Access site complications after peripheral vascular interventions: incidence, predictors, and outcomes.
BACKGROUND
Access site hematomas and pseudoaneurysms are the most frequent complications of peripheral vascular intervention (PVI); however, their incidence and risk factors remain unclear.


RESULTS
We retrospectively analyzed data from the multicenter Vascular Quality Initiative on 22 226 patients who underwent 27 048 PVI from August 2007 to May 2013. Primary end points included incidence and predictors of access site complications (ASCs), length of postprocedural hospitalization, discharge status, and 30-day and 1-year mortality. ASC complicated 936 procedures (3.5%). Of these, 74.4% were minor complications, 9.7% were moderate requiring transfusion, 5.4% were moderate requiring thrombin injection, and 10.5% were severe requiring surgery. Predictors of ASC were age >75 years, female sex, white race, no prior PVI, nonfemoral arterial access site, >6-Fr sheath size, thrombolytics, arterial dissection, fluoroscopy time >30 minutes, nonuse of vascular closure device, bedridden preoperative ambulatory status, and urgent indication. Mean hospitalization was longer after procedures complicated by ASC (1.2±1.6 versus 1.9±1.9 days; range, 0-7 days; P=0.002). Severity of ASC correlated with higher rates of discharge to rehabilitation/nursing facilities compared with home discharge. Patients with severe ASC had higher 30-day mortality (6.1% versus 1.4%; P<0.001), and those with moderate ASC requiring transfusion had elevated 1-year mortality (12.1% versus 5.7%; P<0.001).


CONCLUSIONS
Several factors independently predict ASC after PVI. Appropriate use of antithrombotic therapies and vascular closure device in patients at increased risk of ASC may improve post-PVI outcomes.
From the Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Madison (D.O., M.S., S.A., T.K.B.); Center for Integrative Research on Cardiovascular Aging, Aurora University of Wisconsin Medical Group, Milwaukee (A.J.); and Vascular Center at Aurora St Luke's Medical Center, Milwaukee, WI (M.W.M.).
Daniel
D
Ortiz
From the Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Madison (D.O., M.S., S.A., T.K.B.); Center for Integrative Research on Cardiovascular Aging, Aurora University of Wisconsin Medical Group, Milwaukee (A.J.); and Vascular Center at Aurora St Luke's Medical Center, Milwaukee, WI (M.W.M.).
Arshad
A
Jahangir
From the Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Madison (D.O., M.S., S.A., T.K.B.); Center for Integrative Research on Cardiovascular Aging, Aurora University of Wisconsin Medical Group, Milwaukee (A.J.); and Vascular Center at Aurora St Luke's Medical Center, Milwaukee, WI (M.W.M.).
Maharaj
M
Singh
From the Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Madison (D.O., M.S., S.A., T.K.B.); Center for Integrative Research on Cardiovascular Aging, Aurora University of Wisconsin Medical Group, Milwaukee (A.J.); and Vascular Center at Aurora St Luke's Medical Center, Milwaukee, WI (M.W.M.).
Suhail
S
Allaqaband
From the Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Madison (D.O., M.S., S.A., T.K.B.); Center for Integrative Research on Cardiovascular Aging, Aurora University of Wisconsin Medical Group, Milwaukee (A.J.); and Vascular Center at Aurora St Luke's Medical Center, Milwaukee, WI (M.W.M.).
Tanvir K
TK
Bajwa
From the Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Madison (D.O., M.S., S.A., T.K.B.); Center for Integrative Research on Cardiovascular Aging, Aurora University of Wisconsin Medical Group, Milwaukee (A.J.); and Vascular Center at Aurora St Luke's Medical Center, Milwaukee, WI (M.W.M.). publishing11@aurora.org.
Mark W
MW
Mewissen
D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use; D001803:Blood Transfusion; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006406:Hematoma / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D005343:Fibrinolytic Agents
aneurysm, false; hematoma; mortality