HYPOTHESIS: The antegrade access (AA) for percutaneous arterial interventions is associated with a higher complication rate than is the retrograde access (RA). DESIGN: Retrospective case review. SETTING: A statewide consortium for peripheral vascular interventions consisting of 13 Michigan hospitals collecting data on their endovascular procedures. PATIENTS: Demographic and procedure data on all patients receiving a percutaneous peripheral arterial intervention were entered prospectively by a full-time clinical nurse specialist in each hospital site. MAIN OUTCOME MEASURES: We evaluated vascular complications as a composite of retroperitoneal hematoma, pseudoaneurysm, hematoma requiring blood transfusion, arteriovenous fistula, acute thrombosis, or the need for surgical repair of the access site. RESULTS: In a 2-year period, we collected 6343 cases, of which 5918 had complete data regarding arterial access; of these, 745 (12.6%) were performed via an AA. There were fewer women and smokers (P < .001) in the AA group but more diabetic patients (P < .001). The indications for intervention were more frequently rest pain (P < .001) and limb salvage (P < .001) in the AA group. Multivariate regression analysis showed that the odds of complications were significantly higher with a larger sheath (95% confidence interval, 1.53-4.06; P < .001). Also, the incidence of blood transfusion and subsequent amputation was significantly higher in the AA group (P < .001). CONCLUSION: Endovascular procedures performed via an AA are more likely to result in perioperative complications and therefore should be used cautiously.
HYPOTHESIS: The antegrade access (AA) for percutaneous arterial interventions is associated with a higher complication rate than is the retrograde access (RA). DESIGN: Retrospective case review. SETTING: A statewide consortium for peripheral vascular interventions consisting of 13 Michigan hospitals collecting data on their endovascular procedures. PATIENTS: Demographic and procedure data on all patients receiving a percutaneous peripheral arterial intervention were entered prospectively by a full-time clinical nurse specialist in each hospital site. MAIN OUTCOME MEASURES: We evaluated vascular complications as a composite of retroperitoneal hematoma, pseudoaneurysm, hematoma requiring blood transfusion, arteriovenous fistula, acute thrombosis, or the need for surgical repair of the access site. RESULTS: In a 2-year period, we collected 6343 cases, of which 5918 had complete data regarding arterial access; of these, 745 (12.6%) were performed via an AA. There were fewer women and smokers (P < .001) in the AA group but more diabeticpatients (P < .001). The indications for intervention were more frequently rest pain (P < .001) and limb salvage (P < .001) in the AA group. Multivariate regression analysis showed that the odds of complications were significantly higher with a larger sheath (95% confidence interval, 1.53-4.06; P < .001). Also, the incidence of blood transfusion and subsequent amputation was significantly higher in the AA group (P < .001). CONCLUSION: Endovascular procedures performed via an AA are more likely to result in perioperative complications and therefore should be used cautiously.
Authors: Joel L Ramirez; Devin S Zarkowsky; Thomas A Sorrentino; Caitlin W Hicks; Shant M Vartanian; Warren J Gasper; Michael S Conte; James C Iannuzzi Journal: J Vasc Surg Date: 2020-03-09 Impact factor: 4.268
Authors: Joseph Anderson; Ryan King; Thomas Brothers; Jacob Robison; Ravi Veeraswamy; Mathew Wooster; Rupak Mukherjee; Jean Marie Ruddy Journal: Ann Vasc Surg Date: 2020-01-07 Impact factor: 1.466
Authors: Ruby C Lo; Margriet T M Fokkema; Thomas Curran; Jeremy Darling; Allen D Hamdan; Mark Wyers; Michelle Martin; Marc L Schermerhorn Journal: J Vasc Surg Date: 2014-09-18 Impact factor: 4.268