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Multicenter Study
. 2014 Dec;7(6):821-8.
doi: 10.1161/CIRCINTERVENTIONS.114.001306. Epub 2014 Nov 11.

Access site complications after peripheral vascular interventions: incidence, predictors, and outcomes

Daniel Ortiz  1 , Arshad Jahangir  1 , Maharaj Singh  1 , Suhail Allaqaband  1 , Tanvir K Bajwa  1 , Mark W Mewissen  2
Affiliations
Multicenter Study

Access site complications after peripheral vascular interventions: incidence, predictors, and outcomes

Daniel Ortiz et al. Circ Cardiovasc Interv. 2014 Dec.

Abstract

Background: Access site hematomas and pseudoaneurysms are the most frequent complications of peripheral vascular intervention (PVI); however, their incidence and risk factors remain unclear.

Methods and results: We retrospectively analyzed data from the multicenter Vascular Quality Initiative on 22 226 patients who underwent 27 048 PVI from August 2007 to May 2013. Primary end points included incidence and predictors of access site complications (ASCs), length of postprocedural hospitalization, discharge status, and 30-day and 1-year mortality. ASC complicated 936 procedures (3.5%). Of these, 74.4% were minor complications, 9.7% were moderate requiring transfusion, 5.4% were moderate requiring thrombin injection, and 10.5% were severe requiring surgery. Predictors of ASC were age >75 years, female sex, white race, no prior PVI, nonfemoral arterial access site, >6-Fr sheath size, thrombolytics, arterial dissection, fluoroscopy time >30 minutes, nonuse of vascular closure device, bedridden preoperative ambulatory status, and urgent indication. Mean hospitalization was longer after procedures complicated by ASC (1.2±1.6 versus 1.9±1.9 days; range, 0-7 days; P=0.002). Severity of ASC correlated with higher rates of discharge to rehabilitation/nursing facilities compared with home discharge. Patients with severe ASC had higher 30-day mortality (6.1% versus 1.4%; P<0.001), and those with moderate ASC requiring transfusion had elevated 1-year mortality (12.1% versus 5.7%; P<0.001).

Conclusions: Several factors independently predict ASC after PVI. Appropriate use of antithrombotic therapies and vascular closure device in patients at increased risk of ASC may improve post-PVI outcomes.

Keywords: aneurysm, false; hematoma; mortality.

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Figures

Figure 1
Figure 1
Predictors of access site complication. CI indicates confidence interval; FA, femoral artery; OR, odds ratio; PVI, peripheral vascular intervention.
Figure 2
Figure 2
Discharge status by type of access site complication (ASC).
Figure 3
Figure 3
A, Predictors of 30-day mortality. B, Kaplan-Meier curves for 30-day mortality by type of access site complication (ASC). BMI indicates body mass index; CI, confidence interval; OR, odds ratio.
Figure 4
Figure 4
A, Predictors of 1-year mortality. B, Kaplan-Meier curves for 1-year mortality by type of access site complication (ASC). BMI indicates body mass index; CI, confidence interval; DM, diabetes mellitus; FA, femoral artery; OR, odds ratio.
See this image and copyright information in PMC

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