Jason Q. Alexander, Kate Zimmerman, Andrew Cragg, Peter Alden, John Graber, Adnan Rizvi, Alex Tretinyak, Timothy Sullivan
Vascular and Endovascular Surgery, Minneapolis Heart Institute, Minneapolis, MN.
OBJECTIVES: Evaluate whether closure devices (CD) are a safe method for preventing surgical complications associated with femoral access. As a secondary goal, the use of ultrasound for femoral access and performance of an adequate completion angiogram prior to CD deployment were evaluated.
METHODS: All patients at a tertiary care facility that underwent femoral arterial access from January 2009 to July 2011 were reviewed. Arterial complications that resulted in operative repair during hospitalization were identified. Cases were separated into those utilizing CD and those employing manual compression (MC). The two groups were evaluated for demographic and procedural differences. The subgroup of patients that underwent CD placement was then evaluated for ultrasound use and performance of adequate completion angiogram.
RESULTS: A total of 11,114 cases were reviewed. CD were placed in 5,576 (50.2%) while MC was used in 5,538 (49.8%). Surgical complications were identified in 30 (0.54%) of CD cases and 26 (0.47%) of MC cases(p=0.61). Demographic data and procedural data was not statistically significant between the two groups except for younger average age in the CD subset (p=0.032).
Amongst the 30 surgical complications employing CD, 7 patients (23.3%) were found to have access in the wrong vessel. Ultrasound was utilized in 4/30 cases (13.3%). Completion angiograms were not recorded in 12/30 (40%) of cases. In 11/18 cases (61%) completion angiograms were determined to be inadequate for placement of a CD.
CONCLUSIONS: Our data suggests that use of CD following femoral artery access does not decrease the rate of surgical complications compared with MC. Demographic and procedural factors did not appear to influence the complication rate. In 10/30 (33.3%) cases the wrong vessel was accessed or a device was deployed in an inadequate vessel by completion angiography. Unless, factors can be employed to decrease the rate of complications, we cannot justify the use of CD in the prevention of surgical complications.
AUTHOR DISCLOSURES: P. Alden, Nothing to disclose; J. Q. Alexander, Nothing to disclose; A. Cragg, Nothing to disclose; J. Graber, Nothing to disclose; A. Rizvi, Nothing to disclose; T. Sullivan, Nothing to disclose; A. Tretinyak, Nothing to disclose; K. Zimmerman, Nothing to disclose.
Posted April 2012