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

ABSTRACT

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.