Outcomes of elective peripheral endovascular interventions for peripheral arterial disease performed in hospital outpatient departments, ambulatory surgical centers and office-based labs.

Feb 06, 2023

Experts: C Y Chow,A Mathlouthi,S Zarrintan,E P Swafford,J J Siracuse,M B Malas

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 labs (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 post-procedural outcomes and intraprocedural details between the three settings.
The Vascular Quality Initiative (VQI) database was queried for all elective infrainguinal PVIs for occlusive peripheral arterial disease (PAD) 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. Chi square, ANOVA, and multivariate logistic regression were used to analyze the outcomes.
A total of 66,101 PVI cases (HOPD: 57,062 [83.33%], ASC: 4,591 [6.95%], OBL: 4,448 [6.73%]) were included in the study. Cases requiring hospital admission were (HOPD: 398 [0.70%], ASC: 26 [0.57%], OBL: 21 [0.47%], p=0.126). 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 to ASCs (aOR:3.70, 95% CI:1.70 – 8.03, p=0.001) and significantly lower in ASCs in comparison to HOPDs (aOR: 0.27, 95% CI: 0.18 – 0.41, p<0.001). 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 versus HOPD setting (aOR: 16.79, 95% CI:11.77 – 23.95, p<0.001) and a five-fold increase in the use of atherectomy devices in an ASC versus HOPD setting (aOR: 5.37, 95% CI: 2.47 – 11.65, p<0.001). There was a five-fold decrease in the use of special balloons in an OBL versus HOPD setting (aOR: 0.20, 95% CI: 0.10 – 0.39, p<0.001) and a four-fold decrease when comparing ASCs to HOPDs (aOR: 0.25, 95% CI: 0.12 – 0.51, p<0.001).
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 greater use of atherectomy devices in OBLs and greater use of special balloons in HOPDs. Long-term studies are needed to evaluate durability and reintervention outcomes and understand factors associated with practice pattern variability across these different settings.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

C Y Chow,A Mathlouthi,S Zarrintan,E P Swafford,J J Siracuse,M B Malas

C Y Chow

Division of Vascular and Endovascular Surgery, Department of Surgery, University of Miami, Miami, Florida.

A Mathlouthi

Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California.

S Zarrintan

Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California.

E P Swafford

University of Miami Miller School of Medicine, Miami, Florida.

J J Siracuse

Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston MA.

M B Malas

Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California. Electronic address: mmalas@ucsd.edu.