Access Site Complications of Peripheral Endovascular Procedures: A Large, Prospective Registry on Predictors and Consequences

Purpose The purpose of this study was to investigate predictors and consequences of acute vascular access site complications (ASCs) related to peripheral endovascular diagnostic or interventional procedures. Despite improvement of puncture techniques, access site–related morbidity and mortality is still considerable. Materials and Methods A total of 5263 participants who underwent 5385 endovascular procedures at a single center were consecutively included in this prospective, observational study. Primary outcomes were ASCs defined as composite of puncture site hematoma, pseudoaneurysm, arteriovenous fistula, and overt puncture site bleeding on the first day after procedure. Results ASCs occurred in 16.6% of peripheral endovascular procedures (78.6% hematomas, 18.9% pseudoaneurysms, 1.4% arteriovenous fistulas, 1.1% overt bleedings). Independent predictors were advanced age [odds ratio (OR) per 10 years: 1.12, p=0.004], female sex (OR men, 0.77; p=0.001), lysis (OR 3.56; p<0.001), periprocedural heparin (OR 5000 IU, 1.96; p=0.001; OR >5000 IU, 3.56; p=0.02), time to access (OR per 10 seconds, 1.01; p<0.001), sheath size (OR per French, 1.59; p<0.001), brachial artery access (OR vs retrograde transfemoral, 4.58; p<0.001), and compression only (OR Angio-Seal, 0.57, p=0.02; ProGlide, 0.36, p<0.001; FemoSeal, 0.57, p<0.001). Treatment was required in 20.2% and prolonged hospitalization in 17.7% of ASC. Three participants died from access site–related bleeding. Conclusion ASCs after peripheral endovascular procedures are associated with advanced age, female sex, periprocedural antithrombotic medication, brachial artery access, postinterventional bleeding, and nonuse of vascular closure devices.

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Vascular puncture site complications - diagnosis, therapy, and prognosis

VASA ◽

10.1024/0301-1526/a000551 ◽

2016 ◽

Vol 45 (6) ◽

pp. 461-469 ◽

Cited By ~ 6

Author(s):

Wolfgang Mlekusch ◽

Irene Mlekusch ◽

Schila Sabeti-Sandor

Keyword(s):

Vascular Access ◽

Endovascular Procedures ◽

Puncture Site ◽

Access Site ◽

The Past ◽

Technical Advances ◽

Diagnostic Work ◽

Diagnosis Therapy ◽

Work Up ◽

Diagnostic Work Up

Abstract. The numbers of endovascular procedures have been noted to substantially increase over the past two decades. Besides all the technical advances and the increasing skills of more and more trained interventionists, the vascular access site still offers the possibilities and carries the risk of access site complications, which have not been changed dramatically over the past years. Guidelines on the vascular puncture procedure itself are lacking. Complications at different vascular access sites presentclinically different, require different diagnostic work up and therapy. The aim of the following review is to systematically list the most likely vascular access site complications their diagnosis and if necessary the proper treatment.

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Complication Rates of Percutaneous Brachial Artery Puncture: Effect of Live Ultrasound Guidance

10.21203/rs.3.rs-747907/v1 ◽

2021 ◽

Author(s):

Konrad Appelt ◽

Martin Takes ◽

Christoph J Zech ◽

Tilman Schubert

Keyword(s):

Upper Extremity ◽

Brachial Artery ◽

Complication Rates ◽

Puncture Site ◽

Access Site ◽

Femoral Access ◽

Technical Success Rate ◽

Us Guidance ◽

Major Complications ◽

The Impact

Abstract PurposeThe current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications.Materials and MethodsThis is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 hours, either achieved hemostasis.Results75 procedures in 71 patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (11/14.7%), upper extremity (36/48%), visceral (20/26.7%), and lower extremity (12/16%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred.ConclusionExclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

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Complication rates of percutaneous brachial artery puncture: effect of live ultrasound guidance

CVIR Endovascular ◽

10.1186/s42155-021-00262-2 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

K. Appelt ◽

M. Takes ◽

C. J. Zech ◽

KA Blackham ◽

T. Schubert

Keyword(s):

Upper Extremity ◽

Brachial Artery ◽

Complication Rates ◽

Puncture Site ◽

Access Site ◽

Femoral Access ◽

Technical Success Rate ◽

Us Guidance ◽

Major Complications ◽

The Impact

Abstract Purpose The current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications. Materials and methods This is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis. Results Seventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred. Conclusion Exclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

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Simple and Durable Resolution of Steal Syndrome by Conversion of Brachial Artery Arteriovenous Fistulas to Proximal Radial Artery Inflow

The Journal of Vascular Access ◽

10.5301/jva.2010.2492 ◽

2010 ◽

Vol 11 (4) ◽

pp. 352-355 ◽

Cited By ~ 17

Author(s):

Brett A. Beecher ◽

Kevin E. Taubman ◽

William C. Jennings

Keyword(s):

Radial Artery ◽

Brachial Artery ◽

Arteriovenous Fistulas ◽

Steal Syndrome

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Giant brachial artery aneurysm as a rare complication of a dialysis shunt

The Journal of Vascular Access ◽

10.1177/1129729819886746 ◽

2019 ◽

Vol 21 (5) ◽

pp. 799-802 ◽

Cited By ~ 1

Author(s):

Elisa Maria Schilling ◽

Malte Weinrich ◽

Thomas Heller ◽

Sebastian Koball ◽

Andreas Neumann

Keyword(s):

Brachial Artery ◽

Rare Complication ◽

Artery Aneurysm ◽

Giant Aneurysm ◽

Magnetic Resonance Imaging Scan ◽

Dialysis Access ◽

Large Tumor ◽

Arteriovenous Fistulas ◽

Arteriovenous Shunts ◽

Ongoing Care

Our patient exhibited a large tumor on his right upper arm where his former dialysis access site had been. X-ray, Doppler ultrasound, and magnetic resonance imaging scan could not fully reveal the nature of that tumor. Eventually, a surgical approach showed a giant aneurysm of the inflowing brachial artery to a partially obliterated arteriovenous fistula. This case highlights the importance of ongoing care for patients with arteriovenous shunts. Even arteriovenous fistulas, that are obliterated or no longer in use, can, especially when immunosuppressant therapy and other vascular risk factors are added to the overall cardiovascular risk, transform and endanger the health of our patients.

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Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access

Vascular ◽

10.1177/17085381211004306 ◽

2021 ◽

pp. 170853812110043

Author(s):

Jay Patel ◽

Stephanie Chang ◽

Shaan Manawar ◽

John Munn ◽

Mark C Rummel ◽

...

Keyword(s):

Percutaneous Intervention ◽

Dialysis Access ◽

Arteriovenous Graft ◽

Hemodialysis Access ◽

Upper Arm ◽

Access Site ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts ◽

The Mean

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

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Fundamentals of Endovascular Surgery

10.2310/tywc.3061 ◽

2018 ◽

Author(s):

C Louis Garrard III

Keyword(s):

Endovascular Procedures ◽

Endovascular Surgery ◽

Patient Assessment ◽

Endovascular Techniques ◽

Access Site ◽

Arterial Access ◽

Rapid Pace ◽

Angioplasty And Stenting ◽

Access Technique ◽

Preoperative Patient

The technology and innovations in endovascular surgery are advancing at a dramatically rapid pace. In this review, the fundamentals of endovascular procedures that are necessary to take advantage of this advancing technology are outlined and explained. Preoperative patient assessment, appropriate access site selection, and vascular access technique are explained. The selection and use of appropriate guide wires, catheters, and sheaths are also reviewed and outlined. The basic techniques for angioplasty and stenting are described as well. Finally, appropriate closure techniques and postprocedure care are described. As with any operation or procedure, mastering the fundamentals is necessary to proceed to advanced intervention. This review contains 10 figures, 1 table, 1 video, and 13 references. Key words: access troubleshooting, arterial access, endovascular instruments, endovascular preparation, endovascular techniques

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