Retrograde iliofemoral endarterectomy facilitated by balloon angioplasty is a safe, easy-to-perform, and viable option for patients with combined external iliac artery and common femoral artery occlusive disease. Midterm results (36.4 months) are favorable, and most hemodynamic failures are easy to correct with standard endovascular techniques.
Purpose: To evaluate the feasibility and safety of outpatient percutaneous endovascular intervention in the treatment of arterial occlusive disease. Methods: The records of 134 patients who underwent 151 outpatient endovascular procedures between 1992 and 1997 were reviewed retrospectively. According to established protocol, focal lower limb (n = 145) and subclavian (n = 6) arterial lesions requiring relatively straightforward endoluminal interventions were appropriate for outpatient management provided the patients were free of significant comorbidities. A percutaneous transfemoral approach was used for lower limb lesions, while subclavian angioplasty was performed via a brachial access. Heparin anticoagulation was administered conservatively. Patients were discharged 3 hours after sheath removal. Results: The majority (98%) of patients were discharged as planned. Three (2%) patients were observed overnight in the hospital for treatment of acute iliac artery thrombosis, puncture-site bleeding, and suboptimal angioplasty. No patient required hospitalization following discharge. Periprocedural morbidity Was confined to 2 (1.5%) groin hematomas and 1 (0.7%) femoral pseudoaneurysm. Conclusions: Outpatient endovascular intervention appears safe; however, proper case selection and technical excellence are inseparable components for the success of this strategy.
From July 1988 through December 1988 laser "hot tip" angioplasties coupled with balloon dilations were performed on 95 patients at the Union Memorial and University of Maryland hospitals. The patients ranged in age from 42 to 84 years (mean, 66.4 years), and there were 61 men and 34 women in the study. Indications for the procedure included claudication in 70 (74%) and severe ischemia in 25 (26%). Noninvasive studies were performed on all patients before and after the procedure. One hundred seventeen segments were treated in 28 iliac arteries and 89 superficial femoral/popliteal arteries. No tibial arteries were treated. Fifty-two stenoses and 65 occlusions occurred. The procedures were performed percutaneously in 52 patients (55%), and open surgical technique was used in 43 patients (45%). Nine immediate failures (9.5%) and 86 successes (90.5%) were noted within 24 hours of the procedure. Follow-up ranged from 1 to 6 months with a mean of 3.2 months. Late failures within this time period occurred in 21 patients (22%). The total failure rate was 30/95 or 31.5%. Only one of the patients was made worse by a failed laser-assisted balloon angioplasty. Immediate complications consisted of formation of subcutaneous hematoma in 20 of the 52 patients having percutaneous procedures (38%) and healing difficulty in 3 of the 43 patients having open surgical procedures (7%). Hospital stay was usually 1 day longer in the latter group. No patient required surgical intervention for bleeding as a result of a vessel perforation. However, this phenomenon was noted during the course of three superficial femoral artery laser-assisted balloon angioplasties.(ABSTRACT TRUNCATED AT 250 WORDS)
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