting a trend to endovascular procedures. As evidenced by the authors’ findings, it is no wonder that reimbursement costs rose by 28.0% and the share of hospitalizations with any revascularization increased by 8.9%, driven by an increase in two-step (+ 63.3%), hybrid (+ 58.2%) and sole endovascular revascularizations (+ 32.6%), while sole surgical approaches declined (− 18.2%). Taking into account our ageing society with more and more comorbidities of our PAD patients, making endovascular procedures more complex, the most important finding is that hospitalizations with sole endovascular procedures were associated with lower costs, shorter in-hospital stay and lower in-hospital mortality compared to any other revascularization approach. This reflects the impressions of the interventional radiology (IR) community and our daily work in the angio suite. What that means in detail is: endovascular procedures and IR mainly offer and perform some kind of same day surgery, translated in into IR words, same day endovascular procedure and discharge the next day after a successful procedure. Another important finding of Decker’s and previous papers is that as endovascular revascularization procedures are rising, in-hospital mortality and major amputations of the lower extremity are decreasing [1‐3]. …