Elimination of major vascular access complications (VAC) using ultrasound-guided vascular access and vessel closure protocols during Invasive EP procedures (IEPP)

• Published in: European journal of arrhythmia & electrophysiology 2021-01, Vol.7, p.36
• Main Authors: Verma, S V, Giedrimas, E G, Hernandez, N H, Beard, S B, Pala, S P, Alsheikh, T A
• Format: Article
• Language: English
• Subjects: Fistula; Hematoma; Laboratories; Ultrasonic imaging; Venous access
• ISSN: 2058-3869; 2058-3877

Introduction: Vascular access complications (VAC) are common complications associated with invasive electrophysiology procedures (IEPP) and can lead to significant morbidity and mortality. Reducing the risk of VAC is of considerable interest to Electrophysiologists. We studied the impact of vascular access and vessel closure protocols utilizing ultrasound-guided vascular access (UG) on the incidence of IEPP associated VAC in our institution in a calendar year. Our goal was to achieve a major complication rate of less than 2.5%. Methods: All patients undergoing IEPP during the calendar year 2020 were included. Patients undergoing EP study, AFIB, SVT, PVC and VT ablations and Watchman device implantation were included. Specific protocols to reduce complications included- Elimination of arterial access for the purpose of blood pressure monitoring, reduction in the number of sheaths per case, universal use of UG for common femoral venous and arterial punctures, and immediate sheath removal in the laboratory facilitated by the use of FDA approved vascular closure devices (VCD)- Perclose Proglide™ (Abbott) in 39.2% of cases or Vascade- MVP™ (Cardiva Medical,Inc ) in 33.9% of all cases. Selection of VCD was based upon physician preference. VCD was used in 73% of all EP cases, otherwise manual pressure was held for hemostasis. Intravenous protamine sulfate was used for heparin reversal when applicable. Complications were recorded using prospective physician self-reporting, independent verification by retrospective review of billing codes related to VAC and institutional monitoring. Complications were classified as major if they included AV fistula, pseudoaneurysm or hematoma required surgical or invasive intervention, blood transfusion or readmission. Major and minor complications were recorded and compared to historical cohort from 2018 and 2019. Results: A total of 690 patients underwent IEPP performed by 4 electrophysiologists in three laboratories at two hospitals. We recorded only 2 minor hematomas (not requiring surgery, thrombin injection or transfusion). 0 patients had AV fistula, pseudoaneurysm or hematoma classified as major. There were 0 procedural deaths recorded from any cause. Conclusions: We demonstrated that it is possible to drastically reduce and possibly eliminate major vascular complications during EP procedures with careful use of ultrasound guidance for access and judicious use of vascular closure devices.