O11 – Femke Groenewegen – LUMC

ULTRASOUND GUIDED VERSUS NON-ULTRASOUND GUIDED ANGIO-SEALTM VASCULAR HEMOSASIS AFTER ENDOVASCULAR TREATMENT FOR PERIPHERAL ARTERY DISEASE – AN OBSERVATIONAL STUDY

Samenvatting:
Background
Vascular access complications after endovascular treatment for peripheral artery disease (PAD) are relatively frequent, even after the use of vascular closure devices (VCD). This study investigates the impact of a protocol change towards the use of ultrasound-assisted Angio-SealTM closure on vascular complications, compared with non-ultrasound guided vascular closure.

Methods
All endovascular procedures for PAD from 2017-2018 (Group 1: non-US-guided) and 2020-2022 (Group 2: Ultrasound-guided) were included in this retrospective study. Inclusion criteria were endovascular treatment for PAD in the lower extremities with femoral access and use of Angio-SealTM at femoral access site. Exclusion criterium was acute ischemia. The primary endpoints were total number of complications, number of minor complications and number of major complications at vascular access site.

Results
1298 vascular access closures in 826 patients were included. The ultrasound-guided group showed a significant lower rate of overall complications (n=53, 7.5% vs n=75, 12.6%, p=.002), minor complications (n=49, 7.0% vs n=58, 9.9%, p=0.001) and major complications (n=4, 0.6% vs n=16, 2.7%, p=0.001). Multivariate analysis showed significantly fewer overall complications (Odds Ratio (OR) 0.696, 95%-CI 0.459-1.056, p=0.088) after ultrasound-guided deployment of the VCD. Ultrasound-guidance lowered the chance of major vascular access complications significantly (OR 0.210, 95%-CI 0.070-0.635, p=0.006). Furthermore, severe calcification was shown to be an individual predictor of complications after femoral vascular access (OR 2.014, 95%-CI 1.341-3.025, p=0.001).

Conclusion
The use of ultrasound when deploying the Angio-SealTM device results in to a significant decrease in vascular access complications and could be of significant clinical relevance in PAD-patients. Severe calcification is an individual predictor of vascular access complications.