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Vascular Access for Left Heart Catheterization

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Abstract

While traditionally viewed as benign when compared with nonaccess-site complications, vascular access-site complications are associated with a short- and long-term risk of morbidity or mortality as well as increased costs. In a study of 17,901 consecutive patients undergoing transfemoral PCI at the Mayo Clinic, Doyle et al. demonstrated that major femoral complications (including major hematoma, external bleeding, and retroperitoneal bleeding) were independently associated with a 30-day adjusted hazard ratio (HR) for a mortality of 9.96 (95% confidence interval [95% CI]: 6.94–14.3, p < 0.001). Similarly, Yatskar et al. reported that hematomas requiring transfusions were associated with an increased 1-year mortality (HR 1.65, 95% CI 1.01–2.70, p = 0.048) among patients undergoing PCI during the NHLBI Dynamic registry recruitment waves. While relatively uncommon, retroperitoneal bleeding remains a catastrophic vascular access-site complication, with 73.5% requiring transfusion and 10.4% dying during hospitalization. Furthermore, in an era of increasing public concern regarding healthcare costs, it is also worth noting that even after adjustments for baseline differences among patients enrolled in an economic sub-study of Gusto IIb, each moderate or severe bleeding event increased costs by $3770 and each transfusion event increased costs by $2080. In current practice, while the risk of major bleeding is dependent on patient characteristics and to an extent the choice of antithrombotic agent, the choice of vascular access strategy (transfemoral vs. transradial) and a meticulous attention to good technique, proper equipment, and skilled operators may reduce major bleeding and thereby reduce morbidity, mortality, as well as costs.

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Authors and Affiliations

  1. Duke University Medical Center, Durham, NC, USA

    Aditya Mandawat & Sunil V. Rao

  2. Durham VA Medical Center, Durham, NC, USA

    Aditya Mandawat & Sunil V. Rao

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  1. Aditya Mandawat
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  2. Sunil V. Rao
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Correspondence to Sunil V. Rao .

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Editors and Affiliations

  1. Brighton and Sussex Medical School and the Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

    Aung Myat

  2. Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK

    Sarah Clarke

  3. Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Nick Curzen

  4. Department of Cardiology, Bern University Hospital, Bern, Switzerland

    Stephan Windecker

  5. Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, VA, USA

    Paul A. Gurbel

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Mandawat, A., Rao, S.V. (2018). Vascular Access for Left Heart Catheterization. In: Myat, A., Clarke, S., Curzen, N., Windecker, S., Gurbel, P.A. (eds) The Interventional Cardiology Training Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-71635-0_5

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  • DOI: https://doi.org/10.1007/978-3-319-71635-0_5

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