Predictors of Groin Access Major Complications: a 10 year retrospective review
Abdallah Naddaf, MD, Ravishankar Hasanadka, MD, Stephen Williams, BS, Douglas Hood, MD, Kim Hodgson, MD.
Southern Illinois School of Medicine, Springfield, IL, USA.
OBJECTIVES: Major complications from common femoral artery access occur rarely, which makes studying predictors difficult without extremely large cohorts. The approach of this study was to look at all the patients we treated with femoral pseudoaneurym surgical repair or thrombin injection over a 10-year period, and then compare them to our local data set of peripheral interventions to determine the predictors of major complications.
METHODS: We retrospectively identified through billing codes patients who were treated with thrombin injection or surgical repair for pseudoaneurysms between January 2008 and April 2018. Patients who had alternative access sites or were repaired for reasons that were not post-catheterization complications were excluded. The data sample from our institution’s peripheral vascular intervention registry of the Vascular Quality Initiative database spanning from January 2013 to December 2017 was then extracted. A Chi-square analysis was then performed between patients who had the outcome of operative intervention for a pseudoaneurysm complication and those who did not to identify significant contributing variables. A full model linear regression was then used to determine odds ratios for significant predictors.
RESULTS: There were 77 patients who required thrombin injection or open repair for access related pseudoaneurysms, and 324 patients who did not. Complications occurred more often in patients who were female (57.1 vs 38.6%), obese (59.7 vs 33.3%), hypertensive (96.1 vs 79.3%), who received a sheath >6Fr (32.4 vs 13%), postoperative anticoagulation (52.1 vs 24.2%), and periprocedural P2Y12 inhibitors (48.7 vs 28%, p<.05 for all). Less complications were observed in patients who had ipsilateral peripheral arterial disease (68 vs 38.8%), a closure device used (42.9 vs 8.45%), and bilateral access (15.1 vs 5.3%). The strongest predictors of complications were found to be not using a closure device (OR=5.2), hypertension (OR=19) and sheath size >6Fr (OR= 4.9). The use of ultrasound guidance was not protective (13.51 vs 16.4%, p=.5).
CONCLUSIONS:
Our findings validate the predictors of access site complications from large databases as well as the use of a closure device being protective. Our data notably does not support ultrasound guidance.
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