title: Have CT and MR Angiography Replaced Catheter Angiography in Diagnosing Peripheral Arterial Disease?
abstract: OBJECTIVE
  To determine whether MR angiography (MRA) and CT angiography (CTA) have replaced diagnostic catheter angiography (DCA) in diagnosing peripheral arterial disease.
  
  
  METHODS
  Medicare Part B databases for 2002-2013 were reviewed. Current Procedural Terminology codes for extremity MRA, CTA, and DCA were selected. Physician specialty codes were used to classify providers as radiologists, cardiologists, or surgeons. Utilization rates per 100,000 Medicare beneficiaries were calculated.
  
  
  RESULTS
  Among all specialties, the combined utilization rate of all 3 types of angiography increased from 917 per 100,000 in 2002 to 1,261 in 2006 (+38%), after which it remained stable until 2010, and then declined to 1,010 in 2013. The overall rate of MRA and CTA together increased from 89 in 2002 to 440 in 2006 (+394%), after which it leveled off, and then gradually decreased to 331 in 2013. In 2013, 33% of the total procedures were MRA or CTA, up from 10% in 2002. Radiologists performed >85% of MRA and CTA examinations. Among radiologists, the DCA utilization rate decreased by 75% from 2002 to 2013, whereas among cardiologists and surgeons together, the overall DCA utilization rate increased by 64% from 2002 to 2010 before dropping somewhat in 2011.
  
  
  CONCLUSIONS
  Among radiologists, MRA and CTA have replaced DCA in diagnosing peripheral arterial disease. Although overall utilization of DCA has remained steady, it has risen sharply among cardiologists and surgeons, while dropping sharply among radiologists. Given the increased utilization of DCA among cardiologists and surgeons despite noninvasive alternatives, self-referral continues to be of concern in the setting of increasing health care costs.
authors.affiliation: Department of Radiology, Center for Research on Utilization of Imaging Services (CRUISE), Thomas Jefferson University Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: Manisha.Patel.2@jefferson.edu.
authors.forename: Manisha C
authors.initials: MC
authors.lastname: Patel
authors.affiliation: Department of Radiology, Center for Research on Utilization of Imaging Services (CRUISE), Thomas Jefferson University Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; HealthHelp, LLC, Houston, Texas.
authors.forename: David C
authors.initials: DC
authors.lastname: Levin
authors.affiliation: Department of Radiology, Center for Research on Utilization of Imaging Services (CRUISE), Thomas Jefferson University Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
authors.affiliation: Department of Radiology, Center for Research on Utilization of Imaging Services (CRUISE), Thomas Jefferson University Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Rao
mesh_terms: D000792:Angiography / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data*; D006278:Medicare; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review
keywords: CT angiography; MR angiography; Medical economics; peripheral angiography; radiology and radiologists; socioeconomic issues