1. Day case angioplasty in a secondary care setting – initial experience
- Author
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Michelle Stafford, Christian Heiss, James Clark, Charlotte Allan, Ajay Pankhania, A. Rodway, Ben Field, Vasileios Patsiogiannis, Nikolaos Ntagiantas, Thomas Loosemore, Sophie Wilding, and Felipe Pazos Casal
- Subjects
medicine.medical_specialty ,Arterial disease ,medicine.medical_treatment ,Disease ,030204 cardiovascular system & hematology ,Amputation, Surgical ,Secondary Care ,030218 nuclear medicine & medical imaging ,Secondary care ,03 medical and health sciences ,0302 clinical medicine ,Ischemia ,Angioplasty ,Health care ,medicine ,Humans ,Intensive care medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Multi disciplinary ,business.industry ,Critical limb ischaemia ,Middle Aged ,Limb Salvage ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - 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.
- Published
- 2021