Back to 2015 Annual Symposium Program
Changing Practice pattern for arterial intervention: Growth and safety of office based procedures
Krishna jain, MD, John Munn, MD, Mark Rummel, Dan Johnston, Syed Alam, Chris Longton, RN.
advanced vasular surgery, kalamazoo, MI, USA.
Introduction
Traditionally, peripheral arteriograms and subsequent interventions if needed were carried out in a hospital and many patients stay overnight. With increasing frequency there is a movement towards managing these patients in the office. We have been performing percutaneous arterial procedures in the office since 2007. We wanted to analyze practice pattern between hospital and the office by our group .We also hypothesized that it is safe to do these procedures in office.
Material and methods
Peripheral arterial procedure carried out in the office and the hospital between May 22, 2007 and July 31, 2014 were reviewed. Number and type of procedures in the 2 settings were identified. Office patients were divided in two groups. Group 1 had arteriogram only; Group 2 had arteriogram and intervention. Use of heparin during procedure, use of closure devise, and size of sheath were recorded. In patients who had a complication, indication for the procedure, type of complication and management were recorded. Thirty day mortality and limb loss were recorded.
Results.
During this period 1077 procedures were carried out in hospital as compared to 1290 in the office. Prior to then no cases were done in the office. In office procedures combined complication rate was 17/1290 (1.3%). Complication rate in group 1 was 4/697(0.6%) and in group 2 it was 13/593 (2.2%) not statistically significant p=0.125. In both groups combined 10 patients needed operative intervention: repair of artery 6, revision of bypass 2, embolectomy 1, and thrombin injection in pseudo aneurysm 1. Seven patients not needing an operation had retroperitoneal hematoma 6, cellulitis 1. Indications in patients who had complication were Claudication 11, stenosis of previous bypass 5, and rest pain 1. There was one death after brachial artery angioplasty because of multisystem failure. In 6/17 patients a closure devise was used. Only patients in group 2 were heparinized. Commonest sheath used was 6 Fr (6), 5Fr (4), 4 Fr (3), 7 Fr (1). There was no limb loss.
Conclusion
More than half of all percutaneous interventions can be shifted to the office with satisfactory safety. With the growing concept of “endovascular first” more cases may migrate to the office. This may result in decreased health care costs and better use of strained hospital resources.
Back to 2015 Annual Symposium Program
|
