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Outpatient Endovascular Tibial Artery Intervention in an Office-Based Setting is as Safe and Effective as in a Hospital Setting
Steve M. D'Souza, MS, Sadaf S. Ahanchi, MD, Jean M. Panneton, MD, Christopher L. Stout, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.
OBJECTIVES:
This study seeks to compare outcomes for outpatient tibial artery procedures between an office endovascular center and a hospital angiography suite.
METHODS:
A retrospective review was conducted of all outpatient tibial interventions performed in either the office endovascular center or hospital angiography suite from 2011-2013. Patients who had their procedures done at the hospital while admitted, had planned post-procedure admission, or had a pre-existing infrapopliteal bypass were excluded. Primary outcomes were unplanned admission to the hospital or emergency room, complications, and patency.
RESULTS:
A total of 508 tibial interventions in 384 patients were reviewed to yield 204 outpatient interventions: 100 office and 104 hospital outpatient tibial interventions. The mean age was 72 years, with 48% male. Three risk factors were more prevalent in the hospital group: COPD (21% vs 10%; P=.029), renal insufficiency (45% vs 31%; P=.037), or a previous ipsilateral femoral to popliteal bypass (12% vs 4%; P=.045) compared to the office. No significant difference in mean pre-operative Rutherford score (4.22 vs 4.27; P=.722) was observed.
Of the 100 office procedures, there were 25 percutaneous transluminal angioplasties (PTA), 61 PTA with orbital atherectomy, 13 PTA with laser atherectomy, and 1 PTA with directional atherectomy. Of the 104 hospital procedures, there were 68 PTA, 33 PTA with orbital atherectomy, and 3 PTA with laser atherectomy. No stents. The proportion of atherectomies was higher in the office (75% vs 35%, P<.001). The mean follow-up was 25 months (range 0-52).
30-day morbidity rates (11% vs 17%; P=.336) and mortality rates (1% vs 2%; P=.596) in the office versus hospital setting were not statistically different. Unplanned post-procedural hospital admission rates were lower in the office (2% vs 26%, P<.001).
On Kaplan-Meier analysis at 1 and 2 years, the office group had a trend towards improved primary patency compared to the hospital group (69%, 63% vs 53%, 43%, p=.05), with no difference in primary-assisted patency (90%, 84% vs 89%, 80%, p=.646) or limb salvage (89%,85% vs 83%,81%, p=.476).
CONCLUSIONS:
Efficacy and safety of outpatient endovascular tibial artery interventions are comparable between office and hospital settings. Unplanned admission rates are lower in the office setting and patency rates trended towards better outcomes. The office endovascular center can be a safe alternative to hospital angiography suite.
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