Abstract
Background: Retroperitoneal bleeding (RPB) can be a serious complication related to cardiac catheterization via femoral approach. Despite improvement in procedural safety, women undergoing cardiac catheterization remain at a two-fold higher risk of access site bleeding including RPB compared to men. We sought to compare clinical and angiographic predictors of RPB among men and women undergoing cardiac catheterization. METHODS: Case-control study design was used to identify cases with documented RPB and matched using age, procedure and gender to define controls. Detailed clinical and femoral angiographic data was collected and analyzed. Safe zone arteriotomy (SZA) was defined as access below inferior epigastric artery and above femoral artery (CFA) bifurcation. Univariate comparisons were made between cases and controls in both genders. Multivariate analysis was performed to identify independent predictors of RPB after adjusting for baseline differences. RESULTS: There were significant differences in clinical variables such as BMI and femoral artery anatomy among women with and without RPB (Table). On the other hand among men, BMI or size of CFA was not relevant but non-SZA (high stick) was more likely in men with RPB. On multivariate analysis, BMI trended to be only independent predictor of RPB among women (OR 0.83, 95% CI 0.68-1.0, p=0.05) whereas in men, SZA strongly predicted RPB (OR 0.30, 95 % CI 0.1- 0.3, P< 0.01). Conclusion: There are significant gender differences in mediators of RPB risk. The presence of non-modifiable risk factors such as smaller BMI and CFA vessel size in women may explain the persistent increased risk of RPB and access site complications seen in women.
Published Version
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