Author + information
- Daniel Ortiz,
- Khawaja Afzal Ammar,
- Suhail Allaqaband,
- Tanvir Bajwa and
- Mark Mewissen
Access site complications (ASC) after peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Arteriotomy closure devices (ACD) have been shown to reduce ASC, however, their routine use for the specific purpose of reducing ASC is not recommended (ACC/AHA Class III). We aimed to develop, validate and implement a tool to stratify patients by risk for ASC after PVI and to assess the effect of clinical incorporation of it on ACD utilization.
The Society for Vascular Surgery's Vascular Quality Initiative database yielded 27,997 patients who underwent PVI at 131 North American centers from August 2007 to January 2014. A risk tool was developed in a random 70% sample using clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI ASC and validated in 30% of procedures. Beginning in June 2016, the risk tool was incorporated in a tertiary center's preprocedural time-out to provide individualized ASC estimates. The center's PVI data from August 2015 and March 2017 were analyzed and using a pre-post design, ACD use before and after this implementation was compared for patients at moderate and high risk.
The risk tool successfully identified 742 patients (validated with registry data; model c-statistic = 0.638, validation Brier score = 0.033) and stratified these patients into intermediate risk and high risk groups with ASC rates of 3.6% and 7.5%, respectively. While the ACD use prevalence (16.4% vs 13.9%, p= 0.75) and ASC prevalence (3.36% vs 3.72%, p=0.84) were similar before and after incorporation of the risk tool, the use of ACD increased in intermediate risk patients from 7.7% to 17.0% (p=0.28) and in high risk patients from 13.5% to 17.1% (p=0.62), failing to reach statistical significance.
The novel risk tool identified patients at twice the risk for ASC and its implementation into clinical practice suggests a reversal of a risk-treatment paradox, through an increase in ACD use in patients at high risk and decreased use in intermediate-risk patients. This trend may reach statistical significance in future with increasing sample size.
Poster Hall, Hall A/B
Saturday, March 10, 2018, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Complications: Assessing Risk
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1157-301
- 2018 American College of Cardiology Foundation