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Ultrasound Guided Arterial Access is Associated with Decreased Arterial Complications
Danielle N. Campbell, MD, Adina Robinson, PhD, Andrew Plaska, Hannah Hill, Matthew Sherman, Stefan Garcia, Simanjit Mand, John E. Rectenwald, MD, Peter K. Henke, MD.
University of Michigan, Ann Arbor, MI, USA.
Objective:
Multiple specialties use percutaneous arterial access to perform a range of interventional vascular procedures. Vascular Surgeons manage many of the complications of access. We reviewed our institution to assess the rate of access complications, and factors associated with these complications.
Methods:
All cases involving arterial access completed at our institution from May-December 2010 were identified using CPT codes (N = 1584 cases). Patient demographics as well as the details surrounding each case (service performing the intervention, site of access, ultrasound use, French size, micropuncture technique, closure device, peri and post-operative anticoagulation and/or platelet therapy, and complications) were extracted. Complications were defined as those related to vascular access specifically. These complications ranged from minor (hematoma, arterial-venous fistula and psuedoaneursym), to serious (operative intervention, retroperitoneal hematoma, arterial dissection, and thrombosis). Descriptive, univariate, and multivariate logistical regression statistics were used.
Results:
The mean age of our patients was 51 years old, with a mean BMI of 28.3. Most had hypertension (53%) and were smokers (50%). Only 19% had DM and 16% had PAD. The mean French size used was 5.4, and 51% of cases were completed using a micropuncture technique. Only 19% of arterial access was completed using ultrasound guidance while 14% of cases utilized a closure device. Most patients (54%) were anti-coagulated during or prior to their procedure, yet only 18% were reversed, and 35% remained on post-operative anti-coagulation or anti-platelet therapy. Access related complications occurred in 3% (N = 54) of this cohort. Of the factors assessed, only ultrasound guided access was associated independently with fewer access complications (OR=0.371; 95% CI: .145-.952, p= .039)
Conclusions:
Arterial access complications were lessened with ultrasound guided access. No other factor was significantly associated with complications. Further assessment of access techniques may suggest that ultrasound guided access be the standard of care.
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