Claims-based market share analysis of endovascular procedures for pulmonary embolism by interventional radiology, cardiology, and vascular surgery

Endovascular therapies continue to evolve as promising treatment options for pulmonary embolism (PE), including thrombectomy and thrombolysis. Multidisciplinary pulmonary embolism response teams coordinate multispecialty expertise and prior survey-based responses demonstrate variable involvement of interventional radiology (IR), vascular surgery, and cardiology, all of whom may perform these procedures. This work aims to characterize the market share of each specialty in PE interventions based on practice patterns in a claims database.

Materials and Methods:

Endovascular PE procedures were identified in a national claims database (Preverity) from 2017 to 2024 using Current Procedural Terminology codes 37184 (thrombectomy) and 37211 (thrombolysis), with ICD-10 code I26 for pulmonary embolism. Physicians were categorized based on self-reported specialties using the Centers for Medicare and Medicaid Services Doctors and Clinicians national dataset. The top 20 US News & World Report Best Hospitals were analyzed as a subgroup of academic medical centers (AMCs).    

Results:

Between 2017 and 2024, 27,182 thrombectomies and 27,254 thrombolysis procedures were identified, with annual growth rates of 56.5% and -7.6%, respectively. Market share of PE thrombectomies performed by IR declined from 63.2% in 2017 to 47.8% in 2024, while cardiology and vascular surgery market share increased to 30.0% and 22.1% respectively in 2024. For thrombolysis procedures, market share by IR declined from 48.5% in 2017 to 26.0% in 2024, while cardiology and vascular surgery market share increased to 44.0% and 33.0% respectively. At AMCs, IR market share for PE thrombectomy declined from 86.8% in 2017 to 37.4% in 2024.

Conclusion:

PE thrombectomies have overtaken thrombolysis as the dominant endovascular therapy for PE. Despite rapid growth in thrombectomy volumes, IR lost market share of PE thrombectomies compared to cardiology and vascular surgery, a trend that is notable in academic medical centers. Continued diligence and involvement in multidisciplinary PE teams may help IR physicians maintain a workforce capable of providing PE thrombectomies.