Department of Cardiology, Juntendo University Nerima Hospital, Nerimaku, Tokyo, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
PLoS One. 2021 Mar 12;16(3):e0248416. doi: 10.1371/journal.pone.0248416. eCollection 2021.
A common complication of endovascular treatment for femoropopliteal lesions is bleeding at the vascular access site. Although risk factors of bleeding-associated complications at the approach site have been reported, the results have been inconclusive. Hence, this study aimed to assess the predictors of bleeding-associated complications at the approach site in patients undergoing endovascular treatment for femoropopliteal lesions.
This retrospective, single-center, observational study included consecutive patients who underwent endovascular treatment (n = 366, 75% male, 72.4±9.9 year) for peripheral arterial disease with claudication and critical limb ischemia in our hospital from January 2010 to December 2017. We divided the patients into bleeding and non-bleeding groups, depending on whether bleeding-associated complications occurred at the approach site. Bleeding-associated complications were defined according to the Bleeding Academic Research Consortium criteria types 2, 3, and 5.
Altogether, 366 endovascular treatment procedures and 404 arterial accesses were performed for femoropopliteal lesions in 335 peripheral arterial disease patients with claudication and 69 critical limb ischemia patients. We recorded 35 postprocedural bleeding-associated complications at the approach site (9%), all of which were hematomas. The predictors of increased bleeding-associated complications were age ≥ 80 years (bleeding vs. non-bleeding group, 43% vs. 25%, p<0.05) and antegrade cannulation of the common femoral artery (48% vs. 69%, p<0.05). Ultrasound-guided puncture reduced bleeding-associated complications (odds ratio, 0.28; 95% confidence interval, 0.004-0.21; p<0.05). In contrast, there was no significant difference in puncture site calcification between the groups (bleeding vs. non-bleeding groups, 29% vs. 21%, p = 0.29).
Ultrasound-guided puncture is associated with a decrease in bleeding-associated complications at the approach site, regardless of the presence of calcified plaque. It is particularly effective and should be more actively used in patients aged ≥80 years and for antegrade cannulation of the common femoral artery.
血管腔内治疗股腘病变的常见并发症是血管入路部位出血。尽管已有报道血管入路部位出血相关并发症的危险因素，但结果尚无定论。因此，本研究旨在评估接受腔内治疗股腘病变的患者血管入路部位出血相关并发症的预测因素。
这是一项回顾性、单中心、观察性研究，纳入了 2010 年 1 月至 2017 年 12 月期间在我院因间歇性跛行和严重肢体缺血而接受血管腔内治疗（n=366，75%为男性，72.4±9.9 岁）的外周动脉疾病患者。我们根据血管入路部位是否发生出血相关并发症，将患者分为出血组和非出血组。根据出血学术研究联合会（BARC）标准 2、3 和 5 型定义出血相关并发症。
共有 366 例血管腔内治疗手术和 404 次动脉入路用于治疗 335 例间歇性跛行和 69 例严重肢体缺血患者的股腘病变。我们记录了 35 例血管入路部位术后出血相关并发症（9%），均为血肿。年龄≥80 岁（出血组 vs. 非出血组，43% vs. 25%，p<0.05）和股总动脉顺行穿刺（出血组 vs. 非出血组，48% vs. 69%，p<0.05）是增加出血相关并发症的预测因素。超声引导下穿刺可降低出血相关并发症（比值比，0.28；95%置信区间，0.004-0.21；p<0.05）。相比之下，两组穿刺部位钙化无显著差异（出血组 vs. 非出血组，29% vs. 21%，p=0.29）。
超声引导下穿刺与血管入路部位出血相关并发症减少有关，与钙化斑块的存在无关。对于年龄≥80 岁的患者和股总动脉顺行穿刺，超声引导下穿刺尤其有效，应更积极地使用。
