PC090. Risk Score for Groin Access Complication in Ultrasound-Guided Percutaneous Aortic Procedures

Abstract

Ultrasound-guided access for percutaneous endovascular aortic procedures has been increasingly used. We developed a prediction model to risk stratify patients for access site complications following ultrasound-guided percutaneous approach. We performed a retrospective institutional review of consecutive patients who underwent percutaneous endovascular repair of emergent and elective aortic pathology, from 2014 to 2016. We excluded patients undergoing initial femoral artery (FA) cutdown, endoleak treatment, or aortic arch reconstruction. Our primary outcome was groin access site complication, which included bleeding, thrombosis, infection, and conversion to femoral cutdown. We created a 15-point risk model for groin access complication using logistic regression. We identified 292 FAs from 152 patients undergoing endovascular aortic repair procedures (endovascular aortic aneurysm repair 76.8%, fenestrated endovascular aortic aneurysm repair 7.7%, thoracic endovascular aortic aneurysm repair 15.5%). Surgeons used percutaneous access in 97.3% of FAs (2.7% underwent planned femoral endarterectomy), with 100% ultrasound use and 100% initial success rate. Superficial FA access was performed in three arteries because of prior common FA interposition grafts. There were 18 (6%) access site complications (8 bleeding, 9 thrombosis, 1 infection) leading to immediate (n = 12) or delayed (n = 5) conversion to cutdown. Factors independently associated with percutaneous access site complication were sheath outer diameter to FA diameter ratio (odds ratio [OR], 58.9; 95% confidence interval [CI], 3.5-985.8; P = .005), morbid obesity with a body mass index of >40 kg/m2 (OR, 16.0; 95% CI, 3.0-84.5; P = .001), FA stenosis of >50% (OR, 52.1; 95% CI, 7.7-351.5; P ≤ . 001), FA stenosis of >75% (OR, 271.5; 95% CI, 15.1-4888.6; P ≤ .001), and postoperative anticoagulation (OR, 10.5; 95% CI, 2.0-54.0; P = .005). A risk prediction model based on these criteria produced a C statistic of .91, a Hosmer-Lemeshow goodness of fit of 0.99, and a Brier score of .03. A risk score of >6 of 15 corresponded with a >10% probability of groin access complication (Table). Percutaneous ultrasound-guided access can be safely performed in almost all patients undergoing endovascular aortic procedures; however, access site failures still occur. Application of this risk score can help identify patients at high risk for complications after initial FA ultrasound-guided percutaneous access.TableRisk score and corresponding access site failure risk, frequency, and cumulative frequencyCriteriaPointsTotal pointsPredicted risk of access site failure, %Frequency, %Cumulative frequency, %Sheath: FA diameter0.0621.321.31.160.021.3 ≤0.502.4121.743.0 0.51-0.65131.038.681.6 >0.66342.68.0989.756.4089.7Morbid obesity (BMI > 40 kg/m2)614.97.096.7731.02.2198.9 No0853.50.499.3 Yes3974.601001088.27100Degree of FA narrowing1195.001001297.90100 <50%01399.20100 >50%41499.70100 >75%61599.90100Postoperative anticoagulation No0 Yes3BMI, body mass index; FA, femoral artery. Open table in a new tab