Routine Use of Ultrasound Guidance in Femoral Arterial Access for Peripheral Vascular Intervention Decreases Groin Hematoma Rates in High-Volume Surgeons

Vascular Quality Initiative

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Abstract

Background: There is a documented learning curve when adopting ultrasound guidance (UG) to aid vascular access. In the Vascular Study Group of New England (VSGNE), routine UG during percutaneous femoral artery access was shown to protect against the complication of groin hematoma. We sought to confirm this finding in the Vascular Quality Initiative (VQI), a data set with a larger sample size and broader geographic distribution, and to evaluate the effects of ultrasound usage and interventionalist volume on hematoma rates following peripheral vascular interventions (PVIs). Methods: The VQI PVI database (2010–2014) was queried to identify the complication of groin hematoma after 43,947 PVIs performed via femoral artery access. Both procedure- and interventionalist-level analyses were performed. Multivariable logistic regression was used to assess factors associated with hematoma. Multivariable Poisson regression analyses were used to compare hematoma rates between routine (≥80% of PVIs) and selective (<80% of PVIs) users of UG in the adjusted overall sample and in subgroups based on interventionalist volume (low: <10 PVIs/year; medium: 10–50 PVIs/year; high: >50 PVIs/year). Results: The overall groin hematoma rate was 3.2%, and lower hematoma rates correlated with increasing annual interventionalist volume (low vs. medium vs. high volume: 3.7% vs. 3.4% vs. 2.9%; P = 0.011). UG was associated with increased risk of hematoma (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.13–1.47, P < 0.001), but this risk was isolated to patients treated by selective (OR 1.33, 95% CI 1.17–1.53, P < 0.001) rather than routine users of UG (OR 0.85, 95% CI 0.55–1.33, P = 0.484). In the overall interventionalist-level analysis, routine UG was not found to be protective against hematoma (rate ratio [RR] 0.97, 95% CI 0.85–1.11, P = 0.677), in contrast to what was previously reported from the VSGNE. However, subgroup analysis revealed that routine UG was further protective against hematoma among high-volume interventionalists (RR 0.73, 95% CI 0.54–0.97, P = 0.030). Conclusions: UG in percutaneous femoral artery access may decrease the complication rate of groin hematoma, especially as an interventionalist's volume increases and as selective use transforms into routine adoption. With repetition and practice, interventionalists likely overcome the learning curve associated with adoption of an unfamiliar technology and potentially improve patient outcomes.

Original languageEnglish (US)
JournalAnnals of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

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Groin
Thigh
Hematoma
Blood Vessels
Confidence Intervals
Femoral Artery
New England
Learning Curve
Odds Ratio
Surgeons
Sample Size
Logistic Models
Regression Analysis
Databases
Technology

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{f11c7b94181d4a62a47f9a9f16e1e677,
title = "Routine Use of Ultrasound Guidance in Femoral Arterial Access for Peripheral Vascular Intervention Decreases Groin Hematoma Rates in High-Volume Surgeons",
abstract = "Background: There is a documented learning curve when adopting ultrasound guidance (UG) to aid vascular access. In the Vascular Study Group of New England (VSGNE), routine UG during percutaneous femoral artery access was shown to protect against the complication of groin hematoma. We sought to confirm this finding in the Vascular Quality Initiative (VQI), a data set with a larger sample size and broader geographic distribution, and to evaluate the effects of ultrasound usage and interventionalist volume on hematoma rates following peripheral vascular interventions (PVIs). Methods: The VQI PVI database (2010–2014) was queried to identify the complication of groin hematoma after 43,947 PVIs performed via femoral artery access. Both procedure- and interventionalist-level analyses were performed. Multivariable logistic regression was used to assess factors associated with hematoma. Multivariable Poisson regression analyses were used to compare hematoma rates between routine (≥80{\%} of PVIs) and selective (<80{\%} of PVIs) users of UG in the adjusted overall sample and in subgroups based on interventionalist volume (low: <10 PVIs/year; medium: 10–50 PVIs/year; high: >50 PVIs/year). Results: The overall groin hematoma rate was 3.2{\%}, and lower hematoma rates correlated with increasing annual interventionalist volume (low vs. medium vs. high volume: 3.7{\%} vs. 3.4{\%} vs. 2.9{\%}; P = 0.011). UG was associated with increased risk of hematoma (odds ratio [OR] 1.29, 95{\%} confidence interval [CI] 1.13–1.47, P < 0.001), but this risk was isolated to patients treated by selective (OR 1.33, 95{\%} CI 1.17–1.53, P < 0.001) rather than routine users of UG (OR 0.85, 95{\%} CI 0.55–1.33, P = 0.484). In the overall interventionalist-level analysis, routine UG was not found to be protective against hematoma (rate ratio [RR] 0.97, 95{\%} CI 0.85–1.11, P = 0.677), in contrast to what was previously reported from the VSGNE. However, subgroup analysis revealed that routine UG was further protective against hematoma among high-volume interventionalists (RR 0.73, 95{\%} CI 0.54–0.97, P = 0.030). Conclusions: UG in percutaneous femoral artery access may decrease the complication rate of groin hematoma, especially as an interventionalist's volume increases and as selective use transforms into routine adoption. With repetition and practice, interventionalists likely overcome the learning curve associated with adoption of an unfamiliar technology and potentially improve patient outcomes.",
author = "{Vascular Quality Initiative} and Elica Inagaki and Alik Farber and Siracuse, {Jeffrey J.} and Matthew Mell and Rybin, {Denis V.} and Gheorghe Doros and Jeffrey Kalish",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.avsg.2018.02.008",
language = "English (US)",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Routine Use of Ultrasound Guidance in Femoral Arterial Access for Peripheral Vascular Intervention Decreases Groin Hematoma Rates in High-Volume Surgeons

AU - Vascular Quality Initiative

AU - Inagaki, Elica

AU - Farber, Alik

AU - Siracuse, Jeffrey J.

AU - Mell, Matthew

AU - Rybin, Denis V.

AU - Doros, Gheorghe

AU - Kalish, Jeffrey

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: There is a documented learning curve when adopting ultrasound guidance (UG) to aid vascular access. In the Vascular Study Group of New England (VSGNE), routine UG during percutaneous femoral artery access was shown to protect against the complication of groin hematoma. We sought to confirm this finding in the Vascular Quality Initiative (VQI), a data set with a larger sample size and broader geographic distribution, and to evaluate the effects of ultrasound usage and interventionalist volume on hematoma rates following peripheral vascular interventions (PVIs). Methods: The VQI PVI database (2010–2014) was queried to identify the complication of groin hematoma after 43,947 PVIs performed via femoral artery access. Both procedure- and interventionalist-level analyses were performed. Multivariable logistic regression was used to assess factors associated with hematoma. Multivariable Poisson regression analyses were used to compare hematoma rates between routine (≥80% of PVIs) and selective (<80% of PVIs) users of UG in the adjusted overall sample and in subgroups based on interventionalist volume (low: <10 PVIs/year; medium: 10–50 PVIs/year; high: >50 PVIs/year). Results: The overall groin hematoma rate was 3.2%, and lower hematoma rates correlated with increasing annual interventionalist volume (low vs. medium vs. high volume: 3.7% vs. 3.4% vs. 2.9%; P = 0.011). UG was associated with increased risk of hematoma (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.13–1.47, P < 0.001), but this risk was isolated to patients treated by selective (OR 1.33, 95% CI 1.17–1.53, P < 0.001) rather than routine users of UG (OR 0.85, 95% CI 0.55–1.33, P = 0.484). In the overall interventionalist-level analysis, routine UG was not found to be protective against hematoma (rate ratio [RR] 0.97, 95% CI 0.85–1.11, P = 0.677), in contrast to what was previously reported from the VSGNE. However, subgroup analysis revealed that routine UG was further protective against hematoma among high-volume interventionalists (RR 0.73, 95% CI 0.54–0.97, P = 0.030). Conclusions: UG in percutaneous femoral artery access may decrease the complication rate of groin hematoma, especially as an interventionalist's volume increases and as selective use transforms into routine adoption. With repetition and practice, interventionalists likely overcome the learning curve associated with adoption of an unfamiliar technology and potentially improve patient outcomes.

AB - Background: There is a documented learning curve when adopting ultrasound guidance (UG) to aid vascular access. In the Vascular Study Group of New England (VSGNE), routine UG during percutaneous femoral artery access was shown to protect against the complication of groin hematoma. We sought to confirm this finding in the Vascular Quality Initiative (VQI), a data set with a larger sample size and broader geographic distribution, and to evaluate the effects of ultrasound usage and interventionalist volume on hematoma rates following peripheral vascular interventions (PVIs). Methods: The VQI PVI database (2010–2014) was queried to identify the complication of groin hematoma after 43,947 PVIs performed via femoral artery access. Both procedure- and interventionalist-level analyses were performed. Multivariable logistic regression was used to assess factors associated with hematoma. Multivariable Poisson regression analyses were used to compare hematoma rates between routine (≥80% of PVIs) and selective (<80% of PVIs) users of UG in the adjusted overall sample and in subgroups based on interventionalist volume (low: <10 PVIs/year; medium: 10–50 PVIs/year; high: >50 PVIs/year). Results: The overall groin hematoma rate was 3.2%, and lower hematoma rates correlated with increasing annual interventionalist volume (low vs. medium vs. high volume: 3.7% vs. 3.4% vs. 2.9%; P = 0.011). UG was associated with increased risk of hematoma (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.13–1.47, P < 0.001), but this risk was isolated to patients treated by selective (OR 1.33, 95% CI 1.17–1.53, P < 0.001) rather than routine users of UG (OR 0.85, 95% CI 0.55–1.33, P = 0.484). In the overall interventionalist-level analysis, routine UG was not found to be protective against hematoma (rate ratio [RR] 0.97, 95% CI 0.85–1.11, P = 0.677), in contrast to what was previously reported from the VSGNE. However, subgroup analysis revealed that routine UG was further protective against hematoma among high-volume interventionalists (RR 0.73, 95% CI 0.54–0.97, P = 0.030). Conclusions: UG in percutaneous femoral artery access may decrease the complication rate of groin hematoma, especially as an interventionalist's volume increases and as selective use transforms into routine adoption. With repetition and practice, interventionalists likely overcome the learning curve associated with adoption of an unfamiliar technology and potentially improve patient outcomes.

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U2 - 10.1016/j.avsg.2018.02.008

DO - 10.1016/j.avsg.2018.02.008

M3 - Article

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

ER -