Development and Validation of a Preprocedural Risk Score to Predict Access Site Complications After Peripheral Vascular Interventions Based on the Vascular Quality Initiative Database

Purpose: Access site complications following peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Prediction of access site complication risk may optimize PVI care; however, there is no tool designed for this. We aimed to create a clinical scoring tool to stratify patients according to their risk of developing access site complications after PVI. Methods: The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 27,997 patients who had undergone PVI at 131 North American centers. Clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI access site complications were included in a multivariate logistic regression model, with access site complications as the outcome variable. A predictive model was developed with a random sample of 19,683 (70%) PVI procedures and validated in 8,314 (30%). Results: Access site complications occurred in 939 (3.4%) patients. The risk tool predictors are female gender, age > 70 years, white race, bedridden ambulatory status, insulin-treated diabetes mellitus, prior minor amputation, procedural indication of claudication, and nonfemoral arterial access site (model c-statistic = 0.638). Of these predictors, insulin-treated diabetes mellitus and prior minor amputation were protective of access site complications. The discriminatory power of the risk model was confirmed by the validation dataset (c-statistic = 0.6139). Higher risk scores correlated with increased frequency of access site complications: 1.9% for low risk, 3.4% for moderate risk and 5.1% for high risk. Conclusions: The proposed clinical risk score based on eight preprocedural characteristics is a tool to stratify patients at risk for post-PVI access site complications. The risk score may assist physicians in identifying patients at risk for access site complications and selection of patients who may benefit from bleeding avoidance strategies

Vascular Medicine: A ‘Primary’ Specialty

Message from the Guest Editor introducing special issue on vascular disease

Vascular Medicine: A ‘Primary’ Specialty

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Type II Endoleak Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach to Contemporary Management

Elective endovascular aneurysm repair (EVAR) is the first-line therapeutic option for patients with infrarenal abdominal aortic aneurysm. However, endoleaks –– persistent blood flow outside the lumen of the stent graft (or endograft) but within the aneurysm sac or adjacent vascular segment being treated by the graft –– continue to be a persistent problem in the post-EVAR setting. The type II endoleak is the most common of these and can be a demanding challenge to address by standard endovascular techniques. Currently, two prominent endovascular techniques exist for the management of type II endoleaks: direct translumbar embolization and transarterial embolization. Both of these are fraught with their own limitations and complications. In this review, we describe the contemporary trends in management of type II endoleaks and introduce a novel endovascular technique to treat this challenging and common EVAR complication

Use of Coronary Techniques in Celiac and Hepatic Artery Stenting in Post-Hepatic Transplant Patients

Hepatic artery stenosis (HAS) remains a rare but serious complication after liver transplantation. While invasive surgical techniques were needed for HAS treatment in the past, recently endovascular techniques, including hepatic artery stenting, have been proven to be a safe and effective treatment. The present work focused on a review of the recent literature regarding HAS as well as recent cases demonstrating the various presentations of HAS and the variety of approaches to endovascular intervention. Our single-center experience has shown endovascular treatment of HAS to be safe and effective, including the two specific cases discussed here. While further research is needed, endovascular stenting as a treatment for HAS appears to be a promising, minimally invasive technique to help aid in the long-term health of post-liver transplant patients

Use of Coronary Techniques in Celiac and Hepatic Artery Stenting in Post-Hepatic Transplant Patients

Hepatic artery stenosis (HAS) remains a rare but serious complication after liver transplantation. While invasive surgical techniques were needed for HAS treatment in the past, recently endovascular techniques, including hepatic artery stenting, have been proven to be a safe and effective treatment. The present work focused on a review of the recent literature regarding HAS as well as recent cases demonstrating the various presentations of HAS and the variety of approaches to endovascular intervention. Our single-center experience has shown endovascular treatment of HAS to be safe and effective, including the two specific cases discussed here. While further research is needed, endovascular stenting as a treatment for HAS appears to be a promising, minimally invasive technique to help aid in the long-term health of post-liver transplant patients

Use of Coronary Techniques in Celiac and Hepatic Artery Stenting in Post-Hepatic Transplant Patients

Hepatic artery stenosis (HAS) remains a rare but serious complication after liver transplantation. While invasive surgical techniques were needed for HAS treatment in the past, recently endovascular techniques, including hepatic artery stenting, have been proven to be a safe and effective treatment. The present work focused on a review of the recent literature regarding HAS as well as recent cases demonstrating the various presentations of HAS and the variety of approaches to endovascular intervention. Our single-center experience has shown endovascular treatment of HAS to be safe and effective, including the two specific cases discussed here. While further research is needed, endovascular stenting as a treatment for HAS appears to be a promising, minimally invasive technique to help aid in the long-term health of post-liver transplant patients

Percutaneous femoral artery access strategies in patients undergoing peripheral vascular intervention: trends of use and in-hospital outcomes

BACKGROUND: The efficacy of common femoral artery (CFA) access in preventing access site complications (ASC) in patients undergoing peripheral vascular intervention (PVI) by palpation alone, with fluoroscopy guidance (FG) or with ultrasound guidance (UG) remains unclear. We aimed to elucidate trends of use of each CFA access technique in patients undergoing PVI and to compare patient outcomes. METHODS: We analyzed 75,833 PVIs performed between January 2010 and June 2016 at 210 centers participating in the Society of Vascular Surgery-Vascular Quality Initiative database. RESULTS: FG, UG and palpation alone were used in 26.9%, 49.7% and 23.3% of PVI, respectively, with an overall ASC rate of 3.33%. UG increased from 37.7% to 53.7% (p\u3c0.001) in the second half of the study period. UG PVIs were more likely to include vascular closure devices (61.6% vs 51.2%, p\u3c0.001) and have same-day discharge (48.4% vs 41.1%, p\u3c0.001). In adjusted analysis, FG was protective of ASC (odds ratio 0.85; 95% confidence interval, 0.77-0.93; p\u3c0.001). A physician using the same CFA access strategy in \u3c60% of their PVIs was predictive of ASC (odds ratio 1.18; 95% confidence interval, 1.08-1.3; p\u3c0.001). CONCLUSIONS: FG puncture of the CFA is associated with fewer ASC while inconsistent CFA access strategy is associated with increased ASC after PVI

Outcomes after external physical compression versus vascular clouse device use after peripheral vascular intervention via femoral approach

Background: The comparative effectiveness of external physical compression and different vascular closure devices (VCD) in reducing access site complications (ASC) after peripheral vascular interventions (PVI) remains unclear. Methods: We compared short-term outcomes among 57,166 patients in the multicenter, prospective Vascular Quality Initiative Registry who underwent PVI via femoral artery approach between August 2007 and January 2015. Patients were grouped by the access site hemostasis strategies (ASHS) they received (manual compression or VCD), and propensity score matching was used to obtain a balanced cohort of 13,538 patients in each treatment group. Results:ASHS included manual compression (50.8%), suture VCD (9.8%), clip VCD (8.8%), polyethylene glycol collagen plug (CP) VCD (13.3%), sponge CP (9.9%) and other VCD (7.5%). Unadjusted ASC rates were 4.1%, 2.1%, 2.4%, 3.1%, 2.3% and 2.9%, respectively. In the match groups, patients who received VCD had a lower incidence of ASC (2.6% vs 4.41%, p Conclusions: Patients who received VCD after PVI via femoral approach had fewer complications and improved mortality than those who received external physical compression alone. Randomized comparisons of these agents are needed to confirm these findings