Femoral access site closure without prior femoral angiography : Aretrospective analysis.

Christoph Brenner,Rudolf Kirchmair,Josef Klocker,Peter Marschang,Alexandra Gratl,Julian Margreitter,Guy Friedrich,Nicolas Moes,Bernhard Metzler

doi:10.1007/s00508-018-1314-3

Christoph Brenner, Rudolf Kirchmair + Show 7 more

Open Access

https://doi.org/10.1007/s00508-018-1314-3

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Abstract

SummaryAims and backgroundAlthough guideline recommendations have shifted towards a transradial route, femoral puncture is still an established vascular access, especially for complex coronary interventions. The FemoSeal™ vascular closure device (FVCD) helps to reduce femoral compression time and access site complications after removal of the catheter sheath. To ensure safe use, an angiography of the femoral artery prior to FVCD deployment is recommended by the manufacturer. We postulate that omitting this angiography does not relevantly increase the risk for vascular complications.Methods and resultsIn this retrospective analysis of an all-comers population (n = 1923) including patients receiving a percutaneous coronary intervention (PCI), we could show that combined vascular complication rates without femoral angiography were low (primary endpoint 4.6%) and comparable to a randomized clinical trial that did perform angiography of the vascular access site in a cohort of patients receiving diagnostic coronary angiography only. In addition to this analysis, we could demonstrate that patients with an acute coronary syndrome, receiving periprocedural anticoagulation or anti-platelet therapy had an increased risk for the formation of arterial pseudoaneurysms; however, we did not observe any ischemic vascular event after FVCD deployment.ConclusionClosure of the femoral access site after coronary angiography using the FVCD can be safely performed without femoral angiography; however, due to an increased risk for the formation of pseudoaneurysms we recommend the transradial access in situations with increased bleeding risk.

Highlights

Despite increasing rates of radial access for percutaneous coronary angiography, the femoral vascular access site is still frequently used, especially for complex coronary interventions with use of larger guiding catheters [1]
This helps to ensure that the femoral artery (1) has a sufficient lumen diameter of ≥5 mm (2), no relevant stenosis, atherosclerotic plaques or vascular abnormalities at the puncture site and that (3) the arterial puncture is not located at or distal to the common femoral artery bifurcation; in high-volume centers frequently using the transfemoral approach for coronary angiography, the final femoral angiogram is time-consuming, can lead to a relevant additional radiation exposure for physicians and an increased consumption of the costintensive and nephrotoxic contrast agent
More than 20% of our study patients were admitted for coronary angiography (CAG) due to an acute coronary syndrome

Summary

Introduction

Despite increasing rates of radial access for percutaneous coronary angiography, the femoral vascular access site is still frequently used, especially for complex coronary interventions with use of larger guiding catheters [1]. An angiography of the ipsilateral common femoral artery is recommended by the manufacturer before deployment of the FVCD [5] This helps to ensure that the femoral artery (1) has a sufficient lumen diameter of ≥5 mm (2), no relevant stenosis, atherosclerotic plaques or vascular abnormalities at the puncture site and that (3) the arterial puncture is not located at or distal to the common femoral artery bifurcation; in high-volume centers frequently using the transfemoral approach for coronary angiography, the final femoral angiogram is time-consuming, can lead to a relevant additional radiation exposure for physicians and an increased consumption of the costintensive and nephrotoxic contrast agent

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