Frequency and predictors of access site complications of the transfemoral diagnostic coronary procedures

Year 2020, Volume: 6 Issue: 6, 640 - 646, 04.11.2020

Alper Karakuş Selma Arı Temel Acar Hasan Ari Sencer Çamcı Ahmet Tutuncu Gökhan Özmen Mehmet Melek Mehmet Demir

https://doi.org/10.18621/eurj.707942

Abstract

Objectives: Access site complications (ASC) remain important and common adverse events after coronary angiography. The aim of this study was to evaluate the frequency and predictors of ASC in patients undergoing diagnostic coronary angiography (DCA) via the femoral artery.

Methods: In this prospective analytical cross sectional study, DCA was performed in 3972 patients by transfemoral approach. The femoral access site hemostasis was obtained by manual compression in all patients. Demographic characteristics of the patients, size of the arterial sheaths, duration of compression time, patients blood pressure, medications, hemoglobin and platelet levels were recorded. All patients were evaluated for ASC (pseudoaneurysm, bleeding, dissection, hematoma). The ASC rate was calculated and ASC predictors were determined by multivariate analysis.

Results: The ASC rate was 1.3% (53 of 3972 patients). The complications were more frequent in female (female: 29 of 53 [54.7%] vs male: 24 of 53 [45.3%]; p = 0.007) and chronic renal failure (CRF) patients (103 of 3919 [2.6%] vs 4 of 53 [7.5%]; p = 0.02). Hemoglobin level was lower (13.40 ± 1.73 vs 12.86 ± 1.75; p = 0.02) and manual compression time was longer (9.19 ± 3.28 min vs 14.53 ± 6.47 min; p < 0.001) in the ASC group. Clopidogrel (188 of 3919 [4.8%] vs 7 of 53 [13.2%]; p = 0.005) and low molecular weight heparin (LMWH) using were more frequent (37 of 3919 [0.9%] vs 7 of 53 [13.2%]; p < 0.001) in the ASC group. According to multivariate analysis; female gender; OR: 2.13, 95% CI: 1.14-3.99 (p = 0.017), presence of CRF; OR: 3.15, 95% CI: 1.06-9.29 (p = 0.038), manual compression time; OR: 1.23, 95% CI: 1.17-1.30 (p < 0.001) and LMWH using; OR: 15.68, 95% CI: 6.05-40.61 (p < 0.001) were predictors of ASC.

Conclusions: The incidence of femoral ASC rate was 1.3% in patients with DCA. Female gender, presence of CRF, using LMWH and long manual compression time were predictors of ASC.

Keywords

Vascular access devices, coronary angiography, femoral artery, complication

References

• 1. Rajani NK, Brown AJ, Mccormick LM, Parwaiz H, Kaushal A, Hoole SP, et al. Institutional switch from transfemoral to transradial vascular access for percutaneous coronary intervention was associated with a reduction in bleeding events: a single center experience of > 10,000 consecutive cases. J Interv Cardiol 2015;28:296-304.
• 2. Fitts J, Ver Lee P, Hofmaster P, Malenka D, Group NNECS. Fluoroscopy‐guided femoral artery puncture reduces the risk of PCI‐related vascular complications. J Interv Cardiol 2008;21:273-8.
• 3. Sherev DA, Shaw RE, Brent BN. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc Interv 2005;65:196-202.
• 4. Wongcharoen W, Pinyosamosorn K, Gunaparn S, Boonnayhun S, Thonghong T, Suwannasom P, et al. Vascular access site complication in transfemoral coronary angiography between uninterrupted warfarin and heparin bridging. J Interv Cardiol 2017;30:387-92.
• 5. Bhatty S, Cooke R, Shetty R, Jovin IS. Femoral vascular access-site complications in the cardiac catheterization laboratory: diagnosis and management. Interv Cardiol 2011;3:503-14.
• 6. Ramana RK, Singh A, Dieter RS, Moran JF, Steen L, Lewis BE, et al. Femoral angiogram prior to arteriotomy closure device does not reduce vascular complications in patients undergoing cardiac catheterization. J Interv Cardiol 2008;21:204-8.
• 7. Tarighatnia A, Mohammadalian A, Ghojazade M, Pourafkari L, Farajollahi A. Beam projections and radiation exposure in transradial and transfemoral approaches during coronary angiography. Anatol J Cardiol 2017;18:298-303.
• 8. Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, et al. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2012;59:2221-305.
• 9. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41.
• 10. Rao AK, Pratt C, Berke A, Jaffe A, Ockene I, Schreiber TL, et al. Thrombolysis in Myocardial Infarction (TIMI) Trial—phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 1988;11:1-11.
• 11. Ammann P, Brunner‐La Rocca HP, Angehrn W, Roelli H, Sagmeister M, Rickli H. Procedural complications following diagnostic coronary angiography are related to the operator's experience and the catheter size. Catheter Cardiovasc Interv 2003;59:13-8.
• 12. Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 2011;377:1409-20.
• 13. Choussat R, Black A, Bossi I, Fajadet J, Marco J. Vascular complications and clinical outcome after coronary angioplasty with platelet IIb/IIIa receptor blockade. Comparison of transradial vs transfemoral arterial access. Eur Heart J 2000;21:662-7.
• 14. Mandak JS, Blankenship JC, Gardner LH, Berkowitz SD, Aguirre FV, Sigmon KN, et al. Modifiable risk factors for vascular access site complications in the IMPACT II trial of angioplasty with versus without eptifibatide. J Am Coll Cardiol 1998;31:1518-24.
• 15. Omoigui NA, Califf RM, Pieper K, Keeler G, O'Hanesian MA, Berdan LG, et al. Peripheral vascular complications in the coronary angioplasty versus excisional atherectomy trial (CAVEAT-I). J Am Coll Cardiol 1995;26:922-30.
• 16. Yatskar L, Selzer F, Feit F, Cohen HA, Jacobs AK, Williams DO, et al. Access site hematoma requiring blood transfusion predicts mortality in patients undergoing percutaneous coronary intervention: data from the National Heart, Lung, and Blood Institute Dynamic Registry. Catheter Cardiovasc Interv 2007;69:961-6.
• 17. Waksman R, King SB, Douglas JS, Shen Y, Ewing H, Mueller L, et al. Predictors of groin complications after balloon and new-device coronary intervention. Am J Cardiol 1995;75:886-9.
• 18. Hanlon C, Rosenthal J. The Pennsylvania Learning Exchange: Helping states improve and integrate patient safety initiatives. Summary report. New York: The Commonwealth Fund; 2007.
• 19. Eslami MH, Csikesz N, Schanzer A, Messina LM. Peripheral arterial interventions: trends in market share and outcomes by specialty, 1998-2005. J Vasc Surg 2009;50:1071-8.
• 20. Applegate RJ, Sacrinty MT, Kutcher MA, Kahl FR, Gandhi SK, Santos RM, et al. Trends in vascular complications after diagnostic cardiac catheterization and percutaneous coronary intervention via the femoral artery, 1998 to 2007. JACC: Cardiovasc Interv 2008;1:317-26.
• 21. Sandgren T, Sonesson B, Ahlgren ÅR, Länne T. The diameter of the common femoral artery in healthy human: influence of sex, age, and body size. J Vasc Surg 1999;29:503-10.
• 22. Sulzbach-Hoke LM, Ratcliffe SJ, Kimmel SE, Kolansky DM, Polomano R. Predictors of complications following sheath removal with percutaneous coronary intervention. J Cardiovasc Nurs 2010;25:E1-E8.
• 23. Byrne RA, Cassese S, Linhardt M, Kastrati A. Vascular access and closure in coronary angiography and percutaneous intervention. Nat Rev Cardiol 2013;10:27.
• 24. Le May MR, Wells GA, So DY, Chong AY, Froeschl M, Dick A, et al. The American College of Cardiology Annual Scientific Session (ACC 2019), New Orleans, LA, March 18, 2019.