RT Journal
A1 Wheatley BJ, Mansour M, Grossman P, et al
T1 COmplication rates for percutaneous lower extremity arterial antegrade access
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD April 1
VO 146
IS 4
SP 432
OP 435
DO 10.1001/archsurg.2011.47
UL http://dx.doi.org/10.1001/archsurg.2011.47
AB Hypothesis 
    The antegrade access (AA) for percutaneous arterial interventions is associated with a higher complication rate than is the retrograde access (RA).Design 
    Retrospective case review.Setting 
    A statewide consortium for peripheral vascular interventions consisting of 13 Michigan hospitals collecting data on their endovascular procedures.Patients 
    Demographic and procedure data on all patients receiving a percutaneous peripheral arterial intervention were entered prospectively by a full-time clinical nurse specialist in each hospital site.Main Outcome Measures 
    We evaluated vascular complications as a composite of retroperitoneal hematoma, pseudoaneurysm, hematoma requiring blood transfusion, arteriovenous fistula, acute thrombosis, or the need for surgical repair of the access site.Results 
    In a 2-year period, we collected 6343 cases, of which 5918 had complete data regarding arterial access; of these, 745 (12.6%) were performed via an AA. There were fewer women and smokers (P &lt; .001) in the AA group but more diabetic patients (P &lt; .001). The indications for intervention were more frequently rest pain (P &lt; .001) and limb salvage (P &lt; .001) in the AA group. Multivariate regression analysis showed that the odds of complications were significantly higher with a larger sheath (95% confidence interval, 1.53-4.06; P &lt; .001). Also, the incidence of blood transfusion and subsequent amputation was significantly higher in the AA group (P &lt; .001).Conclusion 
    Endovascular procedures performed via an AA are more likely to result in perioperative complications and therefore should be used cautiously.