Surrey and Sussex Healthcare NHS Trust, Redhill, UK.
Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Vasa. 2021 Apr;50(3):202-208. doi: 10.1024/0301-1526/a000942. Epub 2021 Feb 18.
: 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. : 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. : 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. : 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.
外周动脉疾病在全球范围内带来了日益增长的医疗负担。在二级保健机构中进行日间血管成形术是满足下肢血运重建需求的一种安全有效的方法。我们评估了在英国地区综合医院中基于日间病例的血管成形术服务的安全性和有效性。
连续 138 例患者于 2018 年 8 月至 2020 年 2 月期间行血管腔内血运重建，对其进行回顾性分析。所有患者均在遵循日间病例算法的多学科（糖尿病足）团队会议上进行讨论。比较了日间血管成形术患者和需要过夜或住院的患者的患者和手术特点、技术成功率、围手术期并发症和 30 天结果。
138 例患者中 57%为糖尿病患者，平均年龄为 75±12 岁，95%为严重肢体缺血（Fontaine III 12%，IV 83%），基线踝肱指数[ABI]为 0.40±0.30。63 例（45%）患者按计划行日间病例治疗，21 例（15%）因社会原因需要过夜入院。15 例（11%）计划入院行序贯清创术，39 例（28%）在转诊至血管科时已住院。总体技术成功率为 92%，未成功的手术主要发生在>80 岁的患者中。ABI 在初始随访时增加到 0.84±0.18。53%的患者需要治疗>1 个部位，80%的患者包括慢性完全闭塞的再通，平均总病变长度为 133±90mm。所有病例均使用闭合装置。无重大围手术期并发症。仅发生 1 例轻微的入路相关出血事件（0.8%），需在医院观察 24 小时。虽然门诊患者的伤口愈合明显更多，但两组间死亡率、主要截肢和靶病变血运重建无差异。
在二级保健机构中，为严重肢体缺血需要复杂多水平手术的患者提供安全有效的基于日间病例的血管成形术是可行的。
