title: Increased vascular access complications in patients with renal dysfunction undergoing percutaneous coronary procedures using arteriotomy closure devices.
abstract: BACKGROUND
  Arteriotomy closure device (ACD) use has increased following percutaneous transfemoral coronary procedures (PTCP). However, their safety in patients with chronic kidney disease (CKD) is not known. Therefore, we evaluated the complication rates of ACD among patients with CKD.
  
  
  METHODS
  Six-hundred ten consecutive patients who underwent PTCP and ACD were retrospectively studied. Patients were grouped according to their creatinine clearance (CrCl in ml/min/1.73 m2) calculated by the Cockcroft-Gault formula using the National Kidney Foundation classification system; Stage I (CrCl > or = 90); Stage II (60-89); Stage III (30-59); Stage IV (15-29); and Stage V (< or = 15). The primary endpoint was the combined incidence of pseudoaneurysm, retroperitoneal hematoma, femoral artery thrombosis, surgical vascular repair, and groin infection.
  
  
  RESULTS
  Among 610 patients 283 (46%) underwent PCI. The primary endpoint was seen in 66 (10.8%) patients. Univariate predictors of primary outcome were lower CrCl (p < 0.001), and presence of peripheral vascular disease (p = 0.03). There was an inverse relationship between CrCl and complication rate. CKD was the strongest independent multivariate predictor for the primary endpoint (OR 1.032; 95% CI 1.019-1.046; p < 0.0001), driven by higher infection (p < 0.0001), thrombosis (p = 0.003) and hematoma (p = 0.007).
  
  
  CONCLUSIONS
  Renal function appears to be significantly associated with vascular access-site complications. Worsening renal function is associated with higher vascular access site complications, largely driven by an increased infection rate.
authors.affiliation: Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY 10025, USA.
authors.forename: Emad F
authors.initials: EF
authors.lastname: Aziz
authors.forename: Sandeep
authors.initials: S
authors.lastname: Pulimi
authors.forename: Clinton
authors.initials: C
authors.lastname: Coleman
authors.forename: Calatin
authors.initials: C
authors.lastname: Florita
authors.forename: Dan
authors.initials: D
authors.lastname: Musat
authors.forename: Deborah
authors.initials: D
authors.lastname: Tormey
authors.forename: Ashraf
authors.initials: A
authors.lastname: Fawzy
authors.forename: Steve
authors.initials: S
authors.lastname: Lee
authors.forename: Eyal
authors.initials: E
authors.lastname: Herzog
authors.forename: David L
authors.initials: DL
authors.lastname: Coven
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Tamis-Holland
authors.forename: Mun K
authors.initials: MK
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001424:Bacterial Infections / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000628:therapy*; D002908:Chronic Disease; D004868:Equipment Failure; D004864:Equipment and Supplies / Q000382:microbiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006470:Hemorrhage / Q000453:epidemiology; D006489:Hemostatic Techniques / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology