Vascular complications following coronary intervention correlate with long-term cardiac events

CIRSE Standards of Practice on Arterial Access for Interventions

This CIRSE Standards of Practice document is aimed at healthcare professionals (including interventional radiologists) performing endovascular procedures to provide best practices for performing arterial access for interventions. It has been developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. This paper encompasses up-to-date clinical and technical aspects in performing safe and appropriate arterial access for interventions.

Predictors of femoral hematoma in patients undergoing elective coronary procedure: a trigonometric evaluation

Vascular complications in the femoral artery puncture site are the most common complications of the coronary angiography. Femoral hematoma is the leading participant of the vascular complications. We investigated the femoral hematoma predictive value of angle of sheath to trochanter major in patients undergoing elective coronary procedures. In this prospective analysis, we evaluated the femoral hematoma predictive value of angle of sheath to trochanter major on 246 patients undergoing elective coronary procedures. In this prospective analysis, we evaluated the femoral hematoma predictive value of angle of sheath to trochanter major on 246 patients undergoing elective coronary procedures. Patients were divided into two as femoral hematoma (n = 23) and control (n = 223) groups according to post-procedure femoral hematoma status. Other independent predictors of femoral hematoma were also evaluated. In-hospital multivariable analysis revealed higher rates of femoral hematoma for patients with chronic renal failure (OR 24.97, 95% CI 3.04-78.88, p = 0.003), with higher diastolic blood pressure after the procedure (OR 1.08 95% CI 1.00-1.16, p = 0.037), with femoral vein puncture during procedure (OR 17.74, 95% CI 2.67-54.74, p = 0.003) and with higher angle of sheath to trochanter major (OR 1.52, 95% CI 1.13-2.05, p = 0.005). The best cut-off value of the angle of sheath to trochanter major to predict femoral hematoma was 15.6° with 74% sensitivity and 70% specificity (AUC: 0.75; 95% CI 0.63-0.86; p < 0.001). The angle of sheath to trochanter major provides an independent predictor of femoral hematoma in patients undergoing elective coronary procedures. Our data suggests the importance of fluoroscopic guidance during femoral artery access with the predictive role of the angle of sheath to trochanter major.

Imaging or trusting on surface anatomy? A comparison between fluoroscopic guidance and anatomic landmarks for femoral artery access in diagnostic cardiac catheterization. A randomized control trial

We performed a randomized controlled trial to test the potential benefits of fluoroscopic-guided femoral artery puncture. Observational studies showed a consistent relationship between common femoral artery (CFA) and the head of femur. Fluoroscopy locating the femoral head may increase the accuracy of femoral puncture and consequently decrease the vascular complication. Despite these theoretical benefits, we have no sufficient evidence to verify its advantages. Patients undergoing diagnostic cardiac catheterization were randomized into fluoroscopic and anatomic method groups. Of total of 609 patients participated in this study, 305 and 304 patients were assigned to fluoroscopic and anatomic method groups, respectively. Fluoroscopy significantly increases the puncture over the femoral head (96.7 vs. 82.3 %, p value 0.001) and also the fluoroscopic method increased CFA puncture significantly (93.8 vs. 87.5 %, p value 0.012). The combined end point of “proper” femoral puncture (CFA puncture over the femoral head) was highly significant in our fluoroscopy-guided method (91.8 vs. 75.7 %, p value <0.0001). Hematoma was the only vascular complication trough the study (2.6 % of patients) but no significant difference was seen between the two groups. In conclusion, our study showed the efficacy of fluoroscopy in increasing the proper femoral artery puncture, and although it did not show significant improvement in vascular complications, the method should be regard as an accurate guide for femoral access.

Managing Risk of Complications at Femoral Vascular Access Sites in Percutaneous Coronary Intervention

Percutaneous coronary intervention for acute coronary syndrome or non–ST-elevation myocardial infarction requires the use of potent oral and intravenous anti-platelet and antithrombin medications. Although these potent antithrombotic agents and regimens may increase the effectiveness of percutaneous coronary intervention, they are also generally associated with an increased risk of vascular access complications such as hematoma, retroperitoneal hematoma, pseudoaneurysm, arterial occlusion, and arteriovenous fistula, which in turn are associated with increased morbidity, mortality, and costs. Risk factors predisposing patients to these complications are both modifiable (procedure technique, medications, hemostasis method) and nonmodifiable (sex, age, body mass index, blood pressure, renal function). Patients’ risks can be reduced by nurses who are knowledgeable about these risk factors and identify complications before they become problematic.

Safety after cardiac catheterization

The Pennsylvania Patient Safety Authority's reporting system is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors. Safety Monitor is a column from the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu.

Transradial right and left heart catheterizations: A comparison to traditional femoral approach

OBJECTIVES

This study compares the transradial versus transfemoral approach to combined right- and left-heart catheterization.

BACKGROUND

Central venous access from peripheral veins has been a historically useful technique. Although the need for right-heart catheterization has been considered an exclusion for transradial catheterization, we have combined a peripheral approach to the central venous system with radial arterial access which permits bilateral heart catheterization using a transradial approach.

METHODS

Over an 18-month period all right-heart catheterizations done in conjunction with arterial access were reviewed. Salvage procedures, mixed site access, and biopsy procedures were excluded. Radial procedures were performed using radial artery access and a forearm vein. Femoral procedures used femoral artery/vein. Demographics, procedural information, and postprocedural complications including those requiring vascular ultrasound or transfusion were recorded and used for comparison between groups.

RESULTS

Total of 175 femoral/105 radial cases done by 4 operators met criteria for comparison. Both groups had similar procedural indications and age. Procedural durations were shorter (P < .01) with radial 70 +/- 5.0 min (+/-95% CI) vs. femoral 75 +/- 5.4 min (+/-95% CI). Crossover was noted in several patients from both groups; radial procedures (n = 2) failed due to previous shoulder trauma. Femoral crossover to radial involved difficult arterial access. Complications related to access site occurred in 12 femoral and 0 radial patients.

CONCLUSIONS

Using the forearm for central venous access appears safer than using the femoral vessels. Transradial catheterizations can be done in combination with forearm venous access procedures with excellent results and enhanced patient safety.