Safety and procedural success of daycase-based endovascular procedures in lower extremity arteries of patients with peripheral artery disease: a systematic review and meta-analysis.

Autor:	Hanna L; Department of Surgery and Cancer, Imperial College London, London, UK., Rodway AD; Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK.; Brighton and Sussex University Hospitals NHS Trust, Brighton, UK., Garcha P; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Maynard L; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Sivayogi J; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Schlager O; Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria., Madaric J; Department of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia., Boc V; Clinical Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia., Busch L; Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany., Whyte MB; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Skene SS; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Harris J; School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK., Heiss C; Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK.; Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2024 Sep 05; Vol. 75, pp. 102788. Date of Electronic Publication: 2024 Sep 05 (Print Publication: 2024).
DOI:	10.1016/j.eclinm.2024.102788
Abstrakt:	Background: Timely and economic provision of revascularisation procedures is a major healthcare need. We aimed to examine the safety and efficacy of daycase-based lower extremity endovascular revascularisation procedures in patients with peripheral artery disease. Methods: In this systematic review and meta-analysis, we searched MEDLINE and Embase for studies from Jan 01, 2000 through Apr 01, 2024 reporting complications of lower limb endovascular revascularisation procedures with same-day discharge. Eligibility-criteria, complications, and patient characteristics were extracted, methodological quality assessed (adapted Newcastle-Ottawa Scale), and meta-analyses of complications and technical success performed to provide pooled estimates. This study is registered with PROSPERO, CRD42022316466. Findings: Thirty observational studies (17 retrospective, 13 prospective) and 1 RCT reported 2427 minor and 653 major complications after 99,600 daycase procedures (93,344 patients). Eighteen studies reported daycase eligibility-criteria including 'responsible adult companion' (78%), 'proximity to hospital', and 'telephone availability' and excluding unstable and severe co-morbidities, offset coagulation, and severe chronic kidney disease. Pooled incidences of minor (4.7% [95% CI 3.8-5.6%], I ² = 96%) and major (0.64% [95% CI 0.48-0.79%], I ² = 46%) complications were low and technical success high (93% [95% CI 91-96%], I ² = 97%). Most complications were related to the puncture site. Pooled conversion-to-hospitalisation rates and re-admission after discharge were 1.6% (95% CI 1.1-2.2%, I ² = 82%) and 0.11% (95% CI 0.095-0.23%, I ² = 97%), respectively. Meta-regression identified that minor complications decreased since 2000. Male sex and coronary artery disease were associated with more frequent, and higher age and closure device use with less minor complications. Diabetes mellitus and chronic kidney disease were associated with less major complications. Six studies reported complication rates both in daycases and inpatients and there was no significant difference (-0.8% [95% CI -1.9 to 0.3%]). Interpretation: After careful evaluation of eligibility, lower limb angioplasty can be performed safely with high technical success in a daycase setting. Most complications arise from the puncture site and not the procedure itself highlighting the importance of optimal access site management. The heterogeneity between studies warrants standardised monitoring of complications and outcomes. Funding: European Partnership on Metrology, co-financed from European Union's Horizon Europe Research and Innovation Programme and UK Research and Innovation, and Medical Research Council. Competing Interests: CH, JM and VB are members of the board of the European Society of Vascular Medicine. CH and OS are members of the nucleus of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Disease (CH treasurer and chairperson-elect, OS current chairperson). CH has received research funding from the European Partnership on Metrology, co-financed from European Union’s Horizon Europe Research and Innovation Programme and UK Research and Innovation, and Medical Research Council and honoraria for lectures by Bayer not related to the manuscript. CH declares being a council member and president-elect of Royal Society of Medicine, Vascular Medicine Council. All other authors declare no competing interests. (© 2024 The Author(s).)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu