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[Arterial Access Site Complications after Percutaneous Interventions with Special Regard to the Application of
A Gratl1, J Klocker1, B Glodny2
1Universitätsklinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Österreich.
Insights
Vascular closure devices (VCDs) were intended to reduce complications from endovascular procedures. However, this study found that increased VCD use correlated with a rise in access site complications, questioning their effectiveness.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Context:
- Endovascular procedures for peripheral and coronary heart disease are increasing.
- Access site complications, including bleeding and thrombosis, are a growing concern.
- Vascular closure devices (VCDs) were developed to mitigate these complications.
Purpose:
- To evaluate the incidence of surgical access site complications following percutaneous interventions.
- To assess the impact of vascular closure device (VCD) utilization on complication rates.
- To determine the efficacy of VCDs compared to manual compression in preventing complications.
Summary:
- A retrospective analysis of 522 patients treated surgically for access site complications between 2001-2012 was conducted.
- The study analyzed 90,538 percutaneous interventions, revealing a 0.58% incidence of access site complications.
- Higher VCD usage correlated with increased complication rates, particularly ischemic complications, challenging their preventative role.
Impact:
- Findings suggest that the routine application of VCDs to prevent access site complications may not be justified.
- The study highlights the need for further research into effective strategies for managing endovascular procedure complications.
- Results question the current clinical practice regarding the widespread adoption of VCDs.
Abstract:
Due to an increase in the number of performed endovascular procedures, the number of local access site complications is rising too. Used mainly for treatment of peripheral arterial disease and coronary heart disease, endovascular procedures are gaining importance. Access site complications include bleeding, haematoma, pseudoaneurysm, arteriovenous fistula and arterial thrombosis. Aiming to reduce immobilisation, length of hospital stay, costs and access site complications, vascular closure devices (VCD) were introduced in the mid 1990s, but current trials failed to demonstrate the superiority of these devices compared to conventional manual compression if it comes to access site complications. We retrospectively evaluated all patients who were treated surgically due to access site complications between 2001 and 2012 in our institution. In total, 522 patients needed vascular surgery to treat different access site complications. During this period, 90,538 percutaneous interventions were performed in our institution, leading to a total incidence of 0.58 % of access site complications. Depending on the frequency of application of VCDs, patients have been grouped in groups A-C. With the more frequent use of VCDs, the incidence of access site complications increased and, in particular, ischaemic complications were seen more often. In conclusion, the application of VCDs to prevent access site complications is questionable and not justified when looking at published data.
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