Ultrasound-guided vascular access and modified postprocedural care reduced total vascular complications compared to conventional access (4% vs. 9%; OR 0.48; 95% CI 0.32-0.73; p<0.001).
Cohort (n=1,501)
No
Does ultrasound-guided vascular access and modified post-interventional care reduce vascular complications in patients undergoing electrophysiological procedures?
Implementing ultrasound-guided vascular access with a figure-of-8 suture and reduced bed rest significantly decreases vascular complications after electrophysiological procedures.
Odds Ratio: 0.48 (95% CI 0.32–0.73)
Absolute Event Rate: 4% vs 9%
p-value: p=<0.001
ABSTRACT Background Vascular access and postprocedural access site management remain the leading causes for postprocedural complications following interventional electrophysiological (EP) procedures. Method Patients were consecutively included in a prospective registry (TRUST, NCT05521451). Two vascular access and groin‐site management protocols that changed as an institutional standard at a cut‐off date (August 15, 2022) were compared. Group I used conventional access with an 8‐h pressure bandage and bed rest. Group II utilized ultrasound‐guided access, figure‐of‐8 suture, a 2‐h pressure bandage, and 6 h total bed rest. Minor complications included hematoma, bleeding, AV fistula, or pseudoaneurysm not requiring intervention. Major complications involved any incident necessitating intervention (transfusion, surgery, interventional therapy) or retroperitoneal hematoma. Results A total of 1672 procedures in 1501 patients (median age 65 (IQR 56.74) years, 38% female) were analyzed. Clinical features were balanced with the exception of a higher body mass index (median 27 24;31 vs. 26 24;30, p = 0.011) and more frequent arterial hypertension (63% vs. 56%, p = 0.003) in Group I. Total vascular complication rate was 9% (69/780 procedures) for Group I, and 4% (40/892 procedures) for Group II (OR 0.48 95% CI: 0.32–0.73, p < 0.001). Major complications occurred in 30/109 (28%) cases, of which 20/780 (3%) occurred in Group I and 10/892 (1%) in Group II (OR 0.43 95% CI: 0.18–0.97, p = 0.042). Hematomata were most frequently observed in both groups (Group I: 46/69, 67%; Group II: 30/40, 75%). Conclusion Vascular complication rates in EP‐procedures were significantly reduced by implementing a novel institutional groin‐site management standard including ultrasound‐guided vascular access and modified post‐interventional care.
Schenker et al. (Fri,) conducted a cohort in Interventional electrophysiological (EP) procedures (n=1,501). Ultrasound-guided access, figure-of-8 suture, 2-h pressure bandage, and 6 h total bed rest vs. Conventional access with an 8-h pressure bandage and bed rest was evaluated on Total vascular complication rate (OR 0.48, 95% CI 0.32-0.73, p=<0.001). Ultrasound-guided vascular access and modified postprocedural care reduced total vascular complications compared to conventional access (4% vs. 9%; OR 0.48; 95% CI 0.32-0.73; p<0.001).