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Caution advised with antegrade access for percutaneous arterial interventions

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Vascular complication rates are higher with an antegrade rather than retrograde femoral approach to percutaneous endovascular procedures in the lower extremities, a Michigan team reports in the April issue of the Archives of Surgery.

Dr. M. Ashraf Mansour, with the Spectrum Health Medical Group in Grand Rapids, and colleagues note that percutaneous vascular interventions (PVIs) are increasingly used to treat patients with peripheral arterial disease. The researchers used data from a multicenter regional registry to compare the incidence and type of complications associated with antegrade access versus retrograde access for PVIs.

The registry included 5918 patients with complete data, the majority of whom had severe lower extremity claudication. Retrograde access was used in 5173 (87.4%) of these patients and antegrade access in 745 (12.6%), according to the report. There was no difference in the distribution of sheath sizes used in the two groups, and the use of manual pressure for access site hemostasis was similar.

The incidence of vascular access complications, such as arteriovenous fistula or need for surgical repair, was 5.9% in the antegrade access group compared with 3.2% in the retrograde access group (p<0.001), the investigators found.

The need for transfusion was also significantly higher with antegrade access than retrograde access (11.5% vs 5.6%), and corresponding rates of subsequent amputation were 5.4% vs 1.4%, Dr. Mansour and colleagues report.

They conclude,