Safety and cost savings of endovascular procedures: are outpatient interventions feasible when combined with open surgery?


:As increasing experience and comfort with endovascular interventions performed in an outpatient setting has occurred, the safety and cost effectiveness of performing these procedures without an overnight stay were analyzed, especially when endovascular procedures were combined with open vascular operations requiring an arteriotomy and surgical closure. Ninety patients underwent endovascular procedures alone or concomitantly with open, minor vascular operations to salvage a failing graft between February 1994 and June 1999. Patients undergoing endovascular interventions during primary lower extremity bypass or other major surgical procedures were not included in this review because they were not candidates for outpatient procedures. Balloon angioplasty alone (79) or angioplasty with stent placement (11) was performed to treat stenoses in 50 failing grafts, 16 iliac, 14 femoral, 5 tibial, and 5 axilla/subclavian arteries. A significant increase in outpatient procedures was accomplished as more experience was garnered with these techniques: 19% (8/42) between 1994 and 1996 vs 57% (28/48) between 1997 and 1999 (p = 0.001). Age and comorbidity did not play a role in determining the need for admission because there were no significant differences in patients with diabetes mellitus, hypertension, smoking, or hyperlipidemia and those admitted or discharged the same day (p > 0.05). Patients admitted for overnight observation tended to have longer mean operative times and more complex revascularizations than outpatients (110 vs 69 min, respectively; p < 0.0001). Twenty-seven patients underwent surgical exposure of the access vessel: 63% (17) were admitted and 37% (10) were discharged the same day. Sixty-three patients underwent a percutaneous procedure: 42% (27) were admitted and 58% (37) were discharged the same day. Outpatients were more likely to receive only local anesthesia (83%; 30/35) compared to patients admitted overnight (67%; 36/53); the remaining patients received spinal or epidural anesthesia. Complications included graft thrombosis within 30 days in 6% (5/90) of patients and arterial graft infection in 2% (2). No patient required surgery for bleeding. The average charges for outpatient interventions were $1980 compared to $10,026 for patients who stayed overnight (p < 0.0001). As vascular surgeons become more experienced and comfortable with outpatient endovascular procedures, especially when performed in combination with open minor vascular surgery, significant cost savings can be realized without sacrificing patient safety. Even when open surgical exposure is planned, patients should be instructed preoperatively to anticipate discharge the day of their procedure to minimize resistance to this strategy.


Vasc Endovascular Surg


Lombardi JV,Calligaro KD,Dougherty MJ





Has Abstract


2002-05-01 00:00:00












  • Percutaneous recanalization of the occluded iliac artery: examples, techniques, and complications.

    abstract::Recanalization of an occluded iliac artery represents a technically challenging endovascular technique. Prior to attempting recanalization, the operator must have an approach in mind and understand the risks and complications associated with this endeavor. In this article, the authors provide 2 cases and review the te...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Amankwah KS,Costanza MJ,Gahtan V

    更新日期:2007-10-01 00:00:00

  • A Case of Isolated External Iliac Vein Compression Syndrome and the Role of Advanced Imaging.

    abstract::Isolated external iliac vein compression syndrome is an uncommon cause of nonthrombotic venous stenosis that causes chronic venous hypertension leading to painful swelling, skin discoloration, and ulcer formation. We present a case of an 86-year old man with refractory lower extremity edema for several years who had b...

    journal_title:Vascular and endovascular surgery



    authors: Mukarram O,Dahal K,Azrin M,Lee J

    更新日期:2020-08-01 00:00:00

  • Gender differences in outcomes of endovascular treatment of infrainguinal peripheral artery disease.

    abstract:OBJECTIVE:Our goal was to assess the outcomes of females compared to males treated with endovascular lower extremity interventions in order to determine optimal therapy based on gender. METHODS:We performed a retrospective review evaluating the outcomes of primary transluminal angioplasty (PTA) and PTA + stenting (PTA...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Gallagher KA,Meltzer AJ,Ravin RA,Graham A,Connolly P,Escobar G,Shrikhande G,McKinsey JF

    更新日期:2011-11-01 00:00:00

  • Nicotinamide adenine dinucleotide phosphate oxidase and diabetes: vascular implications.

    abstract::Vascular disease associated with diabetes mellitus is a major cause of morbidity and mortality and is increasing in the United States. It is now recognized that oxidative stress plays a substantial role in the underlying vascular pathology of several diseases, including hypertension and diabetes. In diabetes, there is...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章,评审


    authors: Maier KG

    更新日期:2008-08-01 00:00:00

  • Endovascular Management of External Iliac Blowout Syndrome Secondary to Recurrent Sigmoid Cancer.

    abstract::Blowout syndrome caused by vascular invasion is a dreadful complication of late stage malignancies that carry high morbidity and poor overall prognosis in a compromised population. Endovascular management can offer minimally invasive and life-saving alternative for such acute conditions. We describe the case of a 62-y...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Abdelsalam H,Elmokadem AH

    更新日期:2019-08-01 00:00:00

  • Endovascular repair of traumatic descending thoracic aortic disruptions: should endovascular therapy become the gold standard?

    abstract::Acute arterial disruptions of the thoracic aorta are rare and often lethal. They are most often due to blunt trauma and occur most commonly just distal to the left subclavian artery origin in the setting of multisystem injuries. The very proximal nature of the lesion in survivors makes open surgical repair hazardous, ...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Uzieblo M,Sanchez LA,Rubin BG,Choi ET,Geraghty PJ,Flye MW,Curci JA,Moon MR,Sicard GA

    更新日期:2004-07-01 00:00:00

  • Endovenous laser treatment of saphenous vein reflux: how much energy do we need to prevent recanalizations?

    abstract::The aim of this study was to report the results of high-energy endovenous laser treatment to measure the relationship between the fluence and the outcome in terms of recanalization. In 97 patients, 129 great saphenous veins were treated with endovenous laser treatment, using a 980-nm diode laser. Follow-up visits were...

    journal_title:Vascular and endovascular surgery

    pub_type: 临床试验,杂志文章


    authors: Vuylsteke M,Liekens K,Moons P,Mordon S

    更新日期:2008-04-01 00:00:00

  • Embolization of bleeding duodenal ulcer using Amplatzer vascular plug II and hydrogel coils: case report.

    abstract:PURPOSE:To present a case of upper gastrointestinal bleeding (UGIB) that was treated with percutaneous endovascular embolization using Amplatzer vascular plug and hydrogel coils after failed endoscopic treatment. CASE REPORT:A 78-year-old male was referred for endovascular treatment of massive recurrent UGIB from a du...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Abdel-Aal AK,Osman S,Hamed MF,Saddekni S,Saad WE

    更新日期:2011-04-01 00:00:00

  • External iliac artery stenting: high incidence of concomitant revascularization procedures.

    abstract:OBJECTIVES:To review immediate results, patency rates, hemodynamic success, and incidence of concomitant procedures with external iliac artery stenting (EIAS). METHODS:Demographic features, category and clinical grade, Trans-Atlantic Inter-Society Consensus II classification lesion type, pre- and postprocedure ankle-b...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Smith VL,Peterson L,Starr JE,Satiani B

    更新日期:2012-04-01 00:00:00

  • Case study: chronic femoropopliteal prosthetic graft infection with exposed graft.

    abstract::One of the most feared complications following vascular reconstruction is infection due to the attendant risks of limb loss, sepsis, or death. The reported incidence of infection following infrainguinal prosthetic graft infection is 2.5% with associated mortality rates and amputation rates of 18% and 41%, respectively...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: McCready RA,Bryant MA,Divelbiss J,Wack MF,Mattison HR

    更新日期:2009-06-01 00:00:00

  • Arterial pressure gradient of upper extremity arteriovenous access steal syndrome: treatment implications.

    abstract:PURPOSE:Treatment options after arteriovenous fistula (AVF) associated steal include ligation, banding, and distal revascularization-interval ligation (DRIL). The purpose of this study was to evaluate the arterial pressure gradients in upper extremity steal syndrome. METHODS:Preoperative arteriography and sequential i...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Reifsnyder T,Arnaoutakis GJ

    更新日期:2010-11-01 00:00:00

  • Unusual arterial pattern of the gastrointestinal tract: inferior mesenteric artery arising from the iliac artery and corkscrew external iliac.

    abstract::Anatomical variations of the digestive system arteries are important due to their clinical significance. However, anomalies in the inferior mesenteric artery (IMA) are the least common compared with the celiac trunk and superior mesenteric artery. This report describes the case of a 67-year-old man with an extremely r...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Nassar L,Atweh LA,Jurjus A,Al Kutoubi A

    更新日期:2012-07-01 00:00:00

  • Ruptured hypogastric artery aneurysms: a contemporary review.

    abstract::The ruptured hypogastric artery aneurysm (RHAA) is a rare clinical entity with an evolving and dynamic therapeutic armamentarium. The anatomical location and varied clinical presentation can pose a challenge for successful repair. Recently, endovascular and hybrid operative repairs have significantly improved the hist...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章,评审


    authors: Morris ME,Huber KM,Maijub JG

    更新日期:2013-04-01 00:00:00

  • Posterior nutcracker syndrome.

    abstract::Renal vein compression syndromes are rare causes of hematuria and can be divided into anterior and posterior nutcracker syndrome. When the left renal vein is compressed between the aorta and the superior mesenteric artery it causes anterior nutcracker syndrome. The posterior nutcracker syndrome is very rare and is con...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Skeik N,Gloviczki P,Macedo TA

    更新日期:2011-11-01 00:00:00

  • Extracranial internal carotid artery mycotic aneurysm: case report and review.

    abstract::Mycotic aneurysms of the internal carotid artery (ICA) are rare and often difficult to diagnose. They can have nonspecific signs and symptoms, an unclear etiology, and can lead to severe morbidity and mortality if left untreated. We present a case of a 47-year-old woman with an apparent mycotic aneurysm of the extracr...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章,评审


    authors: O'Connell JB,Darcy S,Reil T

    更新日期:2009-08-01 00:00:00

  • Endovascular repair of a penetrating thoracic aortic ulcer presenting with left recurrent laryngeal nerve palsy.

    abstract::Endovascular repair offers minimally invasive management of otherwise complex thoracic aneurysms. Here, a case is reported of a 74-year-old man, a known hypertensive and ex-smoker, who underwent fiberoptic bronchoscopy for gradually progressing intermittent hoarseness of voice, which revealed incomplete left vocal cor...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Sadat U,Titchner A,Noor N,Naik J,Boyle JR

    更新日期:2007-12-01 00:00:00

  • Near-infrared spectroscopy assessment following exercise training in patients with intermittent claudication and in untrained healthy participants.

    abstract::Selected near-infrared spectroscopy (NIRS) parameters were assessed in healthy untrained participants and in peripheral arterial disease (PAD) trained patients to evaluate their usefulness in rehabilitative outcome. Forty-five PAD and 15 healthy participants were studied at entry and at 34 ± 2 weeks. Healthy participa...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Manfredini F,Malagoni AM,Mandini S,Felisatti M,Mascoli F,Basaglia N,Manfredini R,Mikhailidis DP,Zamboni P

    更新日期:2012-05-01 00:00:00

  • Surgical femorocaval bypass for recalcitrant iliofemoral venous occlusion to endovascular treatment.

    abstract::Patients with chronic occlusion of iliac veins may present with symptoms ranging from mild discomfort to severe disability, including limb swelling, venous claudication, and ulceration. Endovascular treatment has emerged as first line of interventional therapy. Surgical venous-venous bypasses for the management of the...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Adams MK,Anaya-Ayala JE,Ismail N,Peden EK

    更新日期:2012-10-01 00:00:00

  • Endovascular Coil Migration Into the Intestinal Lumen: Two Cases of Successful Nonoperative Management.

    abstract::Endovascular embolization of visceral arteries is commonly performed as treatment for aneurysms, pseudoaneurysms, and emboloradiation of liver tumors; while considered relatively safe, it is not without complications. We are reporting 2 cases of coil migration into the gastrointestinal tract. Patients were successfull...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: French B,Hayes D

    更新日期:2019-02-01 00:00:00

  • Safety and Efficacy of Arterial Closure Devices Following Antegrade Femoral Access: A Case-Control Study.

    abstract:PURPOSE:Vascular closure device (VCD) use following antegrade femoral access may present unique challenges relative to retrograde access. We retrospectively compared safety and efficacy of these devices between antegrade and retrograde patient cohorts undergoing percutaneous intervention. MATERIALS AND METHODS:Over a ...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Barrette LX,Vance AZ,Mantell MP,Kratz KM,Redmond JW,Clark TWI

    更新日期:2020-10-01 00:00:00

  • The diagnosis and management of aortic dissection.

    abstract::Aortic dissection represents the most common aortic emergency, affecting 3 to 4 per 100,000 people per year and is still associated with a high mortality. Twenty percent of the patients with aortic dissection die before reaching hospital and 30% die during hospital admission. Aortic dissections may be classified in 3 ...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章,评审


    authors: Karthikesalingam A,Holt PJ,Hinchliffe RJ,Thompson MM,Loftus IM

    更新日期:2010-04-01 00:00:00

  • Protective effects of ginaton on vascular endothelial cells injured by angiotensin II and hypoxia in vitro.

    abstract::The objective of this study was to explore the protective effect and possible mechanism of Ginkgo biloba extract (Ginaton) on human vascular endothelial cells (VECs) injured by angiotensin II (Ang-II) and hypoxia. The human aortic VECs were divided into different groups to observe the changes in endothelin (ET), intra...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Han L,Li M

    更新日期:2013-07-01 00:00:00

  • Safety and efficacy of carotid angioplasty/stenting in 100 consecutive high surgical risk patients: immediate and long-term follow-up.

    abstract:BACKGROUND/PURPOSE:This study analyzes the safety and efficacy of carotid angioplasty/stenting (CAS) with embolic protection devices in high surgical risk (HSR) patients. PATIENT POPULATION/METHODS: This study includes 100 consecutive HSR patients, who were followed prospectively, and had carotid duplex ultrasounds at ...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: AbuRahma AF,Bates MC,Eads K,Armistead L,Flaherty SK

    更新日期:2008-10-01 00:00:00

  • Successful extra-anatomical recanalization of occluded superficial femoral arteries using the Outback device--a report of 2 cases.

    abstract:INTRODUCTION:We report 2 cases where the Outback catheter facilitated extra-anatomical bypass after vessel perforation during attempted subintimal vessel dissection. REPORT:Attempted subintimal angioplasty of the superficial femoral artery (SFA) resulted in vessel perforation in 2 patients with chronic SFA occlusion a...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Kirk J,Wilson R,Kovacs F,Tennant W,Braithwaite B,Habib S

    更新日期:2012-01-01 00:00:00

  • Endovascular Treatment of Complex Carotid-Jugular Fistula.

    abstract::Inadvertent complications of jugular vein catheterization are not uncommon, however, a persistent symptomatic carotid-jugular fistula has been rarely reported. A 72-year-old male with infected surgical wound after coxofemoral disarticulation for sarcoma presented with symptoms of acute right heart failure. A fistula b...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Alonso-Argüeso G,Rodriguez-Morata A,Vera-Arroyo B,Lara-Villoslada MJ,Gomez-Medialdea R

    更新日期:2016-11-01 00:00:00

  • Lower extremity amputations: factors associated with mortality or contralateral amputation.

    abstract:BACKGROUND:Tissue loss or gangrene in the setting of lower extremity peripheral artery disease (PAD) may result in amputation. Previous studies have demonstrated elevated mortality rates after major transtibial and transfemoral amputation. Also, amputation of 1 leg may be associated with subsequent major amputation of ...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Shah SK,Bena JF,Allemang MT,Kelso R,Clair DG,Vargas L,Kashyap VS

    更新日期:2013-11-01 00:00:00

  • The use of covered nitinol stents to salvage dialysis grafts after multiple failures.

    abstract::The increasing number of patients requiring hemodialysis and the limited number of access sites have resulted in an increase in multiple graft revisions to maintain access for hemodialysis. Venous outflow or anastomotic stenoses in vascular grafts tend to recur and contribute to the difficulty in maintaining a functio...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Naoum JJ,Irwin C,Hunter GC

    更新日期:2006-08-01 00:00:00

  • Imaging Obtained Up To 12 Months Preoperatively Is Adequate for Planning Fenestrated/Branched Endovascular Aortic Aneurysm Repair.

    abstract:OBJECTIVES:Patients referred for fenestrated/branched endovascular aortic repair (F/BEVAR) often present with a previous computed tomography angiogram (CTA), but it is unknown how recent the CTA must be to ensure accurate F/BEVAR planning. We sought to determine whether anatomic planning parameters change significantly...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Nguyen TT,Simons JP,Podder S,Crawford AS,Judelson DR,Arous EJ,Aiello FA,Schanzer A

    更新日期:2019-10-01 00:00:00

  • Endovascular repair of early rupture of Dacron aortic graft--two case reports.

    abstract::Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increas...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章


    authors: Sultan S,Heskin L,Oaikhinan K,Hynes N,Akhter Y,Courtney D

    更新日期:2005-03-01 00:00:00

  • Endovascular management of hoarseness due to a thoracic aneurysm: case report and review of the literature.

    abstract::Although uncommon, hoarseness can be a presenting symptom of a thoracic aneurysm. We present a case of a 67-year-old man with hoarseness, subsequently found to have left vocal paralysis. On workup, a computed tomography scan demonstrated a saccular thoracic aneurysm compressing the recurrent laryngeal nerve at the aor...

    journal_title:Vascular and endovascular surgery

    pub_type: 杂志文章,评审


    authors: Lew WK,Patel K,Haqqani OP,Weaver FA

    更新日期:2009-04-01 00:00:00