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 PS62. Predictors of Access-Site Related Complications After Lower Extremity Percutaneous Revascularization

Ruby C. Lo, Margriet Fokkema, Thomas Curran, Jeremy Darling, Mark Wyers, Allen D. Hamdan, Elliot L. Chaikof, Marc L. Schermerhorn
Vascular Surgery, BIDMC, Boston, MA.

OBJECTIVES: Though well described in the cardiology literature, less is known about risks for access site-related complications (ASC) following percutaneous lower extremity revascularization. We also sought to evaluate the benefit of routine ultrasound-guided access (RUS) in decreasing ASC.

METHODS: We reviewed all percutaneous revascularizations (PTA or stent) performed for lower extremity atherosclerosis at our institution from 2002-2012. RUS began October 2007. Primary outcome was any ASC (bleeding, groin or retroperitoneal [RP] hematoma, vessel rupture or thrombosis). Multivariable logistic regression was used to determine predictors of ASC.

RESULTS: A total of 1,419 punctures were performed on 925 patients (43% women, median age 69 [IQR 60-78] years for claudication (30%), critical limb ischemia (58%) or other (12%) using 4-8Fr sheaths. Seventy-six ASC occurred (5.4%): 15 instances of bleeding, 41 groin and 8 RP hematoma, 2 artery ruptures, 9 pseudoaneurysms, and 1 thrombosis. CT evaluation was done in 13, thrombin injection in 9 and operative repair in 20 patients. ASC were more common before RUS (7.6% vs. 4.5%, p=0.026). Multivariable predictors of ASC were older age, preoperative warfarin use and procedure performance before RUS (Table 1). Vascular closure devices (VCD) were not associated with ASC rates but when attempted, failures were associated with a higher ASC rate (15% vs. 4%, p=0.006).

CONCLUSIONS: RUS has decreased ASC in recent years but VCD have not demonstrated a significant impact. Particular care should be taken on patients >75 years old and those on warfarin preoperatively.

AUTHOR DISCLOSURES: E. L. Chaikof: Nothing to disclose; T. Curran: Nothing to disclose; J. Darling: Nothing to disclose; M. Fokkema: Nothing to disclose; A. D. Hamdan: Endologix, Consulting fees or other remuneration (payment); R. C. Lo: Nothing to disclose; M. L. Schermerhorn: Endologix, Consulting fees or other remuneration (payment); Medtronic, Consulting fees or other remuneration (payment); M. Wyers: Endologix, Consulting fees or other remuneration (payment); Boston Scientific, Consulting fees or other remuneration (payment).
 
Multivariable predictors of ASC
Odds Ratio
95% C.I.
P-value
Age
<65 years
-
-
-
65-74 years
1.65
0.81-3.33
0.167
75+ years
2.37
1.27-4.42
0.006
Pre-operative warfarin use
2.46
1.44-4.19
0.001
VCD vs. manual compression
0.64
0.37-1.13
0.124
Post- vs. pre-RUS period
0.50
0.29-.86
0.012
 
 
Posted April 2013
 

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