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Safety of Early Ambulation After Diagnostic and Therapeutic Neuroendovascular Procedures Without Use of Closure Devices

Wagenbach, Anne CNP, RN; Saladino, Andrea MD; Daugherty, Wilson P. MD, PhD; Cloft, Harry J. MD, PhD; Kallmes, David F. MD; Lanzino, Giuseppe MD

Neurosurgery:
doi: 10.1227/01.NEU.0000359532.92930.07
Clinical Studies
Abstract

OBJECTIVE: To evaluate the safety of manual compression and early ambulation after diagnostic and therapeutic neuroendovascular procedures.

METHODS: Data were prospectively collected and retrospectively analyzed for consecutive patients undergoing diagnostic or therapeutic neuroendovascular procedures. Manual compression at the femoral access site was applied. The target for early ambulation was 2 hours after compression.

RESULTS: Three hundred forty-three patients were enrolled, of whom 295 were eligible for early ambulation. Diagnostic procedures totaled 214 (72.5%); therapeutic procedures, 81 (27.5%). Ambulation occurred at 2 hours for 82 patients who underwent a diagnostic and 11 patients who underwent a therapeutic procedure. Overall, 142 patients (66.4%) after a diagnostic and 21 patients (25.9%) after a therapeutic procedure ambulated within 3 hours; 94% of outpatients ambulated within 2 to 3 hours and were dismissed shortly thereafter. Delayed ambulation was related to nursing staff delays, recovery from general anesthesia, or patient preference. Fourteen patients (4.7%)—9 (4.2%) who had a diagnostic and 5 (6.2%) who had a therapeutic procedure—required delayed ambulation because of local oozing (8 patients), a hematoma of less than 5 cm (3 patients), a pseudoaneurysm (2 patients), or a large hematoma requiring surgical evacuation (1 patient).

CONCLUSION: Early ambulation is feasible and safe after diagnostic and therapeutic procedures and manual compression. A longer period of bed rest or the routine use of closure devices is often not required; thereby avoiding the costs associated with bed rest and the complications associated with closure devices.

Author Information

Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota (Wagenbach) (Saladino) (Daugherty) (Lanzino)

Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (Saladino)

Department of Radiology, Mayo Clinic, Rochester, Minnesota (Cloft) (Kallmes)

Reprint requests: Giuseppe Lanzino, MD, Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Email: lanzino.giuseppe@mayo.edu

Received, January 27, 2009.

Accepted, August 6, 2009.

Copyright © by the Congress of Neurological Surgeons