Original title: Access Site Complications After Peripheral Vascular Interventions. Incidence, Predictors, and Outcomes. Reference: Daniel Ortiz et al. Circ Cardiovasc Interv. 2014 Nov 11. Epub ahead of print.
Hematomas and pseudoaneurysms are the most common complications of peripheral angioplasty, though its incidence and risk factors are unclear. A retrospective analysis was performed in 22226 patients receiving peripheral angioplasty between 2007 and 2013 at several centers. The primary end points included the incidence and complication predictors related to vascular access, post procedure length of stay and mortality at 30 days and one year. Access complications occurred in 936 procedures (3.5%). Of these, 74.4% were minor, 9.7% were moderate requiring transfusion, 5.4% were moderate requiring thrombin injection and 10.5% were severe complications requiring surgery.
Predictors of complications related to access were age (>75 years), female gender, access different to femoral, introducer >6 Fr, use of thrombolytics, arterial dissection, fluoroscopy time >30 minutes, urgent indication and the absence of percutaneous closure devices procedure. In patients who had complications access, hospital stay was significantly higher (1.2 ± 1.6 versus 1.9 ± 1.9 days; p = 0.002) and in which the complication was severe, an increased mortality was observed at 30 days (6.1% versus 1.4%; p <0.001). In those which complication was moderate but requiring transfusion, mortality was higher per year (12.1% versus 5.7%, p <0.001).
Conclusion
Several factors independently predict the risk of complications of vascular access in patients receiving peripheral angioplasty. The appropriate use of anti-thrombotic and vascular closure devices could improve results.
Editorial comment
This issue, which has been widely analyzed in coronary angioplasty, did not have much data for peripheral angioplasty. Two of the most useful resources in coronary angioplasty as radial access and use of bivalirudin, have technical limitations or insufficient evidence in the peripheral angioplasty. The radial access may be useful in selected cases of renal angioplasty, iliac primitive or carotid, but not much further. Bivalirudin has some evidence in carotid angioplasty but not in other territories.
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