Vascular Access Complications: Diagnosis and Management

Abstract

The incidence of vascular access site related complications ranges between 0.8 % to 1.8 % of diagnostic cardiac catheterization and up to 9 % of percutaneous coronary interventions (PCI) [1]. The femoral vessels at the groin are used as the access site for the majority of percutaneous coronary, peripheral arterial and venous, and electrophysiologic interventions. With emergence of endovascular abdominal aortic aneurysm repair (EVAR), thoracic endovascular aneurysm repair (TEVAR), and transcatheter aortic valve replacement (TAVR), larger access sheaths (up to 18Fr-24Fr) are required, which further increases the potential for access site complications. The true incidence of access site complications arising from non-coronary interventions is unknown; hence it is likely that the total incidence of vascular access site complications is greatly underestimated. Vascular closure devices (VCDs), radial artery access, fluoroscopic guidance, and ultrasound guidance have all been used with a hope to minimize these complications. Despite these attempts, vascular access complications have not been eliminated. Cardiovascular specialists must promptly identify these complications and manage them appropriately.

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

“…We identified complications arising from either VCD or MC by using corresponding International Classification of Disease Codes (ICD). We agreed upon the following complications and ICDcodes identified by literature search and after consultation of a clinician and a coder: hematoma and bleeding [3], arteriovenous fistula (AVF) [13], pseudo aneurysm [13], retroperitoneal haemorrhage (RPH) [14], thrombosis [14], infection of access site [14] and other complications as indicated by a ICD code relating to a complication occurring from a procedure. The risk for complication was assessed binary by either having one of these complications or having no complications at all.…”

Transradial access for renal artery intervention

“…BA access is associated with high risk of vascular and nerve complications [18], but despite the disadvantages of the BA access this is the second access site for many interventionalist for PRI, due to the large size of the brachial artery, which makes the puncture easy, while it is not spasmogenic and allows the use of 6-7F large sheaths and the traditional catheter length allows the use of nearly all devices used for PRI. Another potential access site for PRI is the radial and ulnar way which has shown in many coronary and peripheral studies an extremely low rate of access site complications [1,2,6].…”

“…Percutaneous renal intervention (PRI) is usually performed using the femoral or brachial vascular access [3] but limited data exists for renal artery angioplasty and stenting performed from RA [4][5]. The major advantage of the RA access is the extreme low rate of vascular complication rate [6]. Several vascular complications were reported after transradial (TR) angioplasty, but many of them are asymptomatic due to dual blood supply of the hand [6][7][8][9].…”

“…The major advantage of the RA access is the extreme low rate of vascular complication rate [6]. Several vascular complications were reported after transradial (TR) angioplasty, but many of them are asymptomatic due to dual blood supply of the hand [6][7][8][9]. The aim of the study was to analyze the angiographic and clinical results of the renal artery stenting from our database; we describe our technique and provide a review of the literature.…”

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

“…Therefore, studies to evaluate clinical outcomes associated with puncture sites in the different diagnostic and therapeutic options follow advances in the area (1)(2)(3)(4) . 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) .…”