Management of Peripheral Vascular Interventions in an Ambulatory Setting: A Single-Center Retrospective Analysis.

BACKGROUND: The development of minimally invasive devices to treat peripheral artery disease led to a reduction of complications, particularly of the puncture or access site. Subsequently, the number of ambulatory procedures increased, saving costs and resources. This analysis was performed to provide data on patients treated with 4 French (F) compatible devices in ambulatory and in-hospital settings. METHODS: This is a single-center retrospective analysis of prospectively collected data. Consecutive patients who received peripheral vascular interventions from 2013 to 2015 were included. Data were extracted from electronic patients' files; data until the time of last contact were collected. Arterial puncture was performed under ultrasound guidance; 4F compatible devices ought to be selected and compression devices were used to seal the puncture site. The primary outcome was the rate of ambulatory failure in the ambulatory group. RESULTS: A total of 219 patients (68.5% male, 69.5 ± 12.8 years) were included in the analysis. Thereof 71 patients with 80 procedures were hospitalized, predominantly for social reasons (42/80, 52.5%) or emergency conditions (18/80, 22.5%). In the ambulatory group (148 patients), 183 procedures were performed, thereof 92.9% (170/183) with a 4F compatible equipment. Procedural success was 91.8% (168/183) in the ambulatory group and 82.5% (66/80) in the hospitalized group (P = 0.027). Patients in an ambulatory setting were younger and more frequently males. Ambulatory success was 99.2% (181/183). One puncture site complication was observed in each group but no other procedural complication, and all patients were alive after 1 month. In the ambulatory group, the mean follow-up was of 148 ± 260 days and in the hospitalized group, the mean follow-up was of 126 ± 199 days; no patient died during follow-up in the ambulatory group but 3 patients died in the hospitalized group. CONCLUSIONS: Ambulatory endovascular procedures can be safely performed in a large proportion of patients with peripheral artery disease.

Impact of intertendinous connections between the flexor digitorum brevis and longus on percutaneous tenotomy for the treatment of claw toes: an anatomic and ultrasound study.

PURPOSE: Selective percutaneous tenotomy of the flexor digitorum longus (FDL) is a treatment for claw toes that gives astonishingly good functional results despite tendon sacrifice. However, the involution of the FDL tendon stump after tenotomy is unknown. The aim of our study was to assess the involution of the tendon stump after selective percutaneous tenotomy of the FDL. METHODS: The study included two parts. In the clinical part, an ultrasound analysis of 15 FDL tenotomies in 7 patients was carried out 3 months post-surgery. In the anatomic part, the feet of 10 bodies donated to science were dissected and examined anatomically. RESULTS: The proximal stump of the FDL was located near the base of the proximal phalanx and moved synchronously with the flexor digitorum brevis (FDB).Separating the FDB and FDL revealed a large tissue connection between the plantar surface of the tendinous chiasm of the FDB and the dorsal part of the FDL. These connections had significant resistance ranging from 2 to 9 Newtons depending on the toe. Tenotomy of the FDL followed by proximal traction of it led to retraction of the stump up to the base of the proximal phalanx and transfer of its action to the FDB by tensioning the intertendinous structure. Histologically, these structures were mostly comprised of tendon connective tissue. Their vascular component was small. CONCLUSION: The presence of this intertendinous connection leads, in the case of isolated tenotomy of the FDL, to equivalent transfer of the latter to the FDB.