Vascular Access-Site Complications in Chronic Total Occlusion Percutaneous Coronary Intervention. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Vascular access-site complications (VASC) can occur during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We compared the baseline and procedural characteristics, and outcomes of patients with versus without VASC in a large multicenter CTO PCI registry. VASC was defined as any of the following: small hematoma (hematoma < 5 cm), large hematoma (hematoma ≥ 5 cm), arteriovenous fistula, pseudoaneurysm and acute arterial closure. RESULTS: VASC occurred in 158 of 16,810 CTO PCIs (0.9%). VASC patients were older (67 ± 11 vs. 64 ± 10 years, p < 0.001), more likely to be women (28.4% vs. 19.1%, p = 0.004) and less likely to be current smokers (18.9% vs. 27.2%, p = 0.026). They were more likely to have at least one femoral access (89.2% vs. 75.3%, p < 0.001) and less likely to have any radial access (38.0% vs. 52.3%, p < 0.001). Transfemoral access was more common in patients with VASC (60.1% vs. 45.7%, p < 0.001). VASC cases had higher J-CTO (2.57 vs. 2.38, p = 0.05) and PROGRESS-CTO major adverse cardiac events (MACE) scores (3.27 vs. 2.58, p < 0.001). They had similar technical (87.3% vs. 87.1%, p > 0.9) and procedural (82.3% vs. 85.9%, p = 0.2) success, but higher MACE (6.3% vs. 1.9%, p < 0.001) and bleeding (23.4% vs. 0.4%, p < 0.001). Female gender (odds ratio [OR] 1.95, 95% confidence intervals [CI] 1.24-3.00, p = 0.003), at least one femoral access (OR 2.02, 95% CI 1.09-4.04, p = 0.034) and sheath size (7-F: OR 2.16, 95% CI 1.12-4.60, p = 0.031; 8-F: OR 2.11, 95% CI 1.03-4.70,p = 0.051) were associated with VASC in multivariable analysis. CONCLUSION: Female sex, femoral access and larger sheaths ≥ 7 F were associated with VASC in patients undergoing CTO PCI.

publication date

  • March 17, 2025

Research

keywords

  • Catheterization, Peripheral
  • Coronary Occlusion
  • Femoral Artery
  • Percutaneous Coronary Intervention

Identity

Scopus Document Identifier

  • 105000313821

Digital Object Identifier (DOI)

  • 10.1002/ccd.31501

PubMed ID

  • 40095762

Additional Document Info

volume

  • 105

issue

  • 7