Skip to main content
SpringerLink
Log in

Risk Management of Femoral Arterial Access-Related Complications in Percutaneous Coronary Intervention

  • Chapter
Complications of Percutaneous Coronary Intervention

  • 1620 Accesses

Abstract

Femoral vascular access related complications are associated with increased morbidity, mortality, length of stay and cost. Bleeding from a femoral arterial puncture site is the most common complication seen; however, there is heterogeneity in the definition of bleeding used in Acute Coronary Syndrome (ACS) trials. The most commonly used, the Thrombolysis in Myocardial Infarction (TIMI) criteria, divide bleeding into major (>5 g/dL decrease in the haemoglobin concentration or a ≥15 % absolute decrease in haematocrit), minor (≥3 g/dL decrease in the haemoglobin concentration or ≥10 % decrease in the haemotocrit if bleeding is observed, ≥4g/dL and ≥12 % if bleeding not seen), and minimal (any clinically overt sign of haemorrhage associated with a <3g/dL decrease in the haemoglobin concentration or <9 % decrease in the haematocrit) [5]. Similarly, there exists great variability (5–20 %) in the incidence of reported femoral vascular access complications. A preventative approach is described here.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kugelmass AD, Cohen DJ, Brown PP, Simon AW, Becker ER, Culler SD. Hospital resources consumed in treating complications associated with percutaneous coronary interventions. Am J Cardiol. 2006;97:322–7.

    Article  Google Scholar 

  2. Jacobson KM, Long KH, McMurtry EK, Naessens JM, Rihal CS. The economic burden of complications during percutaneous coronary intervention. Qual Saf Health Care. 2007;16:154–9.

    Article  Google Scholar 

  3. Doyle BJ, Ting HH, Bell MR, Lennon RJ, Mathew V, Singh M, et al. Major femoral bleeding complications after percutaneous coronary intervention: incidence, predictors, and impact on long-term survival among 17,901 patients treated at the Mayo Clinic from 1994 to 2005. JACC Cardiovasc Interv. 2008;1:202–9.

    Article  Google Scholar 

  4. Manoukian SV. The relationship between bleeding and adverse outcomes in ACS and PCI: pharmacologic and nonpharmacologic modification of risk. J Invasive Cardiol. 2010;22:132–41.

    PubMed  Google Scholar 

  5. Mehran S, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelbbom J, et al. Standardized bleeding definitions for cardiovascular clinical trials. Circulation. 2011;123:2736–47.

    Article  Google Scholar 

  6. Nasser TK, Mohler 3rd ER, Wilensky RL, Hathaway DR. Peripheral vascular complications following coronary interventional procedures. Clin Cardiol. 1995;18:609–14.

    Article  CAS  Google Scholar 

  7. Garrett PD, Eckart RE, Bauch TD, Thompson CM, Stajduhar KC. Fluoroscopic localization of the femoral head as a landmark for common femoral artery cannulation. Catheter Cardiovasc Interv. 2005;65:205–7.

    Article  Google Scholar 

  8. Dotter CT, Rosch J, Robinson M. Fluoroscopic guidance in femoral artery puncture. Radiology. 1978;127:266–7.

    Article  CAS  Google Scholar 

  9. Lechner G, Jantsch H, Waneck R, Kretschmer G. The relationship between the common femoral artery, the inguinal crease, and the inguinal ligament: a guide to accurate angiographic puncture. Cardiovasc Intervent Radiol. 1988;11:165–9.

    Article  CAS  Google Scholar 

  10. Fitts J, Ver LP, Hofmaster P, Malenka D. Fluoroscopy-guided femoral artery puncture reduces the risk of PCI-related vascular complications. J Interv Cardiol. 2008;21:273–8.

    Article  Google Scholar 

  11. Seto AH, Abu-Fadel MS, Sparling JM, Zacharias SJ, Daly TS, Harrison AT, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access with Ultrasound Trial). JACC Cardiovasc Interv. 2010;3:751–8.

    Article  Google Scholar 

  12. Dudeck O, Teichgraeber U, Podrabsky P, Lopez Haenninen E, Soerensen R, Ricke J. A randomized trial assessing the value of ultrasound-guided puncture of the femoral artery for interventional investigations. Int J Cardiovasc Imaging. 2004;20:363–8.

    Article  Google Scholar 

  13. Hanson JM, Atri M, Power N. Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: Doppler features and technical tips. Br J Radiol. 2008;81:154–63.

    Article  CAS  Google Scholar 

  14. Schneider C, Malisius R, Küchler R, Lampe F, Krause K, Bahlmann E, Kuck KH. A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms. Int J Cardiol. 2009;131:356–61.

    Article  Google Scholar 

  15. Schaub F, Theiss W, Heinz M, Zagel M, Schömig A. New aspects in ultrasound guided compression repair of postcatheterization femoral artery injuries. Circulation. 1994;90:1861–5.

    Article  CAS  Google Scholar 

  16. Mak GY, Daly B, Chan W, Tse KK, Chung HK, Woo KS. Percutaneous treatment of post catheterization massive retroperitoneal hemorrhage. Cathet Cardiovasc Diagn. 1993;29:40–3.

    Article  CAS  Google Scholar 

  17. Dabney A, Bastani B. Enoxaparin-associated severe retroperitoneal bleeding and abdominal compartment syndrome: a report of two cases. Intensive Care Med. 2001;27:1954–7.

    Article  CAS  Google Scholar 

  18. Sommer C, Ferbert A. Damage to the lateral cutaneous femoral nerve after transfemoral angiography. Nervenarzt. 1992;63:633–5.

    CAS  PubMed  Google Scholar 

  19. Sohail MR, Khan AH, Dr Holmes Jr, Wilson WR, Steckelberg JM, Baddour LM. Infectious complications of percutaneous vascular closure devices. Mayo Clin Proc. 2005;80:1011–5.

    Article  Google Scholar 

  20. Nikolsky E, Mehran R, Halkin A, Mintz GS, Lasic Z, Negoita M, et al. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol. 2004;44:1200–9.

    PubMed  Google Scholar 

  21. Lasic Z, Nikolsky E, Kesanakurthy S, Dangas G. Vascular closure devices: a review of their use after invasive procedures. Am J Cardiovasc Drugs. 2005;5:185–200.

    Article  Google Scholar 

  22. Hamel WJ. Femoral artery closure after cardiac catheterization. Crit Care Nurse. 2009;29:39–46.

    Article  Google Scholar 

  23. Rashid MN, Bailey SR. Percutaneous femoral access and vascular closure devices. Available at: http://ccn.aacnjournals.org. Accessed 9 July 2012.

  24. Rao S, Kaul P, Stouffer GA. Successful aspiration of Mynx vascular closure device sealant that embolized to the popliteal artery. J Invasive Cardiol. 2013;25:E172–4.

    PubMed  Google Scholar 

  25. Gupta A, Sadiq I, Borer S. Distal embolisation from Mynx device. Conn Med. 2012;76:545–8.

    PubMed  Google Scholar 

  26. Azmoon S, Pucillio AL, Aronow WS, Ebrahimi R, Vozzolo J, Rajdev A, et al. Vascular complications after percutaneous coronary intervention following hemostasis with the Mynx vascular closure device versus the AngioSeal vascular closure device. J Invasive Cardiol. 2010;22940:175–8.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Royal Derby Hospital, Derby, UK

    Gopal Dubey BSc MBBS MRCP(London) MRCP(UK)

  2. Department of Cardiology, Royal Derby Hospital, Derby, Derbyshire, UK

    Kamal Chitkara MBBS, MD, MRCP

Authors
  1. Gopal Dubey BSc MBBS MRCP(London) MRCP(UK)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamal Chitkara MBBS, MD, MRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kamal Chitkara MBBS, MD, MRCP .

Editor information

Editors and Affiliations

  1. Department of Cardiology, Royal Brompton Hospital, London, UK

    Alistair Lindsay

  2. Royal Derbyshire Hospital, Derby, UK

    Kamal Chitkara

  3. Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK

    Carlo Di Mario

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag London

About this chapter

Cite this chapter

Dubey, G., Chitkara, K. (2016). Risk Management of Femoral Arterial Access-Related Complications in Percutaneous Coronary Intervention. In: Lindsay, A., Chitkara, K., Di Mario, C. (eds) Complications of Percutaneous Coronary Intervention. Springer, London. https://doi.org/10.1007/978-1-4471-4959-0_31

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4959-0_31

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4958-3

  • Online ISBN: 978-1-4471-4959-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation