[Arterial Access Site Complications after Percutaneous Interventions with Special Regard to the Application of Vascular Closure Devices]. / Arterielle Zugangswegkomplikationen nach perkutanen Interventionen unter besonderer Berücksichtigung der Verwendung von Verschlusssystemen.

Due to an increase in the number of performed endovascular procedures, the number of local access site complications is rising too. Used mainly for treatment of peripheral arterial disease and coronary heart disease, endovascular procedures are gaining importance. Access site complications include bleeding, haematoma, pseudoaneurysm, arteriovenous fistula and arterial thrombosis. Aiming to reduce immobilisation, length of hospital stay, costs and access site complications, vascular closure devices (VCD) were introduced in the mid 1990s, but current trials failed to demonstrate the superiority of these devices compared to conventional manual compression if it comes to access site complications. We retrospectively evaluated all patients who were treated surgically due to access site complications between 2001 and 2012 in our institution. In total, 522 patients needed vascular surgery to treat different access site complications. During this period, 90,538 percutaneous interventions were performed in our institution, leading to a total incidence of 0.58 % of access site complications. Depending on the frequency of application of VCDs, patients have been grouped in groups A-C. With the more frequent use of VCDs, the incidence of access site complications increased and, in particular, ischaemic complications were seen more often. In conclusion, the application of VCDs to prevent access site complications is questionable and not justified when looking at published data.

Influence of use of a vascular closure device on incidence and surgical management of access site complications after percutaneous interventions.

AIM: The study aimed to evaluate vascular access site complications (ASCs) after percutaneous interventions (PIs) in our institution for changes in annual incidence and surgical management after increased usage of a vascular closure device (VCD; in all cases: Angioseal™). MATERIAL AND METHODS: All patients who underwent repair of arterial pseudo-aneurysms or access site stenosis/occlusion leading to leg ischaemia (LI) or new-onset disabling claudication (CI) after PIs between 2001 and 2008 were included. Annual rates of procedures and methods of repair of ASC were evaluated. RESULTS: After a total of 58 453 PIs, 352 patients (0.6%) were operated on for: pseudo-aneurysms (n = 300; 0.51%); and local stenosis/occlusion leading to LI/CI (n = 52; 0.09%). Numbers increased significantly with more widespread VCD use: group A (2001-2004: 2860 VCDs; 28 284 PIs; 10.1%): n = 132 (0.47%); and group B (2005-2008: 11,660 VCDs; 30,169 PIs; 38.6%): n = 220 (0.73%) (p < 0.001). In contrast to similar rates of pseudo-aneurysms (group A: n = 124; 0.44%; group B: n = 176; 0.58%; not significant), a significant increase of operations for local stenoses/occlusions was seen with widespread VCD use: n = 8 versus n = 44 (p < 0.001). CONCLUSIONS: In the era of VCDs, complications are rare. However, use of these devices is not without complications, and may require complex reconstructions.

[Operate, cancel, postpone or select?] / Operieren, Absagen, Verschieben oder Selektionieren?: Ergebnisse einer Umfrage unter gefäßchirurgischen Zentren während der Covid-19-Krise in Österreich.

Regional centers performing vascular surgery in Austria (n = 15) were invited in mid-April 2020 by the Austrian Society of Vascular Surgery (ÖGG) to participate in a nationwide survey about implications of the COVID-19 pandemic. Ultimately, a total of 12 centers (80%) answered the questionnaire.All centers were confronted with patients who tested positive for COVID-19 and 75% also had medical personnel who were positive. In contrast, only 25% of the departments of vascular surgery had positively tested patients and 33% had positive staff members. In all departments of vascular surgery elective vascular procedures were either stopped (cancelled or deferred) or selectively limited, including patients with asymptomatic carotid stenosis, aortic aneurysms smaller than 7 cm, peripheral arterial aneurysm, peripheral artery occlusive disease Fontaine stage II and varicosities. All centers continued to carry out operations for all types of vascular surgical emergencies. The strategies of the centers were heterogeneous for patients with chronic ulcers, chronic mesenteric insufficiency, asymptomatic aortic aneurysms larger than 7 cm and shunt surgery.Decisions on surgery cancellation seemed to be particularly problematic due to the uncertain time period of the COVID-19 measures. As a consequence, the risk associated with cancellation or delayed treatment was difficult to assess. At present, especially indications with nonuniform management strategies need selective attention and additional analysis in single center and multicenter studies. In addition, patients might suffer from relevant psychological problems because of surgery cancellations. Changes in the daily routine due to the COVID-19 pandemic may have a long-term impact on health status and may show significant demographic and geographic variations.