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Access site complications (ASC) after peripheral vascular interventions (PVI) are associated with prolonged hospitalization and increased mortality. The association between the use of vascular closure devices (VCDs) and ASC as a function of a patient’s preprocedural risk of complication is unknown. Our aim was to determine the use of VCD and associated post-PVI ASC in a nationally representative PVI population.
The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 82,476 patients who underwent transfemoral PVI at 207 North American centers from April 2010 to May 2016. A previously validated risk tool was used to stratify patients according to preprocedural risk for post-PVI ASC. The primary endpoint was post-PVI ASC prior to hospital discharge.
ASC occurred in 3.3% of patients (n=2733 patients). VCD were used more commonly than manual compression (53.0% vs. 47.0%; p<0.001). VCD were used less often in high-risk patients than those at intermediate risk (49.2% vs 51.4%, p=0.012) and those at low risk (49.2% vs 55.0% to low-risk patients, p<0.001). ASC were lower among patients receiving VCD in the low risk (1.96% vs 2.94%, p<0.001), intermediate (3.18% vs 4.91%, p<0.001) and high risk groups (3.95% vs 7.25%, p<0.001).
In a large multicenter PVI registry VCDs were associated with lower ASC rates, especially among patients at greatest risk for complications. However, these devices were less often used among higher-risk patients. This risk-treatment paradox may be reversed by routine preprocedural patient risk stratification to individualize VCD use.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention