Safety of day-case endovascular interventions for peripheral arterial disease in a rural, underserved area

Abstract

Background: We aimed to investigate the safety of endovascular procedures undertaken in a single outpatient center located in a rural, underserved area. Endovascular procedures for Peripheral Arterial Disease (PAD) have become increasingly common in outpatient settings; their safety is yet to be determined in a rural, underserved area with no stand-by vascular surgeon on site. Methods: We undertook a retrospective case review of endovascular procedures for the investigation and management of lower extremity PAD between December 2012 and August 2015. Patients were classified by Rutherford score, degree of stenosis and length of lesions. Complications were major (requiring hospitalization) or minor, including perforation, distal embolization, hematoma, and allergic reactions, which could be treated immediately in the catheterization laboratory with no sequelae. Patients were monitored in the facility and followed up using clinical, biochemical and radiological parameters at 24 h and 1 month. Results: A total of 692 patients underwent endovascular procedures for the investigation and/or treatment of PAD, of which 608 were interventional. Of these patients, 10.20% experienced procedural complications, of which 0.66% were classified as major, including wire retention and retroperitoneal hemorrhage. In total, 99.34% were discharged safely on the same day as the procedure. No adverse events were reported at follow up. Conclusion: Endovascular procedures for PAD can be performed safely in a rural outpatient setting with low complication rates. Most complications are minor and do not require hospitalization. Outpatient procedures for PAD are safe and may widen access to specialist procedures in areas of socio-economic deprivation.

Wound Healing on the Cutting Plane of Ankle Bones after Incomplete Revascularization for Chronic Limb-Threatening Ischemia in an Elderly Patient: A Case Report

“…However, 10% of complications occurred, of which 0.66% were classified as major, such as wire retention and retroperitoneal hemorrhage. 7 ) High technical success and a low complication rate are desirable, given that vascular-related complications are associated with a patient’s prognosis.…”

Day case angioplasty in a secondary care setting – initial experience

“…In the United Kingdom, the centralisation of vascular services to tertiary "hubs" [6] necessitates that procedures performed in secondary care have a low complication rate due to surgical "cover" being severely limited. Besides the fact that coronary procedures are routinely performed in secondary care setting without cardiac surgery cover, there are international parallels related to peripheral angioplasties: a recent series from Southern California describes safe provision of angioplasty in a "rural area" predicated upon lack of an on-site vascular surgeon, among other factors [29]. By adopting strict inclusion criteria only one patient in our series required transfer to a tertiary care setting for an extended period of observation, a figure we think acceptable to a central hub providing that cover.…”

Peripheral Arterial Disease Treatment in the Non-Hospital Setting

“…Of 692 endovascular procedures performed, 99.3% of them were able to be discharged from the facility to home. 7…”

“…Additional benefits of a nonhospital setting include providing access to care in underserved communities as well as reducing hospital patient burden, a fact recently highlighted by the global coronavirus pandemic. 7 Physician autonomy and having the ability to make key practice decisions are other frequently cited interests for forming an OBL/ASC.…”