3:45 PM Abstract No. 404 Practice Pattern Change in the Management of Iatrogenic Pseudoaneurysms at a Tertiary Care Institution: Experience in 164 Patients

To compare treatment outcomes of iatrogenic pseudoaneurysms (PSAs) before and after a practice change from cross-sectional radiology (CS) to interventional radiology (IR)-based management. 164 patients with iatrogenic PSAs were identified from 2010 through 2016. 88 and 76 were identified before and after practice change, respectively. Patients included 83 (51%) men with mean age of 62 years (range, 1-93 years). PSAs resulted from procedures performed by interventional cardiology (n = 75, 46%), electrophysiology (n = 25, 15%), IR (n = 23, 14%), vascular surgery (VS) (n = 19, 12%), medicine (n = 7, 4%) neurosurgery (n = 5, 3%), cardiac surgery (n = 5, 3%), the intensive care unit (n = 5, 3%), & orthopedic surgery (n = 1, 1%). Prior to practice change, 92% of PSAs were treated by CS, 3% by VS, and 5% by IR; after practice change, 79% were treated by IR, 17% by CS and 4% by VS. Site, PSA, sheath size and closure device use during initial procedure, treating service, time from initial puncture to treatment, volume of thrombin, number of treatment sessions required, advanced techniques used, clinical success, and complications prior to and following practice change were recorded. No differences were observed in age, PSA volume, PSA neck size before or after practice change. More deep femoral artery PSAs were treated after practice change (p = .033); no difference in other access sites PSAs. Mean time from initial consult to treatment decreased significantly (45 to 15 hours, p = .015), with non-significant change in time to discharge. Mean time from consult to discharge also decreased, but not significantly (160 vs 124 hours). Advanced techniques were used in more patients (11% vs 2%, p = .028) with increased successful first repair attempts (91% vs 87%, p = .46). Advanced techniques were required in 13 cases patients after the practice change: angiography with balloon-assisted thrombin injection (5), open surgery (4), stent deployment (2), and coiling (1); advanced techniques were performed twice before change. IR provides a shorter latency to treatment and enables successful treatment of more complex PSAs, as evidenced by both PSA location and proportion of cases requiring advanced techniques.