Practice patterns in utilization of atherectomy and embolic protection devices in inpatient and outpatient treatment settings.

Autor:	Sansosti AA; Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY. Electronic address: aas2350@cumc.columbia.edu., Munoz J; Columbia University Vagelos College of Physicians & Surgeons, New York, NY., Lazar AN; Division of Vascular Surgery, Department of Surgery, New York University Langone Health, New York, NY., Zenilman AL; Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY., Mehta A; Department of General Surgery, Massachusetts General Hospital, Boston, MA., Aljabban I; Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY., Chen P; Division of Vascular Surgery, Cornell University, New York Presbyterian Hospital, New York, NY., Johnson AP; Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC., Siracuse JJ; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA., Patel VI; Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY., Morrissey NJ; Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2024 Dec; Vol. 80 (6), pp. 1806-1812.e4. Date of Electronic Publication: 2024 Jun 27.
DOI:	10.1016/j.jvs.2024.06.164
Abstrakt:	Objective: The frequency of atherectomy in lower extremity arterial disease has increased substantially over the past several years, specifically in the office-based laboratory (OBL) setting, yet the efficacy compared with other interventions and the consequences of distal embolization remain unknown. Embolic protection devices (EPDs) have been used at varying rates depending on physician and practice setting. Previous studies have described lesion characteristics to consider when weighing the benefits and drawbacks associated with device use. Our study focuses on the use of atherectomy and EPDs in femoropopliteal arterial disease to better characterize resource use trends and postoperative outcomes in the inpatient and OBL interventional settings. Methods: We conducted a retrospective analysis on endovascular interventions performed for femoral-popliteal occlusive disease that were entered into the Vascular Quality Initiative data registry between 2017 and 2021. A one:one greedy match, adjusted analysis based on inpatient or OBL location of procedure was used to compare the groups. Hierarchical logistical regression with selective use of principal component analysis was used to further explore the differences in EPD use and immediate postoperative outcomes. A proportional hazard model was used to demonstrate differences in reintervention rates up to 2 years postoperatively between patients who underwent atherectomy in the inpatient vs OBL treatment setting. Results: 2849 matched pairs were inlcuded in the final analysis. In our cohort, there was 22% EPD use overall, 40% in the hospital setting and 4.4% in the OBL setting (P < .001). Among the patients with available follow-up information, OBL intervention setting increased probability of reintervention by 18% at 2 years postoperatively compared with the inpatient setting; however, there was no difference associated with EPD placement and rate of reintervention. Conclusions: Use of EPDs in the OBL setting compared with the hospital setting is dramatically decreased; however, no increased incidence of postoperative complications was seen compared to procedures performed in the hospital setting when controlling for patient and lesion characteristics. Patients with available follow-up data were more likely to undergo ipsilateral reintervention between 6 months and 2 years postoperatively if atherectomy was done in the OBL setting. Dedicated studies are encouraged to ensure patient safety, effective resource allocation, and long-term efficacy of OBL atherectomy as an ever-growing number of peripheral arterial procedures are transitioned to the OBL setting. Competing Interests: Disclosures None. (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu