title: Feasibility of ambulatory percutaneous femoral access without the use of arterial closure systems.
abstract: BACKGROUND
  To evaluate the feasibility of early ambulation in patients treated for peripheral occlusive lesions by femoral percutaneous access, without the use of closure systems and the application to ambulatory practice.
  
  
  METHODS
  This single-center observational exploratory study was undertaken among 99 consecutive patients between August 1-December 31, 2011 (mean age: 72 years; 72 men) who were treated by percutaneous femoral route for peripheral arterial lesions. All the patients had a manual compression then pressure bandage. A clinical evaluation was carried out after 4 hours, seeking a local or a general complication and checking the procedure. Rising and walking in the unit of hospitalization were authorized in the absence of complication as of 4 hours postoperatively. All patients remained in hospital for at least 1 night, with a clinical revaluation before discharge. All patients were contacted by telephone at postoperative day 7 in order to verify the absence of local complications. All the individual factors and those related to the procedure were analyzed.
  
  
  RESULTS
  With criteria of complications related to the gesture, 72 patients (72.7%) were considered ready to be discharged as of postoperative hour 4. Among the 27 patients who were not able to leave, 7 presented with an early local complication without reoperation, and 20 could not walk because of a necrotic lesion (n = 8), their advanced age (n = 4), morbid obesity (n = 2), or a choice of the surgeon in charge (n = 6). Twenty-five patients could, however, stroll after 12 hours. The mean duration of hospitalization was 1.3 days (range: 0-10 days). Two patients required distal amputation during the same hospitalization, and 1 underwent a femoropopliteal bypass after failure of a femoropopliteal recanalization. With univariate analysis, the treatment by anticoagulants and the duration of the hospitalization were the only factors significantly related to the impossibility of early ambulation. The occurrence of complications was linked with the experience of the surgeon, the age of the patient, and the female sex. Three patients, including 2 regarded as ready to walk by postoperative hour 4, were rehospitalized after 1 week for reoperation because of 1 major hematoma and 2 femoral false aneurysms.
  
  
  CONCLUSIONS
  Percutaneous endovascular surgery by the femoral route without using an arterial closure system is feasible in an ambulatory practice in nearly 75% of cases. Particular monitoring must be done in the oldest patients, women, and those treated with anticoagulants.
authors.affiliation: Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France.
authors.forename: Djelloul
authors.initials: D
authors.lastname: Gouicem
authors.affiliation: Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Palcau
authors.affiliation: Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Le Hello
authors.affiliation: Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Cameliere
authors.affiliation: Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Dufranc
authors.affiliation: Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Coffin
authors.affiliation: Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France. Electronic address: berger-l@chu-caen.fr.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Berger
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000671:Amputation, Surgical; D000925:Anticoagulants / Q000627:therapeutic use; D002983:Clinical Competence; D058128:Compression Bandages; D004434:Early Ambulation; D057510:Endovascular Procedures / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D005602:France; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D007902:Length of Stay; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D011312:Pressure; D011446:Prospective Studies; D011677:Punctures; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants