title: Complication rates for percutaneous lower extremity arterial antegrade access.
abstract: OBJECTIVE
  The antegrade access (AA) for percutaneous arterial interventions is associated with a higher complication rate than is the retrograde access (RA).
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  A statewide consortium for peripheral vascular interventions consisting of 13 Michigan hospitals collecting data on their endovascular procedures.
  
  
  METHODS
  Demographic and procedure data on all patients receiving a percutaneous peripheral arterial intervention were entered prospectively by a full-time clinical nurse specialist in each hospital site.
  
  
  METHODS
  We evaluated vascular complications as a composite of retroperitoneal hematoma, pseudoaneurysm, hematoma requiring blood transfusion, arteriovenous fistula, acute thrombosis, or the need for surgical repair of the access site.
  
  
  RESULTS
  In a 2-year period, we collected 6343 cases, of which 5918 had complete data regarding arterial access; of these, 745 (12.6%) were performed via an AA. There were fewer women and smokers (P < .001) in the AA group but more diabetic patients (P < .001). The indications for intervention were more frequently rest pain (P < .001) and limb salvage (P < .001) in the AA group. Multivariate regression analysis showed that the odds of complications were significantly higher with a larger sheath (95% confidence interval, 1.53-4.06; P < .001). Also, the incidence of blood transfusion and subsequent amputation was significantly higher in the AA group (P < .001).
  
  
  CONCLUSIONS
  Endovascular procedures performed via an AA are more likely to result in perioperative complications and therefore should be used cautiously.
authors.affiliation: Department of Surgery, Grand Rapids Medical Education and Research Center, Michigan State University, Grand Rapids, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Wheatley
authors.forename: M Ashraf
authors.initials: MA
authors.lastname: Mansour
authors.forename: P Michael
authors.initials: PM
authors.lastname: Grossman
authors.forename: Khan
authors.initials: K
authors.lastname: Munir
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cali
authors.forename: Jill M
authors.initials: JM
authors.lastname: Gorsuch
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cuff
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Wong
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Chambers
mesh_terms: D000208:Acute Disease; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017541:Aneurysm, False / Q000453:epidemiology* / Q000209:etiology; D017130:Angioplasty / Q000009:adverse effects* / Q000379:methods*; D001158:Arteries / Q000601:surgery*; D001164:Arteriovenous Fistula / Q000453:epidemiology* / Q000209:etiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003287:Contrast Media / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000453:epidemiology / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006406:Hematoma / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D051437:Renal Insufficiency / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology
chemical_list: D003287:Contrast Media