Day-Case Treatment of Peripheral Arterial Disease: Results from a Multi-Center European Study.

Abstract

The purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease. This was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals. Exclusion criteria were not related to the type of lesion and included unavailability of an adult able to take care of patient overnight; high bleeding risk and ASA score ≥4. Primary efficacy outcome was the rate of procedures performed on an outpatient basis requiring no further hospitalization and primary safety outcome was freedom from 30-day major complications' rate. The study included 652 patients (male 75%; mean age 68±10years; range: 27-93), 24.6% treated for CLI. In 53.3% of the cases a 6Fr sheath was used. Technical success was 97.1%. Haemostasis was obtained by manual compression in 52.4% of the accesses. The primary efficacy outcome occurred in 95.4% (622/652 patients) and primary safety outcome in 98.6% (643/652 patients). Major complications included five (0.7%) retroperitoneal hematomas requiring transfusion; one (0.1%) common femoral artery pseudoaneurysm successfully treated with US-guided thrombin injection, two cases of intra-procedural distal embolization treated with catheter-directed local thrombolysis and one on-table cardiac arrest necessitating >24h recovery. No major complication was noted after same-day discharge. Day-case endovascular procedures for the treatment of IC or CLI can be safely and efficiently performed in experienced IR departments of large tertiary hospitals.