Division of Vascular and Endovascular Surgery, Department of Surgery, University of Miami, Miami, FL.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, CA.
J Vasc Surg. 2023 Jun;77(6):1732-1740. doi: 10.1016/j.jvs.2023.01.191. Epub 2023 Feb 3.
A recent shift in the location where peripheral endovascular interventions (PVI) are performed has occurred, from traditional settings such as hospital outpatient departments (HOPD), to ambulatory surgical centers (ASC) and outpatient-based laboratories (OBL). Different settings may influence the safety and efficacy of the PVI, as well as how it is done. This study aims to compare the postprocedural outcomes and intraprocedural details between the three settings.
The Vascular Quality Initiative database was queried for all elective infrainguinal PVIs for occlusive peripheral arterial disease between January 2016 and December 2021. The primary outcomes were rates of postprocedural hospital admissions, postprocedural medical complications, and access site complications. Secondary outcomes included technical success and intraprocedural details, such as types and number of devices used, amount of contrast, and fluoroscopy time. The χ test, analysis of variance, and multivariate logistic regression were used to analyze the outcomes.
A total of 66,101 PVI cases (HOPD, 57,062 [83.33%]; ASC, 4591 [6.95%]; OBL, 4448 [6.73%]) were included in the study. There were 445 cases requiring hospital admission (HOPD, 398 [0.70%]; ASC, 26 [0.57%]; OBL, 21 [0.47%]; P = .126). There were no significant differences in cardiac, pulmonary, or renal complications. Access site complications occurred in less than 1.7% of all cases and were significantly higher in OBLs when compared with ASCs (adjusted odds ratio [aOR], 3.70; 95% confidence interval [CI], 1.70-8.03; P = .001) and significantly lower in ASCs in comparison to HOPDs (aOR, 0.27; 95% CI, 0.18-0.41; P < .001). Technical success occurred in at least 92% of all cases, regardless of setting. There was a 16-fold increase in the use of atherectomy devices in an OBL vs HOPD setting (aOR, 16.79; 95% CI, 11.77-23.95; P < .001) and a five-fold increase in the use of atherectomy devices in an ASC vs HOPD setting (aOR, 5.37; 95% CI, 2.47-11.65; P < .001). There was a five-fold decrease in the use of special balloons in an OBL vs HOPD setting (aOR, 0.20; 95% CI, 0.10-0.39; P < .001) and a four-fold decrease when comparing ASCs with HOPDs (aOR, 0.25; 95% CI, 0.12-0.51; P < .001).
Elective PVIs performed in any outpatient setting proved to be safe and technically successful. However, there are significant differences in the way PVIs are performed in each setting, such as the greater use of atherectomy devices in OBLs and greater use of special balloons in HOPDs. Long-term studies are needed to evaluate the durability and reintervention outcomes and understand factors associated with practice pattern variability across these different settings.
外周血管腔内介入治疗（PVI）的实施地点最近发生了变化，从传统的医院门诊部门（HOPD）转移到了门诊手术中心（ASC）和门诊实验室（OBL）。不同的设置可能会影响 PVI 的安全性和疗效，以及操作方式。本研究旨在比较这三种设置下的术后结果和术中细节。
从 2016 年 1 月至 2021 年 12 月，使用血管质量倡议数据库对所有择期下肢 PVI 闭塞性外周动脉疾病进行了检索。主要结局为术后住院率、术后医疗并发症和入路并发症。次要结局包括技术成功率和术中细节，如使用的设备类型和数量、造影剂用量和透视时间。采用卡方检验、方差分析和多变量逻辑回归分析结果。
共纳入 66101 例 PVI 病例（HOPD，57062[83.33%]；ASC，4591[6.95%]；OBL，4448[6.73%]）。有 445 例需要住院治疗（HOPD，398[0.70%]；ASC，26[0.57%]；OBL，21[0.47%]；P=0.126）。心脏、肺部或肾脏并发症无显著差异。入路并发症发生率低于所有病例的 1.7%，与 ASC 相比，OBL 显著更高（调整后优势比[aOR]，3.70；95%置信区间[CI]，1.70-8.03；P=0.001），与 HOPD 相比，ASC 显著更低（aOR，0.27；95%CI，0.18-0.41；P<0.001）。所有病例的技术成功率均至少为 92%。与 HOPD 相比，OBL 中使用旋切设备的比例增加了 16 倍（aOR，16.79；95%CI，11.77-23.95；P<0.001），ASC 中使用旋切设备的比例增加了 5 倍（aOR，5.37；95%CI，2.47-11.65；P<0.001）。与 HOPD 相比，OBL 中使用特殊球囊的比例下降了 5 倍（aOR，0.20；95%CI，0.10-0.39；P<0.001），与 HOPD 相比，ASC 中使用特殊球囊的比例下降了 4 倍（aOR，0.25；95%CI，0.12-0.51；P<0.001）。
在外周血管腔内介入治疗的任何门诊环境中，该治疗方法都被证明是安全且技术上成功的。然而，在每种设置下，PVI 的操作方式存在显著差异，如 OBL 中旋切设备的使用更多，HOPD 中特殊球囊的使用更多。需要进行长期研究来评估耐久性和再干预结果，并了解这些不同环境下的实践模式差异相关因素。
