Validation of an extrinsic compression and early ambulation protocol after diagnostic transfemoral cerebral angiography: a 5-year prospective series

Abstract

Background and purposeAccess-site complications constitute a substantial portion of the morbidity associated with transfemoral cerebral angiography, yet no standardized protocol exists for femoral closure and practice patterns vary widely. The objective of this single-arm prospective cohort study was to validate the efficacy and safety of a standardized femoral closure strategy for all diagnostic angiography, regardless of antiplatelet regimen.MethodsA single-arm, prospective study was designed enrolling consecutive patients undergoing diagnostic transfemoral cerebral angiography by a single neurointerventional surgeon from March 2013 – March 2018. The closure protocol consisted of 20 minutes of manual compression to the site of arterial access and 2 hours of bedrest. The primary outcome was hematoma or oozing after manual compression. Demographic, clinic, and laboratory data were collected and analyzed, and patients were stratified by antiplatelet use.ResultsOf 525 angiograms, 263 (50.1%) were on patients taking antiplatelet medication, with 66 (12.6%) on dual antiplatelet regimens. Five patients (0.95% of all patients) met the primary outcome: in all five cases, there was no further oozing or enlarging hematoma after the additional compression period. There were not significant differences in primary outcome in groups stratified by antiplatelet use, and there were no instances of delayed hematoma, pseudoaneurysm, or arteriovenous fistula.ConclusionIn this single-arm cohort study of 525 consecutive transfemoral angiograms with a standardized extrinsic compression protocol, hemostasis was achieved without complication in >99% regardless of antiplatelet strategy. This protocol is effective and safe for diagnostic transfemoral angiography regardless of a patient’s antiplatelet use.

Early Ambulation After Transfemoral Diagnostic Cerebral Angiography: A Pilot Study

“…[1,6] For the transfemoral approach, the access site complications include hematoma (0.5-1.7%), pseudoaneurysm and arteriovenous stula (0.1-0.6%), and infection (0-1%). [1][2][3][4] Several methods are available to obtain access site hemostasis such as manual nonocclusive compression, external compression devices, and vascular closure devices. [1][2][3][4]8] Historically, hemostasis at the access site was obtained through pressure dressing followed by six hours of bed rest, with a recent trend toward the use of manual compression with early mobilization.…”

“…[1][2][3][4] Several methods are available to obtain access site hemostasis such as manual nonocclusive compression, external compression devices, and vascular closure devices. [1][2][3][4]8] Historically, hemostasis at the access site was obtained through pressure dressing followed by six hours of bed rest, with a recent trend toward the use of manual compression with early mobilization. [2,4,5] Our results showed that the overall rate of groin hematoma was (3%), which is higher than other closure techniques.…”

“…[1] A wide range of complications have been connected to the transfemoral approach, with a signi cant proportion related to the access site (e.g., groin hematoma, pseudoaneurysm, arteriovenous stula, etc.). [1][2][3][4] There are different closure protocols with no clear consensus regarding the optimal technique. [1][2][3][4][5][6] In this study, we assessed the e cacy and safety of a new closure protocol for transfemoral diagnostic cerebral angiography.…”

“…[1][2][3][4] There are different closure protocols with no clear consensus regarding the optimal technique. [1][2][3][4][5][6] In this study, we assessed the e cacy and safety of a new closure protocol for transfemoral diagnostic cerebral angiography.…”

Pediatric diagnostic cerebral angiography: practice recommendations from the SNIS Pediatric Committee

“…There are, however, reports in adults suggesting that a shorter period of 2-3 hours is sufficient. 34 Limiting knee and hip flexion can be aided by tightly tucking a sheet around the leg or securing a padded board to the leg in infants.…”