Percutaneous femoral artery access strategies in patients undergoing peripheral vascular intervention: trends of use and in-hospital outcomes
Ortiz D, Nfor T, Allaqaband S, Bajwa T, Mewissen MW. Percutaneous Femoral Artery Access Strategies In Patients Undergoing Peripheral Vascular Intervention: Trends Of Use And In-Hospital Outcomes. Journal of the American College of Cardiology. 2017;69(11):1364. doi:10.1016/s0735-1097(17)34753-8.
BACKGROUND: The efficacy of common femoral artery (CFA) access in preventing access site complications (ASC) in patients undergoing peripheral vascular intervention (PVI) by palpation alone, with fluoroscopy guidance (FG) or with ultrasound guidance (UG) remains unclear. We aimed to elucidate trends of use of each CFA access technique in patients undergoing PVI and to compare patient outcomes.
METHODS: We analyzed 75,833 PVIs performed between January 2010 and June 2016 at 210 centers participating in the Society of Vascular Surgery-Vascular Quality Initiative database.
RESULTS: FG, UG and palpation alone were used in 26.9%, 49.7% and 23.3% of PVI, respectively, with an overall ASC rate of 3.33%. UG increased from 37.7% to 53.7% (p<0.001) in the second half of the study period. UG PVIs were more likely to include vascular closure devices (61.6% vs 51.2%, p<0.001) and have same-day discharge (48.4% vs 41.1%, p<0.001). In adjusted analysis, FG was protective of ASC (odds ratio 0.85; 95% confidence interval, 0.77-0.93; p<0.001). A physician using the same CFA access strategy in <60% of their PVIs was predictive of ASC (odds ratio 1.18; 95% confidence interval, 1.08-1.3; p<0.001).
CONCLUSIONS: FG puncture of the CFA is associated with fewer ASC while inconsistent CFA access strategy is associated with increased ASC after PVI.