Routine use of ultrasound-guided access reduces access site-related complications after lower extremity percutaneous revascularization

Abstract

Objectives We sought to elucidate the risks for access site-related complications (ASC) following percutaneous lower extremity revascularization and to evaluate benefit of routine ultrasound-guided access (RUS) in decreasing ASC. Methods We reviewed all consecutive percutaneous revascularizations (PTA or stent) performed for lower extremity atherosclerosis at our institution from 2002–2012. RUS began September 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 1,371 punctures were performed on 877 patients (43% women, median age 69 [IQR 60–78] yrs for claudication (29%), critical limb ischemia (59%), or bypass graft stenosis (12%) using 4–8Fr sheaths. There were 72 ASCs (5%): 52 instances of bleeding or groin hematoma, 9 pseudoaneurysms, 8 retroperitoneal hematomas, 2 artery lacerations, and 1 thrombosis. ASC were less frequent when RUS was used (4% vs. 7%, P=.02). Multivariable predictors of ASC were age >75 years (OR 2.0, 95% CI 1.1–3.7, P=.03), CHF (OR 1.9, 95% CI 1.1–1.3, P=.02), preoperative warfarin use (OR 2.0, 95% CI 1.1–3.5, P=.02), & RUS (OR 0.4, 95% CI 0.2–0.7, P<.01). Vascular closure devices (VCDs) were not associated with lower rates of ASCs (OR 1.1, 95% CI 0.2–0.7, P<.01). RUS lowered ASCs in those >75 years (5% vs. 12%, P<.01) but not those on warfarin preoperatively (10% vs. 13%, P=.47). RUS did not decrease VCD failure (6% vs. 4%, P=.79). Conclusions We were able to decrease the rate of ASCs during lower extremity revascularization with the implementation of RUS. VCDs did not impact ASCs. Particular care should be taken on patients >75 years old, those with CHF, and those on warfarin.

A Novel Technique of Femoral Artery Angiography for the Detection of Post-bifurcation Puncture and the Avoidance of Complication

“…To avoid post-puncture bifurcation, ultrasound guidance has been reported to be effective. 13,14) However, in our study, recognition of post-bifurcation punctures after the cannula insertion did not have any effect on the rate of complications. Hence, from the viewpoint of convenience, we believe that our angiography technique is sufficiently effective for reducing the complication rate.…”

“…Ultrasound-guided puncture can be considered for especially high-risk patients, such as those >75 years old, those with congestive heart failure, and those taking anticoagulants. 14) Moreover, our strategy does not answer how to deal with the bilateral high-bifurcation cases. 10) In our series, there was no bilateral post-bifurcation puncture.…”

Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo

“…Other complications, such as artery laceration (4) , artery perforation (41) , granuloma (42) , mycotic aneurysm, arterial dissection, compartment syndrome, and limb ischemia (43) were reported in the selected publications, but due to their rare presentation they were only mentioned in the definitions of the complications evaluated or were reported in review studies as rare occurrences.…”

“…Therefore, studies to evaluate clinical outcomes associated with puncture sites in the different diagnostic and therapeutic options follow advances in the area (1)(2)(3)(4) . Femoral vessels are still used as the most common access site for the different specialties performed in hemodynamic laboratories, especially in percutaneous procedures that require the use of large-caliber introducers such as in endovascular correction of aneurysms and valvuloplasties, which further increases the potential for access site complications (5) .…”

Basics of Angiography for Peripheral Artery Disease

“…In particular, patients with PAD may be more likely to have atherosclerosis affecting the CFA. Ultrasound guidance is an emerging trend for all percutaneous procedures and its use for femoral artery puncture has decreased vascular complications and improved first-pass success rates [4][5][6].…”