PAD’s promise: Same-day discharge after angioplasty

Hospitals that want to add efficiencies to their peripheral artery disease (PAD) programs might take a page from PCI’s playbook. Just as same-day PCI can be feasible and safe for selected patients, same-day discharge after angioplasty may be possible for PAD patients.

Paula Maher, BSc, RN, of St. James Hospital in Dublin, Ireland, made a case for same-day peripheral angioplasty in the September issue of the Journal of Vascular Nursing. Peripheral angioplasty is standard treatment for patients with lifestyle-limiting claudication and critical limb ischemia, she wrote. Typically it is performed as an inpatient procedure.

Many of the pressures that compelled hospitals to roll out same-day PCI programs apply to angioplasty for PAD. Those include hospital bed shortages, staffing, reimbursement, reduction in risks related to hospital stays, cost savings and patient satisfaction. 

Few studies have explored the feasibility and safety of same-day discharge for PAD but interventional cardiologists have built a strong case for early discharge for elective PCI. Maher acknowledged that some of that research involved radial access, but results for transfemoral access PCI were also positive, she noted. In the case of PAD, angioplasty would require a femoral approach.

As with PCI, those studies that have demonstrated safety and effectiveness of same-day angioplasty for PAD underscored the importance of patient selection. Use of a nurse-led preclinical admissions clinic helped on that front, Maher pointed out.

The availability of less invasive devices and femoral closure devices also facilitate uptake of same-day procedures. “The development of lower profile systems of 4-, 5-, and 6-Fr diameter has meant a significant reduction in the size of access arterial holes,” she noted. “As such, peripheral angioplasty can now be performed with minimal complications, bringing into question the appropriateness of routine hospitalization for these procedures.”   

Maher called the evidence in support of same-day angioplasty for PCI convincing but “[l]arger randomized studies are needed in peripheral angioplasty to ascertain if results in the PCI population are truly applicable to this patient cohort.”