title: Influence of use of a vascular closure device on incidence and surgical management of access site complications after percutaneous interventions.
abstract: OBJECTIVE
  The study aimed to evaluate vascular access site complications (ASCs) after percutaneous interventions (PIs) in our institution for changes in annual incidence and surgical management after increased usage of a vascular closure device (VCD; in all cases: Angioseal™).
  
  
  METHODS
  All patients who underwent repair of arterial pseudo-aneurysms or access site stenosis/occlusion leading to leg ischaemia (LI) or new-onset disabling claudication (CI) after PIs between 2001 and 2008 were included. Annual rates of procedures and methods of repair of ASC were evaluated.
  
  
  RESULTS
  After a total of 58 453 PIs, 352 patients (0.6%) were operated on for: pseudo-aneurysms (n = 300; 0.51%); and local stenosis/occlusion leading to LI/CI (n = 52; 0.09%). Numbers increased significantly with more widespread VCD use: group A (2001-2004: 2860 VCDs; 28 284 PIs; 10.1%): n = 132 (0.47%); and group B (2005-2008: 11,660 VCDs; 30,169 PIs; 38.6%): n = 220 (0.73%) (p < 0.001). In contrast to similar rates of pseudo-aneurysms (group A: n = 124; 0.44%; group B: n = 176; 0.58%; not significant), a significant increase of operations for local stenoses/occlusions was seen with widespread VCD use: n = 8 versus n = 44 (p < 0.001).
  
  
  CONCLUSIONS
  In the era of VCDs, complications are rare. However, use of these devices is not without complications, and may require complex reconstructions.
authors.affiliation: Department of Vascular Surgery, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. josef.klocker@i-med.ac.at
authors.forename: J
authors.initials: J
authors.lastname: Klocker
authors.forename: A
authors.initials: A
authors.lastname: Gratl
authors.forename: A
authors.initials: A
authors.lastname: Chemelli
authors.forename: N
authors.initials: N
authors.lastname: Moes
authors.forename: G
authors.initials: G
authors.lastname: Goebel
authors.forename: G
authors.initials: G
authors.lastname: Fraedrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001317:Austria; D002406:Catheterization, Peripheral / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011677:Punctures; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult