A New Preprocedural Score to Predict Bleeding Complications of Endovascular Interventions for Peripheral Artery Disease.
Purpose: To investigate the bleeding complications associated with endovascular therapy (EVT) for peripheral artery disease (PAD) and develop a dedicated peripheral bleeding score (PBS). Materials and Methods: This prospective, single-center study enrolled 530 patients (mean age 67.6±9.8 years; 396 men) undergoing endovascular procedures between August 2016 and July 2018 for chronic PAD. Primary endpoints were the incidence of 30-day bleeding complications [minor and major (prolonging hospitalization, causing permanent sequelae, or resulting in death)], the identification of factors associated with bleeding events, and the development of a dedicated PBS based on univariate and multivariate analysis. Hazard ratios (HR) and 95% confidence intervals (CI) are reported. The HAS-BLED score was compared with the PBS. Results: The overall peripheral bleeding complication rate was 3.8% (20/530), of which 3.2% (17/530) were major and included 4 (0.7%) active retroperitoneal bleeding events and 13 (2.4%) pseudoaneurysms. The annualized incidences of overall bleeding and major bleeding complications were 1.9% and 1.6%, respectively. Multivariable regression analysis identified age ≥75 as a correlate of significantly increased bleeding risk (HR 3.32, 95% CI 1.12 to 9.80, p<0.02). Male gender (HR 0.193, 95% CI 0.49 to 0.75, p<0.001) and statin therapy (HR 0.245, 95% CI 0.08 to 0.71, p=0.01) were correlated with a significantly decreased bleeding risk. Based on the regression analysis findings an 8-point PBS was developed, demonstrating 75.0% sensitivity and 78.4% specificity in detecting bleeding complications. The HAS-BLED score failed to identify 30-day bleeding events. Conclusion: The annualized incidence of bleeding complications associated with peripheral EVT was low. Advanced age and female sex were correlated with increased bleeding risk. The PBS demonstrated satisfactory statistical performance and could be considered for inclusion in the preprocedural endovascular checklist to help optimize intra- and postprocedural care.
['Spiliopoulos|Stavros|S|0000-0003-1860-0568', 'Tsochatzis|Athanasios|A|', 'Festas|Georgios|G|', 'Reppas|Lazaros|L|', 'Christidi|Foteini|F|', 'Palialexis|Konstantinos|K|', 'Brountzos|Elias|E|']
D000368:Aged D057189:Checklist D003661:Decision Support Techniques D057510:Endovascular Procedures D005260:Female D006115:Greece D006470:Hemorrhage D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D058729:Peripheral Arterial Disease D011237:Predictive Value of Tests D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
bleeding complications endovascular interventions peripheral artery disease peripheral bleeding score age HAS-BLED score retroperitoneal bleeding pseudoaneurysm gender statins female sex access site