Femoral artery catheterization complications: A study of 503 consecutive patients

Abstract

This report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.

Avaliação técnica do dispositivo de fechamento vascular Exoseal-Cordis®

“…[12][13][14][15] This wide range of variations leads to studies reporting conflicting results that range from protective effects to an increased risk of complications. [16][17][18] Another controversial subject is the financial impact.…”

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

“…The unfractionated heparin bolus should be reduced to 50 to 70 IU per kg when GP IIb/IIIa inhibitors are given in order e236 ACC/AHA/SCAI Practice Guidelines ACC -www.acc.org AHA -www.americanheart.org SCAI -www.scai.org degree to which these technologies reduce length of hospital stay and cost remains to be determined (764,(770)(771)(772).…”

“…Major factors associated with vascular complications include use of fibrinolytic or platelet inhibitor therapy, coexisting peripheral vascular disease, female gender, prolonged heparin use with delayed sheath removal, and older age (736,758,(760)(761)(762)(763)(764). Although most bleeding complications at the vascular access site are obvious and readily managed, physicians and nurses should remain alert for retroperitoneal hematoma, the signs and symptoms of which may include hypotension, marked suprainguinal tenderness, and severe back or lower-quadrant abdominal pain (765).…”

“…Post-PCI hematocrit should be monitored for a decrease greater than absolute 5% to 6%. Computed tomography can confirm the diagnosis of retroperitoneal hematoma, and more than 80% of patients can be treated conservatively with transfusions without surgery (764). Pseudoaneurysms may be treated effectively with ultrasound-directed compression in the majority of patients who are not bleeding and do not require continued anticoagulation (763,766,767).…”

Prospective Comparison of Angio-Seal versus Manual Compression for Hemostasis after Neurointerventional Procedures under Systemic Heparinization

“…Although manual compression has been accepted as the criterion standard for access-site hemostasis, it is limited by additional operator time, prolonged patient immobilization following the procedure, and complication rates in the range of 1.3%-3.4%. [1][2][3] Additionally, hemostasis by manual compression in anticoagulated patients receiving larger access sheaths can be difficult to achieve. The major concern in achieving hemostasis of the arteriotomy after neurointerventional procedures is the level of anticoagulation, not only during the endovascular treatment but also after the procedure, when it occasionally is sustained to minimize thrombotic events.…”