Abstract
BackgroundFemoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the influence of sheath size on overall complication rates and morbidity following femoral arterial access is not well described. This prospective single centre study reports our experience of vascular sheath size, patient and procedural factors in influencing complication rates following femoral arterial access. From April 2010 to May 2013, data was collected prospectively for all femoral arterial access procedures performed in the Interventional Radiology department of a tertiary hospital. For vascular sheath size <6-Fr, haemostasis was achieved by manual compression. For 6-Fr sheath size, a closure device was used in the absence of any contraindication.ResultsOf the 320 femoral access cases with eligible inclusion criteria, 52.5% had 4-Fr whilst 47.5% had 6-Fr vascular sheaths inserted. Overall post procedure complications rates were significantly higher following 6-Fr sheath (17/152 (11.2%)) versus 4-Fr systems (3/168 (1.8%)) (p=0.0007) mostly comprising self-limiting hematoma. There was no significant difference in major complications that required escalation of treatment.ConclusionNo significant difference has been demonstrated between the use of either sheath systems for major complications. The practical limitations of a smaller system, combined with existing body of evidence, may not justify the routine use of 4-Fr sheath systems as the primary sheath size for all endovascular procedures.
Highlights
Femoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures
Arterial access site characteristics The arterial access site characteristics, operator seniority and methods of closure are recorded in Table 2. 75.6% were retrograde access, with the majority (95.3%) constituting puncture of the common femoral artery. 85% were successful with a single anterior wall puncture. 4-Fr vascular access sheaths were used in 52.5%, whilst 6-Fr sheaths were used in 47.5%
Arterial puncture was achieved with either ultrasound guidance alone (44.7%) or a combination of ultrasound and fluoroscopic guidance (34.4%); only 15.9% were accessed by manual palpation alone. 78.1% of access sites were sealed by manual compression
Summary
Femoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the influence of sheath size on overall complication rates and morbidity following femoral arterial access is not well described. This prospective single centre study reports our experience of vascular sheath size, patient and procedural factors in influencing complication rates following femoral arterial access. The aim was to assess the overall complication rates when using 4-French vascular access sheaths for femoral arterial endovascular interventions compared with 6-French sheaths; and evaluate the influence of patient and procedural parameters on these complication rates
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