Abstract
Femoral vascular access related complications are associated with increased morbidity, mortality, length of stay and cost. Bleeding from a femoral arterial puncture site is the most common complication seen; however, there is heterogeneity in the definition of bleeding used in Acute Coronary Syndrome (ACS) trials. The most commonly used, the Thrombolysis in Myocardial Infarction (TIMI) criteria, divide bleeding into major (>5 g/dL decrease in the haemoglobin concentration or a ≥15 % absolute decrease in haematocrit), minor (≥3 g/dL decrease in the haemoglobin concentration or ≥10 % decrease in the haemotocrit if bleeding is observed, ≥4g/dL and ≥12 % if bleeding not seen), and minimal (any clinically overt sign of haemorrhage associated with a <3g/dL decrease in the haemoglobin concentration or <9 % decrease in the haematocrit) [5]. Similarly, there exists great variability (5–20 %) in the incidence of reported femoral vascular access complications. A preventative approach is described here.
Keywords
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Kugelmass AD, Cohen DJ, Brown PP, Simon AW, Becker ER, Culler SD. Hospital resources consumed in treating complications associated with percutaneous coronary interventions. Am J Cardiol. 2006;97:322–7.
Jacobson KM, Long KH, McMurtry EK, Naessens JM, Rihal CS. The economic burden of complications during percutaneous coronary intervention. Qual Saf Health Care. 2007;16:154–9.
Doyle BJ, Ting HH, Bell MR, Lennon RJ, Mathew V, Singh M, et al. Major femoral bleeding complications after percutaneous coronary intervention: incidence, predictors, and impact on long-term survival among 17,901 patients treated at the Mayo Clinic from 1994 to 2005. JACC Cardiovasc Interv. 2008;1:202–9.
Manoukian SV. The relationship between bleeding and adverse outcomes in ACS and PCI: pharmacologic and nonpharmacologic modification of risk. J Invasive Cardiol. 2010;22:132–41.
Mehran S, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelbbom J, et al. Standardized bleeding definitions for cardiovascular clinical trials. Circulation. 2011;123:2736–47.
Nasser TK, Mohler 3rd ER, Wilensky RL, Hathaway DR. Peripheral vascular complications following coronary interventional procedures. Clin Cardiol. 1995;18:609–14.
Garrett PD, Eckart RE, Bauch TD, Thompson CM, Stajduhar KC. Fluoroscopic localization of the femoral head as a landmark for common femoral artery cannulation. Catheter Cardiovasc Interv. 2005;65:205–7.
Dotter CT, Rosch J, Robinson M. Fluoroscopic guidance in femoral artery puncture. Radiology. 1978;127:266–7.
Lechner G, Jantsch H, Waneck R, Kretschmer G. The relationship between the common femoral artery, the inguinal crease, and the inguinal ligament: a guide to accurate angiographic puncture. Cardiovasc Intervent Radiol. 1988;11:165–9.
Fitts J, Ver LP, Hofmaster P, Malenka D. Fluoroscopy-guided femoral artery puncture reduces the risk of PCI-related vascular complications. J Interv Cardiol. 2008;21:273–8.
Seto AH, Abu-Fadel MS, Sparling JM, Zacharias SJ, Daly TS, Harrison AT, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access with Ultrasound Trial). JACC Cardiovasc Interv. 2010;3:751–8.
Dudeck O, Teichgraeber U, Podrabsky P, Lopez Haenninen E, Soerensen R, Ricke J. A randomized trial assessing the value of ultrasound-guided puncture of the femoral artery for interventional investigations. Int J Cardiovasc Imaging. 2004;20:363–8.
Hanson JM, Atri M, Power N. Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: Doppler features and technical tips. Br J Radiol. 2008;81:154–63.
Schneider C, Malisius R, Küchler R, Lampe F, Krause K, Bahlmann E, Kuck KH. A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms. Int J Cardiol. 2009;131:356–61.
Schaub F, Theiss W, Heinz M, Zagel M, Schömig A. New aspects in ultrasound guided compression repair of postcatheterization femoral artery injuries. Circulation. 1994;90:1861–5.
Mak GY, Daly B, Chan W, Tse KK, Chung HK, Woo KS. Percutaneous treatment of post catheterization massive retroperitoneal hemorrhage. Cathet Cardiovasc Diagn. 1993;29:40–3.
Dabney A, Bastani B. Enoxaparin-associated severe retroperitoneal bleeding and abdominal compartment syndrome: a report of two cases. Intensive Care Med. 2001;27:1954–7.
Sommer C, Ferbert A. Damage to the lateral cutaneous femoral nerve after transfemoral angiography. Nervenarzt. 1992;63:633–5.
Sohail MR, Khan AH, Dr Holmes Jr, Wilson WR, Steckelberg JM, Baddour LM. Infectious complications of percutaneous vascular closure devices. Mayo Clin Proc. 2005;80:1011–5.
Nikolsky E, Mehran R, Halkin A, Mintz GS, Lasic Z, Negoita M, et al. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol. 2004;44:1200–9.
Lasic Z, Nikolsky E, Kesanakurthy S, Dangas G. Vascular closure devices: a review of their use after invasive procedures. Am J Cardiovasc Drugs. 2005;5:185–200.
Hamel WJ. Femoral artery closure after cardiac catheterization. Crit Care Nurse. 2009;29:39–46.
Rashid MN, Bailey SR. Percutaneous femoral access and vascular closure devices. Available at: http://ccn.aacnjournals.org. Accessed 9 July 2012.
Rao S, Kaul P, Stouffer GA. Successful aspiration of Mynx vascular closure device sealant that embolized to the popliteal artery. J Invasive Cardiol. 2013;25:E172–4.
Gupta A, Sadiq I, Borer S. Distal embolisation from Mynx device. Conn Med. 2012;76:545–8.
Azmoon S, Pucillio AL, Aronow WS, Ebrahimi R, Vozzolo J, Rajdev A, et al. Vascular complications after percutaneous coronary intervention following hemostasis with the Mynx vascular closure device versus the AngioSeal vascular closure device. J Invasive Cardiol. 2010;22940:175–8.
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Dubey, G., Chitkara, K. (2016). Risk Management of Femoral Arterial Access-Related Complications in Percutaneous Coronary Intervention. In: Lindsay, A., Chitkara, K., Di Mario, C. (eds) Complications of Percutaneous Coronary Intervention. Springer, London. https://doi.org/10.1007/978-1-4471-4959-0_31
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