This limited series supports the suitability, in selected patients, of covering the celiac artery origin for a distal landing zone when the distal sealing zone proximal to the celiac artery is inadequate. We recommend the angiographic evaluation of the collateral circulation between the celiac and superior mesenteric arteries when covering the celiac artery origin is being considered.

A vascular surgery practice can benefit from office-based procedures. Procedures can be done safely. It results in an increase in the number of percutaneous procedures and revenue with a significant savings to the health care system. Surgeons can control their schedule. Every vascular surgeon should consider doing these procedures in office.

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Objective:The Practice of Vascular Surgery is under pressure from various specialties and payers. Our group started office based procedures in May of 2007. The purpose of this paper is to study the impact of this change on our case volume, office revenue and the financial impact on healthcare system.Methods: Between 5/1/06 and 4/30/07 (Period1) and between 6/1/07 and 5/31/08 (Period 2), total of 3041 and 3351 cases were performed respectively. In Period 1 only venous cases could be done in the office. Prior to arteriogram BUN and Creatinine level is obtained. The number of percutaneous cases done in hospital and office setting were analyzed and revenue was calculated based on the 2008 Medicare fee schedule for our region. Thirty day amputation rate and mortality was documented. Hospital DRG payment schedule was obtained.Results: In Period 1, 670 (22% of total) percutaneous procedures were performed as compared to 1502 (44.8%) in Period 2, a two fold increase. In Period1, 1.5% of total cases were done in office as compared to 31% in Period 2. There was a fivefold increase in revenue from these procedures. There was no mortality or amputation as a result of procedures performed in office. There was no anesthesiologist's expense and minimal pre-procedure expense. Total payment by Medicare, DRG payment to hospital plus physician component is higher in all the cases.