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OBJECTIVE For same-day discharge lower extremity arterial disease (LEAD) endovascular procedures, femoral manual compression could be an alternative to arterial closure devices. The aim of this study was to assess the security and efficacy of same-day discharge after manual compression in patients treated for LEAD endovascular revascularization with 5F sheath. METHODS FREEDOM OP was a national multicenter, prospective, single arm study. Patients with symptomatic LEAD (Rutherford 2 to 5) and eligible for same-day discharge were included. The primary endpoint was the total in-hospital admission rate, which includes overnight surveillance and rehospitalization rate at 1 month. RESULTS Between September 2017 and August 2019, 114 patients were included. The mean age of the patients was 66 ± 10 years and most of them were claudicant (103; 94%). Mainly femoropopliteal lesions were treated (178; 70%) and the technical success was 97%. One hundred forty two 5F stents and fifty one 5F drug coated balloon were delivered. The mean manual compression duration was 13 ± 4 min. Major access-related complications rate was 4.5%. Total in-hospital admission rate was 11%. Seven patients had overnight surveillance and 5 were rehospitalized (2 for the target lesion). No rehospitalisation was carried out within 24 hours after discharge. No major cardiovascular event, including death, was observed. The patients were significantly improved in term of clinical status (p

Background Ambulatory hospitalization for endovascular repair of lower extremity peripheral arterial disease (PAD) could be a real opportunity to respond to the burden of PAD, to reduce costs, and to improve patients' empowerment. The French Society of Vascular and Endovascular Surgery (SCVE) established guidelines to facilitate the development of ambulatory hospitalization in France. Methods In 2017, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and MEDLINE database to conduct a systematic review of available literature. A total of 448 relevant articles were found. Twelve articles, all published after the year 2000, were included and reviewed by two independent investigators. The SCVE mandated a scientific committee to collectively establish these guidelines. Results Eligibility for ambulatory management shall be based on the assessment of the triad: (1) patient, (2) procedure, and (3) structure. Comprehensive information and a detailed procedural pathway should be provided for the patient. No age limit is recommended. American Society of Anesthesiologists I, II, and III stable patients are eligible for ambulatory intervention. Specific comorbidities such as severe obesity, sleep apnea, and/or chronic kidney failure should be assessed preoperatively. Critical limb ischemia and complex lesions have not been considered as exclusion criteria. Antiplatelet drug use (aspirin and/or clopidogrel) has not been considered as a contraindication. Femoral ultrasound-guided puncture is recommended. Manual compression or closure devices have been recommended for 7F sheath or less. A minimum of 4 hours of monitoring after percutaneous femoral access is required before discharge. Conclusions The SCVE guidelines aim to frame the practice of ambulatory endovascular procedures for lower extremity peripheral artery disease and to give vascular interventionalists help in their routine practice.

Objectifs Le traitement de l’arteriopathie obliterante des membres inferieurs (AOMI) par technique endovasculaire en ambulatoire (HA) est une alternative a l’hospitalisation conventionnelle (HC). Nous rapportons dans ce travail les resultats cliniques en termes de securite et d’efficacite a 30 jours de la comparaison de ces deux prises en charge. Materiels AMBUVASC est une etude prospective, multicentrique controlee et randomisee. Les principaux criteres d’inclusion etaient l’egibilite a l’hospitalisation ambulatoire, l’ischemie d’effort, l’utilisation d’un introducteur de 5 a 7 French inclus, une ponction femorale retrograde. Les ponctions femorales retrogrades, radiales et humerales etaient exclues. Un systeme de fermeture arterielle etait utilise systematiquement dans le groupe HA et selon l’operateur dans le groupe HC. Le critere principal etait le ratio cout-utilite incremental. Les criteres secondaires etaient le deces, les complications ; les reinterventions et d’efficacite (rutherford, IPS). Resultats Cent-soixante patients etaient randomises (80 par groupe). Dans le bras HA, 4 patients changeaient de bras (refus de l’ambulatoire ; contre-indication de l’anesthesiste). En intention de traiter modifiee, 76 etaient analyses dans le bras HA et 77 dans le bras HC. Cent pour cent des patients etaient ASA 1, 2 ou 3 stable ; 95 % des patients etaient claudicants. Un stenting etait realise dans 96 % des cas dans le groupe HA et 86 % des cas dans le groupe HC (p = 0,03). Le succes technique etait de 96 % dans le groupe HA et de 99 % dans le groupe HC (p = 0,37). Quatre-vingt-neuf pour cent des patients en ambulatoire sortaient le soir meme. A 30 jours, on notait un deces dans le groupe HA non lie a l’AOMI. A 30 jours, 3 et 1 reinterventions etaient respectivement realisees dans les groupes HA et HC. Trois reinterventions etaient realisees en raison de complications au niveau de l’artere traitee et 1 complication en raison d’une thrombose au point de ponction. Aucune reintervention pour hemorragie n’etait realisee. Le taux de complications etait similaire entre le bras HA et HC (20 % vs 18 %, p = 0,81). Il n’y avait pas de difference entre les 2 groupes en termes d’amelioration clinique (p = 0,39) et hemodynamique (p = 0,84). Conclusion Le traitement de l’arteriopathie obliterante des membres inferieurs par technique endovasculaire en ambulatoire est sur et efficace.