Predictors of groin complications after balloon and new-device coronary intervention.
We reviewed the clinical course of 5,042 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) using balloons or new devices: (stent, laser, directional and rotational atherectomy). A vascular complication was defined as the formation of a groin hematoma, bleeding, pseudoaneurysm, fistula, or the need for surgical repair. Vascular complications occurred in 309 (6.1%) patients, and 117 (2.3%) required vascular repair; among these patients, surgery was performed for correction of an an arteriovenous fistula in 12%, repair of pseudoaneurysm in 72%, repair for expanding hematoma and femoral artery lacerations in 10%, and retroperitoneal bleeding in 6%. The correlates of vascular complications were older age (66.8 vs 62.1 years; p < 0.0001), female gender (43% vs 26%; p < 0.0001), increased weight (82.1 +/- 16.46 vs 78.0 +/- 16.6 kg; p < 0.001), higher systolic blood pressure (140 +/- 25 vs 134 +/- 20 mm Hg; p < 0.001), increased heparin dose during the procedure (14,352 +/- 3,879 vs 13,599 +/- 3,508 IU; p = 0.001), administration of heparin after the procedure (232 vs 2,985 patients; p < 0.0001) and intracoronary stenting (14.9% vs 3.5%; p < 0.0001). Fifteen patients of 214 (7.0%) who underwent stent implantation had surgical repair. Vascular complications were not related to the size of the arterial sheath (8.11 +/- 0.8 vs 8.8 +/- 0.7Fr; p = 0.11) and the use of devices other than stents (laser, atherectomy) did not increase the rate of vascular complications.
Waksman
R
R
Andreas Gruentzig Cardiovascular Center, Emory University Hospital, Atlanta, Georgia 30322, USA.
King
S B
SB
Douglas
J S
JS
Shen
Y
Y
Ewing
H
H
Mueller
L
L
Ghazzal
Z M
ZM
Weintraub
W S
WS
D000368:Aged; D000783:Aneurysm / Q000209:etiology / Q000601:surgery; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D016342:Angioplasty, Laser / Q000009:adverse effects; D001164:Arteriovenous Fistula / Q000209:etiology / Q000601:surgery; D017225:Atherectomy, Coronary / Q000009:adverse effects; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D006119:Groin; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome