Risk Factors for Puncture Site Complications After Endovascular Procedures in Patients With Peripheral Arterial Disease

Hackl, Gerald; Tse, Gary; Belaj, Klara; Hafner, Franz; Eller, Philipp; Brodmann, Marianne

doi:10.1177/1538574415608268

Cited by 16 publications

(17 citation statements)

References 27 publications

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“…The total number of complications (7.6%) was low and mainly related to the access site. In general, this number is similar to previously published data reporting rates of access site complications of up to 13% [14,[31][32][33]. The additional distal access did not increase the number of serious adverse complications (SAR) as only one case suffered from compartment syndrome requiring surgery.…”

Section: Discussionsupporting

confidence: 89%

Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort

Grözinger¹,

Hallecker

Grosse³

et al. 2020

Eur Radiol

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Objective To evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success. Material and methods One hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted. Results OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access. Conclusion The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/ or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion's degree of calcification. Key Points • Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion. • Target lesion's degree of calcification decreases technical success. • Complications related to the distal vascular access were rare.

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Section: Discussionsupporting

confidence: 89%

Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort

Grözinger¹,

Hallecker

Grosse³

et al. 2020

Eur Radiol

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“…ASC, accesssite complication, MAE, major adverse event, TLR, clinically driven target lesion revascularization devices B 7F to decide on the use of VCD based on factors that may be associated with impaired haemostasis such as obesity, coagulation disorder, and physician's experience. While the comparison of outcomes to other studies is hampered through different patient population, different scrutiny in monitoring, and different definitions of ASCs, it can still be concluded that the ASC-rate of 2.8% in the 4F group and 3.2% in the 6F group (3.3% and 2.6% in the matched cohort, respectively) is low and consistent with the 3.3% rate observed in the 4-Ever trial [11], the 3.5% rate in the Vascular Quality Initiative [14], the 0-3% major haematomas reported in a systematic review [7], and lower than the 11.5% rate reported in a retrospective single centre study [22], or the 12% of hematoma and closure device failure reported by Albert et al [8].…”

Section: Access Site Complicationssupporting

confidence: 85%

Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies: The Bio4amb Multicentre Trial

Brodmann

Deloose

Steinmetz

et al. 2020

Cardiovasc Intervent Radiol

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Purpose Ambulatory peripheral vascular interventions have been steadily increasing. In ambulatory procedures, 4F devices might be particularly useful having the potential to reduce access-site complications; however, further evidence on their safety and efficacy is needed. Materials and Methods BIO4AMB is a prospective, non-randomized mulitcentre, non-inferiority trial conducted in 35 centres in Europe and Australia comparing the use of 4F- and 6F-compatible devices. The main exclusion criteria included an American Society of Anaesthesiologists class ≥ 4, coagulation disorders, or social isolation. The primary endpoint was access-site complications within 30 days. Results The 4F group enrolled 390 patients and the 6F group 404 patients. Baseline characteristics were similar between the groups. Vascular closure devices were used in 7.7% (4F group) and 87.6% (6F group) of patients. Patients with vascular closure device use in the 4F group were subsequently excluded from the primary analysis, resulting in 361 patients in the 4F group. Time to haemostasis was longer for the 4F group, but the total procedure time was shorter (13.2 ± 18.8 vs. 6.4 ± 8.9 min, p < 0.0001, and 39.1 ± 25.2 vs. 46.4 ± 27.6 min, p < 0.0001). Discharge on the day of the procedure was possible in 95.0% (4F group) and 94.6% (6F group) of patients. Access-site complications were similar between the groups (2.8% and 3.2%) and included predominantly groin haematomas and pseudoaneurysms. Major adverse events through 30 days occurred in 1.7% and 2.0%, respectively. Conclusions Ambulatory peripheral vascular interventions are feasible and safe. The use of 4F devices resulted in similar outcomes compared to that of 6F devices.

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“… 14) Previous studies investigating the relationship between BMI and procedural complications have reported conflicting results, possibly due to differences in study populations and procedures. 15) 16) …”

Section: Discussionmentioning

confidence: 99%

Association between Body Mass Index and Clinical Outcomes of Peripheral Artery Disease after Endovascular Therapy: Data from K-VIS ELLA Registry

Lim

Won

et al. 2021

Korean Circ J

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Author's summary We investigated the association between body mass index and clinical outcomes of peripheral artery disease (PAD) after endovascular therapy (EVT). A total of 2914 PAD patients undergoing EVT were participated according to body mass index groups. Underweight was significantly associated with increased risk of major adverse cardiovascular events (MACE) (adjusted hazard ratio [HR], 1.540; 95% confidence interval [CI], 1.091–2.173) and major adverse limb events (MALE) (adjusted HR, 1.523; 95% CI, 1.066–2.177) compared with normal weight. Plus, overweight was associated with lower risk of MACE and not with MALE. However, obesity showed no significant association with MACE or MALE.

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Risk Factors for Puncture Site Complications After Endovascular Procedures in Patients With Peripheral Arterial Disease

Abstract: We observed an inferiority of conventional manual compression. Age, procedure duration > 45 minutes, BTK procedures, uncontrolled hypertension, and impaired coagulation were risk factors.

Cited by 16 publications

References 27 publications

Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort

Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort

Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies: The Bio4amb Multicentre Trial

Association between Body Mass Index and Clinical Outcomes of Peripheral Artery Disease after Endovascular Therapy: Data from K-VIS ELLA Registry

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