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June 13, 2026 — New research shows that infrainguinal endovascular interventions for peripheral artery disease (PAD) account for the largest cost of vascular surgeries paid within the Department of Veterans Affairs (VA) Community Care program as more Veterans receive vascular surgical care outside the VA system. Researchers presented data from this comprehensive analysis at the Society for Surgery Vascular Annual Meeting (VAM26) in Boston, Massachusetts.
PAD affects more than 200 million people worldwide and can progress to chronic limb-threatening ischemia (CLTI). Patients with PAD and CLTI are often treated with infrainguinal endovascular procedures, minimally invasive interventions used to open blocked or narrowed arteries in the legs. As demand for vascular care has grown, an increasing number of Veterans have received these services through VA Community Care. Since its implementation in 2019, the MISSION Act has expanded access to care outside the VA healthcare system.
The study ("VA Community Care Vascular Surgery Costs are Dominated by Endovascular Interventions for Peripheral Artery Disease") analyzed data from fiscal years 2020 through 2025 using the VA Community Care Referral (CCR) Dashboard and Integrated Informatics and Analytics. Given the growth in vascular surgery care provided outside the VA system, including the use of endovascular atherectomy despite limited comparative data, researchers evaluated the number of referrals, justification for community care, cost, and total payment claims for Vascular Surgery-related Current Procedural Terminology (CPT) codes from all VA centers nationwide.
The analysis found that vascular surgery CCRs nearly tripled from 21,407 to 62,487 during the study period. Distance from a VA facility was the most common reason for referral, accounting for 88% of cases. Femoral-popliteal atherectomy, a minimally invasive procedure to remove plaque from the arteries, was the highest-paid procedure code across nearly all years analyzed, with payments increasing from approximately $4.5 million to $9.9 million. Payments for iliac endovascular interventions, a minimally invasive procedure to treat blockages in the iliac arteries, increased from $1.65 million to $5.6 million, while payments for all infrainguinal endovascular interventions increased from $8.8 million to $40.2 million. Despite national concerns about increased use of atherectomy procedures, due to questions about their effectiveness and cost, the proportion of infrainguinal endovascular charges attributable to atherectomy remained relatively stable, ranging from 60.1% to 67% of total charges. Notably, researchers found that the highest-paid non-endovascular procedure ranked only in the seventh to ninth position among paid codes, and no open bypass or groin-level reconstruction procedures appeared among the top 30 paid codes.
“As access to care outside the VA Community Care continues to expand, it is crucial to know which vascular procedures Veterans are receiving and how resources are being utilized,” said senior author Dr. Gale Tang, Associate Professor of Vascular Surgery at the University of Washington and Section Chief of Vascular Surgery at the VA Puget Sound Health Care System. “These findings underscore the importance of comparative effectiveness research to help physicians make evidence-based treatment decisions.”
Researchers plan to examine regional variation in atherectomy and other endovascular procedure rates within and outside the VA Community Care. They also plan to evaluate the number of procedures performed per patient to improve the quality of care and better inform resource allocation.
May 06, 2026 
