Safety of cardiac catheterization via peripheral vascular grafts

Basic data underlying clinical decision making in vascular surgery: arterial access for percutaneous procedures

Percutaneous arterial access has become a mainstay in the armamentarium of vascular specialists. Vascular surgeons for decades have managed iatrogenic complications sustained by other specialists and now are more frequently performing catheter-based procedures themselves. A thorough understanding of the basic data underlying complications related to these procedures is imperative and is thoroughly reviewed.

Maintenance of hemostasis after invasive cardiac procedures: implications for outpatient catheterization

OBJECTIVES

This study investigated the efficacy of four different methods of arterial puncture site management during recovery from invasive cardiac procedures. The primary goals were less patient discomfort and improved clinical outcome.

BACKGROUND

The increasing use of outpatient catheterization, large interventional devices and potent periprocedural anticoagulation regimens has made the reduction of groin complications a high priority. Despite these trends, there are no randomized trials comparing commonly used techniques in treating the catheter entry site for the first few hours after the procedure.

METHODS

Four-hundred consecutive patients undergoing catheterization laboratory procedures were randomly assigned to one of four dressing techniques applied after achieving hemostasis: a sandbag placed over the site; a pressure dressing constructed from surgical gauze and elastic tape; a commercially available compression device; and no use of compressive dressing. Of these 400 patients, 171 would have been eligible for outpatient procedures in the absence of geographic constraints. The dressings were removed, and ambulation was encouraged 5 h after sheath removal. Uniform initial compression times, patient instructions, nursing follow-up and a structured interview and physical examination at 24 h were used.

RESULTS

The level of patient discomfort before and after dressing removal, as well as site tenderness at 24-h follow-up, was statistically similar in all four groups. Hematomas (typically small) and areas of ecchymosis were observed in 58 and 122 patients, respectively, but both their frequency and size were equally represented in each group. Important adverse events were confined to bleeding, rated as mild in 5.8%, moderate in 0.8% and severe in 0.6% of patients. Again, all four groups were statistically similar. Comparable findings were observed in the subgroup of patients eligible for outpatient procedures.

CONCLUSIONS

Despite an increase in inconvenience and expense, none of the three compression techniques that were investigated improved patient satisfaction or outcome. Therefore, the routine use of compression dressings after invasive cardiac procedures cannot be recommended.