Maurel Blandine, Paumier Antoine, Jacobi David, Bleuet François, Martinez Robert, Lermusiaux Patrick
Service de Chirurgie Vasculaire, CHRU, Tours, France.
Ann Vasc Surg. 2011 Feb;25(2):191-6. doi: 10.1016/j.avsg.2010.08.007. Epub 2010 Dec 4.
The aim of this study was to evaluate the feasibility of outpatient peripheral angioplasty in patients who were treated for lower limb claudication.
Between February 1 and December 31, 2007, a monocentric observational study was carried out on 98 consecutive patients who presented with claudication (mean age: 63 years [range: 31-90]; 81 men) and were treated by using a percutaneous femoral approach for either iliac (n = 62) or femoropopliteal lesions (n = 36). Exclusion criteria were requiring a renal angioplasty or an associated surgical procedure, having a creatinine clearance value of <30 mL/min/1.73 m(2), body mass index exceeding 35 kg/m(2), and critical ischemia or vascular surgery history at the site of femoral puncture. Treatment involved manual compression and/or use of a closure system, after which the patients were made to wear a compression bandage. After 4 hours, the patients were carefully examined for the presence of a local complication (puncture site), a general complication (thoracic pain), or a complication related to the surgical procedure (early thrombosis). When no complications were detected, the patients were allowed to get up and walk. At the sixth hour, the patients were again examined for the presence of the aforementioned complications. In the absence of any complications, the patients were deemed as "fit to be discharged" and were allowed to stroll about inside the hospital. The following day, a final evaluation was carried out just before their discharge. The risk factors and comorbidities were evaluated.
At the sixth postoperative hour, 78 patients (80%) were deemed as "fit to be discharged." The remaining 20 (20%) were deemed as "unfit to be discharged" because of either a major hematoma (n = 3, including two redo surgeries and a blood transfusion) or a minor evolutive hematoma. All the complications (n = 17) occurred before the fourth postoperative hour. Bilateral femoral puncture was the only risk factor found to be associated with contraindication to being discharged in the evening (OR = 3.8, p = 0.02).
Ambulatory treatment for patients with claudication treated with an endovascular approach was possible because complications that required overnight surveillance always occurred within the first 4 postoperative hours. Bilateral femoral puncture is a potential risk factor for failure of outpatient management.
本研究的目的是评估门诊外周血管成形术在下肢间歇性跛行患者中的可行性。
在2007年2月1日至12月31日期间，对98例连续出现间歇性跛行的患者（平均年龄：63岁[范围：31 - 90岁]；81例男性）进行了一项单中心观察性研究，这些患者采用经皮股动脉途径治疗髂动脉病变（n = 62）或股腘动脉病变（n = 36）。排除标准包括需要进行肾血管成形术或相关外科手术、肌酐清除率<30 mL/min/1.73 m²、体重指数超过35 kg/m²以及股动脉穿刺部位存在严重缺血或血管手术史。治疗包括手动压迫和/或使用闭合系统，之后让患者佩戴压迫绷带。4小时后，仔细检查患者是否存在局部并发症（穿刺部位）、全身并发症（胸痛）或与手术相关的并发症（早期血栓形成）。未检测到并发症时，允许患者起床行走。在第6小时，再次检查患者是否存在上述并发症。若无任何并发症，患者被视为“适合出院”，并允许在医院内走动。次日，在出院前进行最终评估。评估危险因素和合并症。
术后第6小时，78例患者（80%）被视为“适合出院”。其余20例（20%）因出现大血肿（n = 3，包括2例再次手术和1例输血）或小的进展性血肿而被视为“不适合出院”。所有并发症（n = 17）均发生在术后第4小时之前。双侧股动脉穿刺是唯一与夜间出院禁忌相关的危险因素（OR = 3.8，p = 0.02）。
采用血管内治疗方法的间歇性跛行患者进行门诊治疗是可行的，因为需要过夜监测的并发症总是发生在术后最初4小时内。双侧股动脉穿刺是门诊管理失败的潜在危险因素。
