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PVSS16. Closure Device Use Following Arterial Access Is Associated with Decreased Rate of Pseudoaneurysm Formation

Olusegun Osinbowale, Douglas Joseph, Matthew Eagleton, Brendan Duffy, Kathy Wolski.
Cleveland Clinic Foundation, Cleveland, Ohio.

OBJECTIVES: Pseudoaneurysm (PSA) formation following arterial access occurs in 0.04% to 6.3% of patients. The aim of the current study was to determine whether the use of manual compression or closure devices (CD) affected the incidence of PSA formation following diagnostic arteriography (DA) and percutaneous intervention (PI).

METHODS: The medical records of14,063 consecutive patients undergoing DA or PI between January 1, 2006 and September 30, 2007 were reviewed. Subject demographics, medical history, access site complications and management, and PSA characteristics were recorded. Continuous variables were compared using a t-test and categorical variables were compared using the chi-square statistic. A p-value of <0.05 was considered significant.

RESULTS: PSA were detected in 51 (0.36%) patients. Patients with PSA were older (68.53±12.182 v. 64.06±12.669 years, p=0.010), had a lower weight (78.93±18.995 v. 87.08±20.980 kg, p=0.004), and had a lower BMI (27.66±5.401 v. 29.72±6.581 kg/m2, p=0.024). Hypertension was more common in PSA patients (68.63%) compared to those without (52.50%, p=0.021). PSA was more frequent following PI compared with DA (0.27% v. 0.57%, p=0.006). The majority of PSA (78.4%) involved the distal external iliac or common femoral arteries, and 80.4% were single chambered. The mean PSA size was 22.0±9.10 mm (range 7-53mm). Mean time to diagnosis was 3.47±6.03 days (range 0-39 days). A CD was used in 6779 patients including Angioseal (75.26%), Perclose (21.40%), Starclose (3.17%), and other (0.53%). The rate of PSA formation was lower in those patients treated with a CD compared with manual compression (MC) (0.21% v. 0.51%, p=0.003). For DA, PSA incidence was 0.12% with CD and 0.38% with MC (p=0.015). For PI, PSA incidence was 0.34% with CD and 0.91% with MC (p=0.015).

CONCLUSIONS: PSA incidence is low, but increases with older age, lower BMI and hypertension. PSA was most common in patients undergoing PI treated with manual compression. This study suggests that patients may benefit from the use of a closure device, particularly if they are undergoing an intervention. The study is underpowered to determine differences among specific CD. Further study is needed to determine if one device is superior to another.