Retrospective review of femoral access bleeding events among transplant patients

Author

Lu Mao

Statistical analysis

Categorical variables were summarized as counts and percentages, and continuous variables were summarized as means and standard deviations. Comparisons between groups were performed using chi-square or Fisher’s exact tests for categorical variables and Wilcoxon rank sum test for continuous variables. A p-value of <0.05 was considered statistically significant. All analyses were conducted using R (version 4.2.3).

Results

Patient characteristics and outcomes are summarized in Table 1 by transplant status.

Table 1: Characteristics and outcomes of patients undergoing femoral access procedures by transplant status.
Characteristic Transplant before, N = 1801 Transplant after, N = 511 p-value2
Age (years) 55 (46, 64) 59 (51, 64) 0.12
Sex

0.8
    Female 53 (29%) 14 (27%)
    Male 127 (71%) 37 (73%)
BMI (kg/m2) 26.0 (22.0, 31.0) 29.0 (27.0, 32.0) <0.001
Indication

<0.001
    TRAS 41 (23%) 1 (2.0%)
    Hepatic artery stenosis 39 (22%) 0 (0%)
    GIB 33 (18%) 5 (9.8%)
    Other bleed 40 (22%) 11 (22%)
    Other 12 (6.7%) 21 (41%)
    Diagnostic 15 (8.3%) 13 (25%)
Organ

<0.001
    Kidney 74 (41%) 7 (14%)
    Liver 95 (53%) 44 (86%)
    Other (e.g. pancreas) 11 (6.1%) 0 (0%)
On steroids within 30 days of procedure 165 (92%) 14 (27%) <0.001
Hydrocortisone equivalent dose (mg) 40 (20, 80) 1,173 (120, 1,333) <0.001
    Unknown 18 38
Sheath size

0.013
    4Fr 2 (1.1%) 0 (0%)
    5Fr 125 (71%) 47 (92%)
    6Fr 41 (23%) 4 (7.8%)
    7Fr 8 (4.5%) 0 (0%)
    8Fr 0 (0%) 0 (0%)
    Unknown 4 0
Closure

0.2
    Angioseal 157 (87%) 41 (80%)
    Perclose 3 (1.7%) 1 (2.0%)
    Mynx 8 (4.4%) 1 (2.0%)
    Manual pressure 9 (5.0%) 4 (7.8%)
    Other 3 (1.7%) 4 (7.8%)
Antiplatelet therapy within 72 hrs

<0.001
    None 75 (42%) 40 (78%)
    ASA 81 57 (32%) 11 (22%)
    ASA 325 20 (11%) 0 (0%)
    DAPT 21 (12%) 0 (0%)
    Other 7 (3.9%) 0 (0%)
Blood thinner

0.2
    Warfarin 14 (7.8%) 5 (9.8%)
    DOAC 13 (7.2%) 0 (0%)
    Bivalirudin 0 (0%) 0 (0%)
    Other 3 (1.7%) 0 (0%)
    None 150 (83%) 46 (90%)
Periprocedural heparin gtt within 72 hrs 26 (14%) 2 (3.9%) 0.042
Intraprocedural heparin 33 (18%) 2 (3.9%) 0.011
Hypertensive SBP ≥ 180 and DBP ≥ 95 within 72 hrs 30 (17%) 6 (12%) 0.4
Type of bleeding event

>0.9
    Pseudoaneurysm 11 (6.1%) 2 (3.9%)
    Dissection 3 (1.7%) 0 (0%)
    Hematoma w/o documented psuedoaneurysm 9 (5.0%) 2 (3.9%)
    Other (AVF, true aneurysm) 0 (0%) 0 (0%)
    None 157 (87%) 47 (92%)
Bleeding event within 30 days 23 (13%) 4 (7.8%) 0.3
1 Median (IQR); n (%)
2 Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test
  • Transplant before procedure: 23/180 (12.8%) had bleeding events.
  • Transplant after procedure: 4/51 (7.8%) had bleeding events.
  • The difference is not statistically significant (p = 0.333).