Day case angioplasty in a secondary care setting – initial experience

Abstract

Summary: Background: Peripheral artery disease presents an increasing healthcare burden worldwide. Day-case angioplasty in a secondary care setting can be a safe and effective means of meeting the growing demand for lower limb revascularisation. We evaluated the safety and efficacy of a day-case-based angioplasty service in a UK district general hospital. Patients and methods: Consecutive patients undergoing endovascular revascularisation between August 2018–February 2020 were analysed retrospectively. All patients were discussed at a multi-disciplinary (diabetic foot) team meeting following a day case algorithm. Patient and procedural characteristics, technical success, peri-procedural complications, and 30-day outcome of day-case angioplasties were compared with those requiring overnight stay or were hospitalized. Results: Fifty-seven percent of 138 patients were diabetic, mean age 75 ± 12 years, 95% had critical limb ischaemia (Fontaine III 12%, IV 83%), and baseline ankle brachial pressure index [ABPI] 0.40 ± 0.30. Sixty-three patients (45%) were treated as planned day cases, 21 (15%) required overnight admission for social indications. Fifteen (11%) were planned admissions with the need for sequential debridement procedures, and 39 (28%) were already hospitalised at the time of referral to the vascular service. The overall technical success was 92% and not successful procedures mainly occurred in patients > 80 years. The ABPI increased at the initial follow-up to 0.84 ± 0.18. Fifty-three percent required treatment of > 1 level, 80% included recanalisations of chronic total occlusions, and average total lesion length was 133 ± 90 mm. Closure devices were employed in all cases. There were no major peri-procedural complications. A single minor access-site related bleeding episode (0.8%) occurred, requiring 24 h observation in hospital. While significantly more wounds had closed in out-patients, the mortality, major amputation and target lesion revascularization did not differ between groups. Conclusions: Safe and effective day-case-based angioplasty can be provided in a secondary care setting for patients with critical limb ischaemia needing complex multi-level procedures.

Understanding the Impact of COVID-19 on Angioplasty Service and Outcome of Patients Treated for Chronic Limb-Threatening Ischaemia: A Single-Centre Retrospective Cohort Study

“…Potential risk factors for outpatient procedures in CLTI were recently discussed [17]. Our current data support the safety and efficacy of day-case angioplasties [11] even in patients with CLTI [17], as the complication rates were low and technical and clinical success high, with increased ABPI in most patients and high rates of wound healing independent of the COVID-19 period. The complications, 30-day mortality, major amputation and TLR did not differ between day cases and hospitalised patients.…”

“…Day-case-based angioplasty is becoming increasingly common, and we have previously reported our experience and 30-day outcomes [11]. Potential risk factors for outpatient procedures in CLTI were recently discussed [17].…”

“…Our vascular spoke centre specialises in day-case-based revascularisations in CLTI patients as part of a multidisciplinary foot salvage service [11]. Independent of COVID-19, we aimed to follow the PAD quality improvement framework (QIF) guidance for 'nonadmitted' and 'admitted' pathways for CLTI, aiming at revascularisation in less than 14 days or less than 5 days, respectively.…”

Prognostic and predictive value of ultrasound-based estimated ankle brachial pressure index at early follow-up after endovascular revascularization of chronic limb-threatening ischaemia: a prospective, single-centre, service evaluation

“…Earlier data from this programme have been published previously. 14 The hospital is a secondary care district general hospital supported by the vascular hubs at Brighton and Sussex Medical School and St. George's University Hospital NHS Foundation Trust in London with vascular surgeons and interventional radiologists on joint appointments. Clinical outcomes (mortality, major amputations, amputation-free survival [AFS], clinically driven target lesion revascularization [cdTLR], major adverse limb events [MALE; cdTLR, major amputation], wound healing) were assessed over the first year after endovascular revascularisation based on electronic healthcare records.…”