ENDOVASCULAR PROCEDURES FOR LOWER LIMB PERIPHERAL ARTERIAL DISEASE IN AN AMBULATORY UNIT
DOI:
https://doi.org/10.48729/pjctvs.167Abstract
Objectives: To analyse the safety and outcomes of endovascular procedures in an ambulatory practice.
Methods: Data were collected from a cohort of patients admitted in an ambulatory unit for an endovascular procedure for lower limb (LL) arterial occlusive disease during a one year period.
Results: A total of 168 procedures were carried out in 134 patients. Patients’ mean age was 67 (39-91) years and 78% were male. Most patients presented with lower limb ulcer or gangrene (43%) or disabling claudication (40%). Most frequent comorbidities included hypertension (75.4%), dyslipidemia (72.4%) and diabetes mellitus (57.5%). The preferred vascular access for the procedures was the common femoral artery (52%), superficial femoral artery (24%) and humeral artery (21%). Global complication rate was 19% but only one major, non-fatal complication was identified. The most common complication was arterial dissection (8.3%), none compromising blood flow. One-year amputation rate was 6.7%, and one-year mortality was 3.0%. Factors significantly associated with procedure complications were female sex, hypertension and dyslipidemia.
Conclusion: Ambulatory endovascular procedures for PAD are safe and effective in selected patients. Both the low rate and low severity of complications make them an attractive option in the prospect of diminishing the burden of these patients on the health-care system while improving patient comfort.
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References
Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116(9):1509-1526.
Writing Committee Members, Gerhard-Herman MD, Gornik HL, et al. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary. Vasc Med. 2017;22(3):NP1-NP43.
Lin PH, Yang KH, Kollmeyer KR, et al. Treatment outcomes and lessons learned from 5134 cases of outpatient office-based endovascular procedures in a vascular surgical practice. Vascular. 2017;25(2):115-122.
Pineda DM, Calligaro KD, Tyagi S, Troutman DA, Domenico L Jr, Dougherty MJ. Peripheral Arterial Endovascular Procedures Performed in a Non-Hospital-Based Facility by First-Year Vascular Surgery Fellows. Vasc Endovascular Surg. 2019;53(6):441-445.
Society of Interventional Radiology Standards of Practice Committee. Guidelines for Percutaneous Transluminal Angioplasty. J Vasc interv Radiol 2003;14:s209-s217.
Manashil GB, Thunstron BS, Thorpe CD, Lipson SR. Outpatient transluminal angioplasty. Radiology. 1983;147:7–8.
Hong M, Butler K, Fischer T, et al. Trends, charges, and outcomes in endovascular therapy for peripheral arterial disease in Florida. J Vasc Surg. 2010;52(6):1735---6.
Katsuki T, Yamaji K, Tomoi Y, Hiramori S, Soga Y, Ando K. Clinical impact of improvement in the ankle-brachial index after endovascular therapy for peripheral arterial disease. Heart Vessels. 2020 Feb;35(2):177-186. Epub 2019 Aug 23.
Hauguel A, Maurel B, Bague N, et al. Management of ambulatory (day case) endovascular procedures for peripheral arterial disease. J Cardiovasc Surg (Torino). 2017;58(2):293-304.
Hoffer EK, Bloch RD. Percutaneous arterial closure devices. J Vasc Interv Radiol. 2003;14(7):865-885.
Noori VJ, Eldrup-Jørgensen J. A systematic review of vascular closure devices for femoral artery puncture sites. J Vasc Surg. 2018;68(3):887-899.
American Institute of Ultrasound in Medicine. AIUM practice guideline for the use of ultrasound to guide vascular access procedures. J Ultrasound Med 2013;32:191–215
Seto AH, Abu-Fadel MS, Sparling JM, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access with Ultrasound Trial). J Am Coll Cardiol Intv 2010;3:751–8.
Sobolev M, Slovut DP, Lee Chang A, Shiloh AL, Eisen LA. Ultrasound-guided catheterization of the femoral artery: a systematic review and metaanalysis of randomized controlled trials. J Invasive Cardiol 2015;27:318–23.
Alvarez-Tostado JA, Moise MA, Bena JF, et al. The brachial artery: a critical access for endovascular procedures. J Vasc Surg. 2009;49(2):378-385.
Zayed HA, Fassiadis N, Jones KG, et al. Day-case angioplasty in diabetic patients with critical ischemia. Int Angiol. 2008;27(3):232-238.
Ramkumar N, Suckow BD, Brown JR, Sedrakyan A, MacKenzie T, Stone DH, Cronenwett JL, Goodney PP. Role of Sex in Determining Treatment Type for Patients Undergoing Endovascular Lower Extremity Revascularization. J Am Heart Assoc. 2019 Sep 3;8(17):e013088.
Gallagher KA, Meltzer AJ, Ravin RA, Graham A, Connolly P, Escobar G, Shrikhande G, McKinsey JF. Gender differences in outcomes of endovascular treatment of infrainguinal peripheral artery disease. Vasc Endovascular Surg. 2011;45:703–711.
