Prolonged Procedural Time and Its Association With Periprocedural Complications in Endovascular Therapy

Although prolonged operative time in surgical procedures is associated with an increased risk of complications, this has not been systematically evaluated in patients undergoing endovascular therapy (EVT).

This study determined the association between prolonged procedural time and periprocedural complications in patients undergoing EVT for symptomatic lower extremity arterial disease (LEAD).

Data from a nationwide EVT registry in Japan (J-EVT) between 2021 and 2022 were analyzed. Procedural time was categorized into four clinically relevant subgroups (≤ 59, 60-119, 120-179, and ≥ 180 min). The outcome measure was periprocedural complications, defined as a composite of periprocedural death, major bleeding, contrast induced nephropathy, myocardial infarction, ischemic stroke, and major amputation. The logistic regression model was developed to investigate the risk of periprocedural complications across the groups using the shortest subgroup (≤ 59 min) as the reference.

A total of 47,301 patients (average age: 75 ± 9 years, male: 69.0%, chronic limb-threatening ischemia: 51.0%) who underwent EVT for symptomatic LEAD were analyzed. The median procedural time (interquartile range) was 110 (74-161) min. A total of 431 patients (0.9%) developed periprocedural complications. After adjusting for patient characteristics, limb characteristics, hospital and operator volumes, the odds ratios for periprocedural complications with the shortest subgroup set as the reference were 1.18 (p = 0.45) for 60-119 min, 2.30 (p = 0.001) for 120-179 min, and 5.13 (p < 0.001) for ≥ 180 min.

Prolonged procedural time of EVT for symptomatic LEAD is significantly associated with an increased risk of periprocedural complications.