IP239. Delayed Sheath Removal after Catheter-Directed Thrombolysis Does Not Decrease Complications

Treatment of acute limb ischemia by catheter-directed thrombolysis has associated bleeding risks, which has led some physicians to delay sheath removal after tissue plasminogen activator is discontinued. We aimed to determine rates of complications for early (<6 hours) vs late (>6 hours) sheath removal after lytic treatment. A retrospective study was conducted of patients with acute limb ischemia from August 2010 to April 2018 treated with catheter-directed thrombolysis. The primary end point was any access site complication (hematoma, pseudoaneurysm, dissection, arteriovenous fistula, or hemorrhage). Continuous variables were compared using t-test, and χ2 analysis was used to determine differences between categorical variables. There were 52 patients treated (36 men, 16 women), with a mean age of 60 (standard deviation, ± 11) years. Early sheath removal was performed in 30 patients, and 22 patients had late sheath removal. There was no difference in mean duration of lysis (early, 16.7 hours; late, 19.4 hours; P = .32), mean tissue plasminogen activator dose (early, 13.1 mg; late, 15.9 mg; P = .3), or postprocedure fibrinogen (early, 271 mg/dL; late, 298 mg/dL; P = .48). Patients who had early sheath removal were more likely to have a closure device used (early, 7; late, 0; P = .43). The overall access site complication rate was 5.8%. One patient in the early sheath removal group developed a hematoma, and two patients in the late sheath removal group developed pseudoaneurysm (P = .34). Whereas some practitioners believe in delayed sheath removal after catheter-directed thrombolysis, this may be associated with a higher rate of pseudoaneurysm and no decreased rate of bleeding risk. Until further data are available, we recommend removal of femoral sheaths as soon as postoperative bleeding risk is minimized. Closure devices may be of benefit in this population, but more data are needed.