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

Abstract

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.

A Comparison of Costs and Complications of Manual Compression and Vascular Closing Devices in Femoral Cardiac Catheterization Interventions

“…In our study, multiple hospitals of differing sizes were taken into account which provides a more realistic picture of daily routine care. Similar to other studies we found factors that significantly influence the occurrence of complications like e.g., the protective effect of male gender and an increasing risk with the comorbidity renal failure [15,16], indicating the external validity of our analysis. Another strength is that we did separate analyses on diagnostic and interventional procedures.…”

“…We identified the following risk factors for complications by literature search: increasing age, female gender, obesity [15], hypertension [16], Peripheral Vascular Disease (PVD), Coronary Artery Disease (CAD) [17], diabetes mellitus [18], renal dysfunction [16] and the intake of antiplatelet and anticoagulant medication [17,19]. In the dataset, we identified these confounding variables through ICD and OPS codes from inpatient and outpatient records of the insurance company.…”

Ūminio Ir Lėtinio Skausmo Pasireiškimas Intervencijos Vietoje Po Perkutaninės Koronarinės Intervencijos

“…Apie kitas, rečiau pasitaikančias, būkles po procedūros informacijos kol kas yra mažiau. Viena iš jų -skausminis sindromas punkcijos vietoje po PKI, kuris gali būti sąlygotas nervo pažeidimo intervencijos metu, nervo suspaudimo tvarsčiu ar dėl susiformavusios hematomos po kraujagyslės pažeidimo [7,8]. Ūmus ir lėtinis skausmas po procedūros yra retos, tačiau labai trikdančios paciento kasdienį gyvenimą bei ribojančios jo veiksnumą būklės [13].…”

Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo

“…Femoral vessels are still used as the most common access site for the different specialties performed in hemodynamic laboratories, especially in percutaneous procedures that require the use of large-caliber introducers such as in endovascular correction of aneurysms and valvuloplasties, which further increases the potential for access site complications (5) . Among femoral approach complications, the most frequently described are bleeding, hematoma, and pseudo-aneurysm (6)(7) . The trans-radial approach is gaining popularity, especially in diagnostic and therapeutic cardiac procedures, as data regarding the safety and effectiveness of the technique emerge, associating it with lower rates of vascular complications and bleeding (8)(9) .…”

“…Although the risk of complications is low for experienced interventionists, patients must be carefully evaluated regarding signs and symptoms of bleeding and nerve compression (12) . Access site complications lead to longer periods of hospitalization, additional treatments, and higher costs, in addition to being associated with increased morbidity and mortality (6) . In the face of these repercussions, complications must be identified and monitored to prevent, minimize, or resolve potential harm to patients.…”