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Increased vascular access complications in patients with renal dysfunction undergoing percutaneous coronary

Emad F Aziz1, Sandeep Pulimi, Clinton Coleman

  • 1Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY 10025, USA.

The Journal of Invasive Cardiology
|January 6, 2010
PubMed

Insights

Arteriotomy closure devices (ACDs) pose increased risks for patients with chronic kidney disease (CKD). Lower renal function is linked to higher complication rates, particularly infections, thrombosis, and hematoma after percutaneous transfemoral coronary procedures.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Surgery

Background:

  • Arteriotomy closure device (ACD) use is rising after percutaneous transfemoral coronary procedures (PTCP).
  • Safety of ACDs in patients with chronic kidney disease (CKD) remains unestablished.
  • This study evaluates ACD complication rates in CKD patients.

Purpose of the Study:

  • To assess the safety and complication rates of arteriotomy closure devices (ACDs) in patients undergoing percutaneous transfemoral coronary procedures (PTCP).
  • To determine the association between chronic kidney disease (CKD) and vascular access-site complications following PTCP with ACDs.

Main Methods:

  • Retrospective study of 610 patients who underwent PTCP and ACD.
  • Patients were stratified into CKD stages (I-V) based on creatinine clearance (CrCl) using the Cockcroft-Gault formula.
  • Primary endpoint: combined incidence of pseudoaneurysm, retroperitoneal hematoma, femoral artery thrombosis, surgical vascular repair, and groin infection.

Main Results:

  • Lower CrCl and peripheral vascular disease were univariate predictors of complications.
  • A significant inverse relationship existed between CrCl and complication rates.
  • CKD was the strongest independent predictor of complications (OR 1.032), driven by increased infection, thrombosis, and hematoma.

Conclusions:

  • Renal function is significantly associated with vascular access-site complications after PTCP with ACDs.
  • Worsening renal function correlates with higher complication rates, primarily due to increased infection rates.
  • ACD use in CKD patients warrants careful consideration due to elevated risks.
Abstract

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