Increased vascular access complications in patients with renal dysfunction undergoing percutaneous coronary procedures using arteriotomy closure devices.
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.
Aziz
Emad F
EF
Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY 10025, USA.
Pulimi
Sandeep
S
Coleman
Clinton
C
Florita
Calatin
C
Musat
Dan
D
Tormey
Deborah
D
Fawzy
Ashraf
A
Lee
Steve
S
Herzog
Eyal
E
Coven
David L
DL
Tamis-Holland
Jacqueline
J
Hong
Mun K
MK
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