Patient selection for ambulatory endovascular management of lower extremity peripheral arterial disease (PAD) is based on the triad of patient, procedure, and facility. Certain comorbidities frequently encountered in vascular surgery – such as severe obesity, obstructive sleep apnea, chronic kidney disease, and associated cardiovascular disease – require careful preoperative assessment but are not absolute contraindications. There is no strict age limit, and stable ASA I to III patients are eligible. Critical limb ischemia and complex lesions are not formally excluded from an ambulatory approach. Ultrasound-guided femoral access is strongly recommended. A minimum postoperative monitoring period of 4 hours before same-day discharge is mandatory. Antiplatelet therapy (aspirin and/or clopidogrel) is not considered a contraindication to ambulatory management. Large databases and registries show that ambulatory endovascular interventions are associated with a low rate of major complications (cardiac, renal, or vascular), and the need for unplanned hospital admission (failure of ambulatory management) is below 10%.

Lower extremity arterial revascularization can be safely and effectively performed on an ambulatory basis, provided that patients are carefully selected, endovascular techniques are well mastered, and the institution has a structured organizational framework.