Outcomes of Elective Percutaneous Peripheral Revascularization in Outpatients: 10-Year Single Center Experience

Background: The aging population, along with increased cardiovascular risk factors, has led to an increase in vascular diseases incidence, and subsequently, the need for therapeutic procedures. Today, percutaneous transluminal angioplasty (PTA) and stenting are considered the first-line treatment for a variety of procedures for patients with disabling peripheral arterial disease (PAD). The aim of this study is to evaluate the safety and feasibility of peripheral percutaneous endovascular procedures in a large group of outpatients suffering from PAD. Methods: We evaluated all elective patients who underwent peripheral balloon angioplasty (PTA) or stenting for PAD of the lower extremities as “out-patient admission protocol” (OPAP) from January 2005 to December 2015. By protocol, patients were expected to be discharged 4 h after the procedure. Clinical profile, procedure details, and technical success were reviewed. Complications, conversion rate, readmission rate, and long-term follow-up were evaluated. Results: Four hundred and forty-nine consecutive patients with a mean age of 66 ± 10.1 years (280 men and 169 women) were evaluated. Four hundred and seventeen patients (93%) suffered from claudication. Femoral access was obtained in 96% (6-French sheath in 87%) of patients. PTA alone was performed in 18% and PTA/stents in 82%. Technical success was 98.6%. Over the 8 observed failures, 4 patients had a second successful procedure. Closure devices were used in 52.4% procedures. All patients received heparin during the procedure and were discharged with dual antiplatelet therapy. Conversion and readmission rates were 2% and 0.6%, respectively. Complication rate was 3.6% (minor and major 2.8% and 0.8%, respectively). No correlation was found between complications and closure device usage. Restenosis rate was 24.5% during the long-term follow-up (mean 44 months). Conclusion: As designed, The OPAP was feasible, safe, and effective with very low conversion and complications rates. These results strongly support a larger use of such approaches as routine practice.

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Artikel online veröffentlicht:
11. Mai 2021