Influence of Use of a Vascular Closure Device on Incidence and Surgical Management of Access Site Complications after Percutaneous Interventions

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 (TM)). 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. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.