Remaining gaps and obstacles in the outpatient setting for peripheral artery disease endovascular revascularization: Lessons learned from the French experience

Abstract

Introduction:

The transition to an outpatient setting for endovascular treatment of lower-limb peripheral artery disease (PAD) remains slow, and obstacles persist. The aim of this study was to identify the obstacles to its development, according to vascular interventionalists.

Methods:

Between September 2022 and October 2023, all French vascular interventionalists, who were members of the participating societies, were asked to answer an online questionnaire on their outpatient setting practice for PAD endovascular treatment. The questionnaire explored patient selection criteria (medical and social), treatments, follow up, and potential obstacles.

Results:

Of the 279 respondents (43%), 228 (82%) were currently performing endovascular treatment of PAD on an outpatient basis. Most interventionalists (n = 179, 79%) declared that an outpatient setting practice did not alter their technical approach. Age, obesity, chronic limb-threatening ischemia (CLTI), and chronic renal failure were not considered exclusion criteria for an outpatient setting by more than half of the respondents. Long iliac and femoropopliteal thrombosis were considered exclusion criteria by 48 (21%) and 75 (33%) of them, respectively. Interventionalists estimated the rate of potentially eligible patients at 58.3 ± 22.5%. Social isolation (lack of comprehension, communication means, or company) was considered the main exclusion criterion for more than 90% of the respondents. Medico-legal risks were identified as the main obstacle for 39% of interventionalists not practicing outpatient care.

Conclusion:

This prospective study identifies, from the perspective of vascular interventionalists, medico-legal risks, social isolation, and the complexity of lesions as the main obstacles to the transition to an outpatient setting for endovascular treatment of lower-limb PAD.