Abstract No. 147 Retrograde recanalization of infrainguinal chronic total occlusions in an outpatient-based lab setting

Abstract

To characterize risk factors for bleeding complications after renal biopsy Materials and Methods: A single-center database of all adult patients who underwent random renal biopsy between July 2017 and November 2019 was compiled. Demographic, clinical, procedural, and follow-up data including pathologic diagnoses were documented. 30-day bleeding complications were assessed using the Society of Interventional Radiology Adverse Event Severity Scale. Multivariate logistic regression was performed to assess association between predetermined clinical variables and bleeding complications. Results: 399 renal biopsies were performed (49% female; median age 51 y; 21% inpatient). Common comorbidities included hypertension (59%), rheumatologic disease (36%), and diabetes (21%). 31% of the cohort was on an antithrombotic agent. Most biopsies were performed on native left kidneys (87%). Typical indications included proteinuria (33%), acute kidney injury (26%), and systemic diseases with renal involvement (19%). Pathologic diagnoses were made for 97% of biopsies; hypertensive nephropathy (20%), lupus (19%), and IgA nephropathy (11%) were the most common. The total 30-day bleeding complication rate was 17.8% (55 mild, 10 moderate, 6 severe). There were 3 deaths, and none were attributable to hemorrhage. On multivariate analysis, rheumatologic comorbidities (OR: 4.9, P< 0.0001) and hypertension (OR: 5.1, P ¼ 0.01) portended significantly increased odds of bleeding complications, while periprocedural coagulation assays, anticoagulation/antiplatelet use, technical factors such as the number of passes and biopsy device, and pathologic diagnosis were not associated with bleeding complications. Conclusions: Less than 5% of kidney biopsies had bleeding complications requiring intervention. Practitioners should carefully assess the risk-benefit ratio of renal biopsy, particularly for patients with rheumatologic comorbidities and hypertension, given their higher bleeding complication rates. The protocol-based decision to hold or continue anticoagulation/antiplatelet therapy periprocedurally did not affect bleeding risk.