Complication rates for percutaneous lower extremity arterial antegrade access

Hypothesis: The antegrade access (AA) for percutaneous arterial interventions is associated with a higher complication rate than is the retrograde access (RA). Design: Retrospective case review. Setting: A statewide consortium for peripheral vascular interventions consisting of 13 Michigan hospitals collecting data on their endovascular procedures. Patients: Demographic and procedure data on all patients receiving a percutaneous peripheral arterial intervention were entered prospectively by a full-time clinical nurse specialist in each hospital site. Main Outcome Measures: We evaluated vascular complications as a composite of retroperitoneal hematoma, pseudoaneurysm, hematoma requiring blood transfusion, arteriovenous fistula, acute thrombosis, or the need for surgical repair of the access site. Results: In a 2-year period, we collected 6343 cases, of which 5918 had complete data regarding arterial access; of these, 745 (12.6%) were performed via an AA. There were fewer women and smokers (P<.001) in the AA group but more diabetic patients (P<.001). The indications for intervention were more frequently rest pain (P<.001) and limb salvage (P<.001) in the AA group. Multivariate regression analysis showed that the odds of complications were significantly higher with a larger sheath (95% confidence interval, 1.53-4.06; P<.001). Also, the incidence of blood transfusion and subsequent amputation was significantly higher in theAAgroup (P<.001). Conclusion: Endovascular procedures performed via an AA are more likely to result in perioperative complications and therefore should be used cautiously.