Femoral Access Site Complications Research Articles

Advanced practice nurse-coordinated same-day-discharge after atrial fibrillation ablation

Abstract Background Catheter ablation is an effective atrial fibrillation (AF) therapy, but a complex, resource-intensive procedure. Same-day discharge (SDD) reduces utilization of health care resources including personell and hospital beds, and may help to accommodate the increasing demand for AF ablation. However, besides structural adaptations, SDD requires more efficient logistics and coordination. Purpose Against this background, we established and validated a streamlined SDD program fully coordinated by an advanced practice nurse. Methods As dedicated SDD coordinator the advanced practice nurse was in charge of the full SDD protocol, including patient eligibility, patient flow, in-hospital logistics, patient education, discharge and short-term follow-up. For inclusion, basic home support and accessibility of the hospital within 60 minutes had to be warranted. Patients with LVEF <35% were excluded. Ablation was performed at the operator’s discretion. Ultrasound-guided femoral puncture was at the operator’s discretion for the first 150 SDD patients but became mandatory per protocol for all subsequent patients. Discharge by the SDD coordinator followed a standardized protocol including supervised ambulation, patient education, femoral inspection and echo. On post-ablation days 1 and 3, patients were called by the SDD coordinator to ensure well-being and good aspect of the femoral access site (smartphone foto control). In addition, patients could consult the SDD coordinator via mobile phone any time during working hours. In-person follow-up visits were scheduled at 2 weeks and 3, 6 and 12 months post-ablation. Results 420 consecutive patients were evaluated by the SDD coordinator of whom 331 were eligible for SDD. Reasons for exclusion were lack of home support (4.5%), living remotely (6.9%), or LVEF <35% (4.0%). 300 of the eligible patients (91%) were successfully discharged the same day (Fig. 1). Rates of unplanned medical attention (4.0%) and 30d-readmission (1.6%) were extremely low. Importantly, there was no major post-SDD complication. Unplanned medical attention and hospital readmissions were largely driven by minor femoral access site complications. Of note, those were significantly reduced upon introduction of mandatory ultrasound-guided puncture after the first 150 SDD patients (p=0.0145, Fig. 2). SDD coordination by the advanced practice nurse streamlined patient flow and in-hospital logistics and significantly reduced the total workload of nursing and medical staff. This resulted in great acceptance of the SDD program and satisfaction both among staff and patients. Conclusions Advanced practice nurse-coordinated SDD after AF ablation is safe and efficient. In fact, the position of a dedicated coordinator may be a key in the forthcoming transition of hospitals to SDD. Importantly, ultrasound-guided femoral puncture virtually eliminated relevant femoral access site complications and should be a prerequisite for SDD.Figure 1Figure 2

Utilization of Percutaneous Closure Devices for Large Bore Arterial Access in Genetic Aortopathy Patients Does Not Result in Increased Rates of Femoral Cutdown or Access Site Complications

Utilization of Percutaneous Closure Devices for Large Bore Arterial Access in Genetic Aortopathy Patients Does Not Result in Increased Rates of Femoral Cutdown or Access Site Complications

Femoral access site complications following neurointerventional procedures: economic implications at a single center.

Transfemoral access (TFA) has been the traditional route of arterial access for neurointerventional procedures. Femoral access site complications may occur in 2%-6% of patients. Management of these complications often requires additional diagnostic tests or interventions, each of which may increase the cost of care. The economic impact of a femoral access site complication has not yet been described. The objective of this study was to evaluate the economic consequences of femoral access site complications. The authors conducted a retrospective review of patients undergoing neuroendovascular procedures at their institute and identified those who experienced femoral access site complications. The subset of patients experiencing these complications during elective procedures was matched in a 1:2 fashion to a control group undergoing similar procedures and not experiencing an access site complication. Femoral access site complications were identified in 77 patients (4.3%) over a 3-year period. Thirty-four of these complications were considered major, requiring blood transfusion or additional invasive treatment. There was a statistically significant difference in total cost ($39,234.84 vs $23,535.32, p = 0.001), total reimbursement ($35,500.24 vs $24,861.71, p = 0.020) and reimbursement minus cost (-$3734.60 vs $1326.39, p = 0.011) between the complication and control cohorts in elective procedures, respectively. Although occurring relatively infrequently, femoral artery access site complications increase the cost of care for patients undergoing neurointerventional procedures; how this influences the cost effectiveness of neurointerventional procedures warrants further investigation.

Extremity Dysfunction After Large-Bore Radial and Femoral Arterial Access.

BackgroundThe use of large‐bore (LB) arterial access and guiding catheters has been advocated for complex percutaneous coronary intervention. However, the impact of LB transradial access (TRA) and transfemoral access (TFA) on extremity dysfunction is currently unknown.Methods and ResultsThe predefined substudy of the COLOR (Complex Large‐Bore Radial PCI) trial aimed to assess upper and lower‐extremity dysfunction after LB radial and femoral access. Upper‐extremity function was assessed in LB TRA‐treated patients by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and lower‐extremity function in LB TFA‐treated patients by the Lower Extremity Functional Scale questionnaire. Extremity pain and effect of access site complications and risk factors on extremity dysfunction was also analyzed. There were 343 patients who completed analyzable questionnaires. Overall, upper and lower‐extremity function did not decrease over time when LB TRA and TFA were used for complex percutaneous coronary intervention, as represented by the median Quick Disabilities of the Arm, Shoulder, and Hand score (6.8 at baseline and 2.1 at follow‐up, higher is worse) and Lower Extremity Functional Scale score (56 at baseline and 58 at follow‐up, lower is worse). Clinically relevant extremity dysfunction occurred in 6% after TRA and 9% after TFA. A trend for more pronounced upper‐limb dysfunction was present in female patients after LB TRA (P=0.05). Lower‐extremity pain at discharge was significantly higher in patients with femoral access site complications (P=0.02).ConclusionsFollowing LB TRA and TFA, self‐reported upper and lower‐limb function did not decrease over time in the majority of patients. Clinically relevant limb dysfunction occurs in a small minority of patients regardless of radial or femoral access.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03846752.

Access Site Related Vascular Complications following Percutaneous Cardiovascular Procedures.

Vascular access site complications (ASC) are among the most frequent complications of percutaneous cardiovascular procedures (PCP) and are associated with adverse outcome and high resources utilization. In this prospective study, we investigated patients with postprocedural clinical suspicion of ASC evaluated by duplex ultrasound (DUS) for the presence of ASC. We assessed the incidence, in-hospital outcome, treatment of complications and predictors for ASC. Overall, 12,901 patients underwent PCP during a 40 months period. Of those, 2890 (22.4%) patients had postprocedural clinical symptoms of ASC and were evaluated using DUS. An ASC was found in 206 of the DUS examined patients (corresponding to 7.1% of the 2890 DUS examined patients). In 6.7% of all valvular/TAVI procedures, an ASC was documented, while coronary, electrophysiological and peripheral PCP had a comparable and low rate of complications (1.2–1.5%). Pseudoaneurysm (PSA) was the most frequent ASC (67.5%), followed by arteriovenous fistula (13.1%), hematoma (7.8%) and others (11.7%). Of all PSA, 84 (60.4%) were treated surgically, 44 (31.6%) by manual compression and 11 (7.9%) conservatively. Three (0.02%) patients died due to hemorrhagic shock. In conclusion, femoral ASC are rare in the current era of PCP with PSA being the leading type of ASC. Nonetheless, patients with predisposing risk factors and postprocedural suspicious clinical findings should undergo a DUS to early detect and mitigate ASC-associated outcome.

Initial implantation experience and short-term follow-up results of implanting leadless intracardiac transcatheter pacing system

Objective: To explore the utility and safety of leadless intracardiac transcatheter pacing system. Methods: The study was a prospective observational study. Patients underwent Micra transcatheter pacing system in Beijing Anzhen hospital from December 2019 to January 2020 were enrolled. The baseline characteristics, platelet count, hemoglobin, anticoagulation and/or antiplatelet therapy, mean procedural time, average fluoroscopy time, number of deployment and electrical parameters (threshold, R-wave amplitude, impedance) were recorded. Ultrasonography of bilateral femoral and iliac veins was performed in all patients. Patients were followed including access site complication, adverse event and device evaluation at implant, hospital discharge, 1 and 3 months post-implant. R-wave≥5 mV, impedance between 400 and 1 500 Ω and threshold increase≤1.5 V than implant is considered a stable parameter. Femoral access site complications included hematoma, hemorrhage, pseudoaneurysm, and arteriovenous fistula. Adverse events included dislodgement, cardiac effusion/perforation and infection. Left ventricular end diastolic diameter and ejection fraction before and at 1 month after implant were reported. Results: Five patients were enrolled and pacemaker implantation was successful in all 5 patients. Patients were all males and the average age was (78.4±8.4) years. 2 patients received aspirin and clopidogrel therapy, 1 patient suffered from anemia and thrombocytopenia occurred in 1 patient. No stenosis, occlusion and vascular malformation of bilateral femoral and iliac veins was observed. The mean implant time was (39.6±1.7) minutes. The average fluoroscopy time was (9.2±1.3) minutes and the number of deployment was (1.40±0.55). Electrical parameters(threshold, R-Wave amplitude and impedance) were as follows: (0.40±0.10) V/0.24 ms, (10.80±3.72) mV and (822.00±162.23) Ω at implant; (0.45±0.07) V/0.24 ms, (13.04±2.41) mV, and (748.0±91.5) Ω at discharge, (0.40±0.06) V/0.24 ms, (14.26±4.11) mV, and (700.0±91.7) Ω at 1 month post-implant and (0.39±0.05) V/0.24 ms, 14.40±3.97 mV, and (682.0±96.0) Ω at 3 months post-implant, respectively. Threshold increase was ≤1.5 V compared to that during implantation, electrical parameters were acceptable and stable. There was no difference in LVEDD [(44.00±5.24) mm vs. (44.00±5.34) mm,P=1.000] and EF [(62.00±3.39)% vs. (62.20±3.56)%, P=0.861] before and 1 month post-implant. No incidence of access site complications, cardiac effusion/perforation, dislodgment or infections occurred during the 3 months. Conclusions: The leadless transcatheter pacemaker implantation performed in our study archived a high implant success rate and favorable safety profile as well as associated with low and stable pacing thresholds. The long-term safety and benefit of leadless pacemaker need to be evaluated in future clinical studies.

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

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.

Vascular closure device in cardiac cath laboratory: A retrospective observational study

Objective: This study is to share our experience of using vascular closure device (VCD) after anterograde femoral arterial access at cardiac cath lab. Background: Vascular access site management is crucial to safe, efficient, comfortable, and cost-effective diagnostic or interventional percutaneous cardiac procedures. As per the literature, femoral artery access site complications following angiographic procedures range from 1% to 5%. The Angioseal VCD has been shown to be safe and effective in reducing the time to hemostasis following angiographic or other cardiac interventional procedures. Materials and Methods: This is a retrospective, observational study carried out at a tertiary care hospital of the Armed Forces. All patients in whom Angioseal (St. Jude Medical) were deployed after undergoing either diagnostic coronary angiography or percutaneous coronary intervention (PCI) through common femoral artery access. All patients from January 2011 to December 2016 in whom VCD was either deployed or attempted were included in the study. Results: A total of 16245 patients were taken up for femoral access for diagnostic procedures and PCI from 2011 to 2016. We observed 98.52% success rate with Angioseal and a mere 1.48% complication rate. Out of the complications observed, only 2 (0.13%) patients had the serious complication of limb ischemia rest were all minor complications. Conclusion: Our observations and experience with the Angioseal VCD are a safe, efficient, and resulting in more favorable patient outcomes.

Permanent Leadless Cardiac Pacemaker Therapy: A Comprehensive Review.

A new technology, leadless pacemaker therapy, was recently introduced clinically to address lead- and pocket-related complications in conventional transvenous pacemaker therapy. These leadless devices are self-contained right ventricular single-chamber pacemakers implanted by using a femoral percutaneous approach. In this review of available clinical data on leadless pacemakers, early results with leadless devices are compared with historical results with conventional single-chamber pacing. Both presently manufactured leadless pacemakers show similar complications, which are mostly related to the implant procedure: cardiac perforation, device dislocation, and femoral vascular access site complications. In comparison with conventional transvenous single-chamber pacemakers, slightly higher short-term complication rates have been observed: 4.8% for leadless pacemakers versus 4.1% for conventional pacemakers. The complication rate of the leadless pacemakers is influenced by the implanter learning curve for this new procedure. No long-term outcome data are yet available for the leadless pacemakers. Larger leadless pacing trials, with long-term follow-up and direct randomized comparison with conventional pacing systems, will be required to define the proper clinical role of these leadless systems. Although current leadless pacemakers are limited to right ventricular pacing, future advanced, communicating, multicomponent systems are expected to expand the potential benefits of leadless therapy to a larger patient population.

Abstract 016: Endovascular Management of Major Vascular Access Site Complications During Transcatheter Aortic Valve Implantation (TAVI).

Background: Major vascular access site complications remain a challenge in the field of TAVI and are associated with higher 30 day mortality. However, outcomes following endovascular management with covered stents for such complications are not well established. Methods: We reviewed the one year data of patients who underwent TAVI at our institution with a Sapien valve by percutaneous femoral approach. Identified were patients who suffered major vascular complications according to the definitions set forth by the Valve Academic Research Consortium. We then compared the outcome of patients managed by an endovascular approach with a population whose femoral access site complications were managed surgically/endovascularly (85.7% surgically), as reported from the Partner trial. Results: A total of 16 patients experienced Major Vascular complications. TAVI was aborted on 2 patients due to access site complication. Excluded were 3 patients who had benign small ascending aortic dissections after successful valve deployment and 3 patients who were managed surgically. Ten remaining patients were managed by a pure endovascular approach with covered stents. Four of these patients suffered ilio-femoral dissection, 4 had perforation and 2 had both perforation and dissection. No significant difference was observed in pre and post procedure creatinine (1.01 vs 1.14, p=0.16) and none required dialysis within 30 days, as compared with 8.1% in Partner trial. We observed no statistically significant difference between the Partner trial cohort and our patients in 30 day all cause mortality (14.1% vs 10%, p=1), stroke rate (4.8% vs 0%, p=1), access site hematoma (22.9% vs 0%, p=0.1), retroperitoneal bleed (9.5% vs 0%, p=0.6), pseudoaneurysm (3.4% vs 0%, p=1), and gastrointestinal ischemia (1.6% vs 0%). No access site infection, stent thrombosis, or stenosis leading to limb ischemia were noted clinically at 30 day follow-up. Conclusion: Many patients with major vascular complications during TAVI can be treated with a pure endovascular approach. In our small series we observed no difference in concurrent complications when an endovascular repair can be rapidly initiated as compared to a primary surgical approach.

Predictors of common femoral artery access site complications in patients on oral anticoagulants and undergoing a coronary procedure.

BackgroundIt is unclear whether patients on oral anticoagulants (OAC) undergoing a procedure using common femoral artery access have higher adverse events when compared to patients who are not anticoagulated at the time of the procedure.MethodsWe retrospectively reviewed data from consecutive patients who underwent a cardiac procedure at a tertiary medical center. Patients were considered (group A) fully or partially anticoagulated if they had an international normalized ratio (INR) ≥1.6 on the day of the procedure or were on warfarin or new OAC within 48 h and 24 h of the procedure, respectively. The nonanticoagulated group (group B) had an INR <1.6 or had stopped their warfarin and new OAC >48 h and >24 h preprocedure, respectively. The index primary end point of the study was defined as the composite end point of major bleeding, vascular complications, or cardiovascular-related death during index hospitalization. The 30-day primary end point was defined as the occurrence of the index primary end point and up to 30 days postprocedure.ResultsA total of 779 patients were included in this study. Of these patients, 27 (3.5%) patients were in group A. The index primary end point was met in 11/779 (1.4%) patients. The 30-day primary composite end point was met in 18/779 (2.3%) patients. There was no difference in the primary end point at index between group A (1/27 [3.7%]) and group B (10/752 [1.3%]; P=0.3155) and no difference in the 30-day primary composite end point between group A (2/27 [7.4%]) and group B (16/752 [2.1%]; P=0.1313). Multivariable analysis showed that a low creatinine clearance (odds ratio [OR] =0.56; P=0.0200) and underweight patients (<60 kg; OR =3.94; P=0.0300) were independent predictors of the 30-day primary composite end point but not oral anticoagulation (P=0.1500).ConclusionPatients on OAC did not have higher 30-day major adverse events than those who were not anticoagulated at index procedure.

CRT-300.27 Predictors of Common Femoral Artery Access Site Complications in Patients on Oral Anticoagulants and Undergoing an Endovascular Intervention

It is unclear whether patients on oral anticoagulants (OAC) undergoing an endovascular procedure using common femoral artery (CFA) access have a higher rate of adverse events when compared to patients who are not anticoagulated with an OAC at the time of the procedure. We hypothesized that patients

Early Treadmill ECG Stress Testing After Percutaneous Coronary Intervention Following Hemostasis with the Angioseal™ Vascular Closure Device: A Prospective Single-Center Cohort Study

Objective: Particularly with the transfemoral access, potential complications at the puncture site with early exercise are a major concern. The purpose of this study was to compare femoral artery access site complications after percutaneous coronary interventions (PCI) in 1) patients following a standard care procedure and 2) performing treadmill electrocardiographic (ECG) stress testing within 24 h after application of the Angioseal™ vascular closure device. Methods: This is a prospective, randomised, single-center cohort study conducted in a high-volume tertiary interventional heart centre in Duisburg, Germany. 221 patients were included and 200 entered analysis. Patients were randomly assigned to treadmill testing within 24 h after transfemoral seven French (F) PCI or discharged with the recommendation of limited exercise for two weeks. Clinical examination and Duplex ultrasound (DUS) of the inguinal region was obtained within 24 h after PCI in both groups and repeated immediately after the treadmill test in the exercise group. Two-weeks clinical follow-up was obtained in both groups. Results: Early treadmill testing could be performed without any major limitations or acute complications in all assigned patients. DUS showed no new pseudoaneurysm (PSA) or arteriovenous fistula (AVF) after treadmill testing. At follow-up, there were 1) no differences regarding pain or physical limitations between the two groups and 2) four patients (4%) in the exercise group and seven patients (7%) in the standard care group developed major hematoma (>6 cm)/minor bleeding, which were clinically uneventful. Conclusions: Treadmill ECG stress testing within 24 h of PCI with the femoral access site closed by the Angioseal device was not associated with a higher complication rate compared to standard care.

Femoral artery anatomy-tailored approach in transcatheter aortic valve implantation.

IntroductionThe best techniques for reduction of femoral access site complications after transcatheter aortic valve implantation (TAVI) remain the object of research.AimWe report on a single center’s experience with TAVI performed via the femoral access site.Material and methodsBetween September 2010 and September 2015, 152 consecutive patients underwent TAVI in our department. Of them, 101 patients with CoreValve implantation from the femoral access site were included in the analysis. The femoral artery anatomy-tailored approach was introduced in 2013 in order to reduce the rate of access-site complications. Patients were assigned to percutaneous puncture or surgical cut-down depending on the femoral artery anatomy assessed in computed tomography. The study patients were divided into two subgroups: group A – patients treated before January 2013, before introduction of the tailored approach program (n = 34); and group B – patients treated between January 2013 and April 2015 (n = 67).ResultsThe access site complication rate significantly decreased from 35.3% in group A (n = 12) to 7.5% in group B (n = 5) (p = 0.0012). Both minor and major access site complications were more frequent in group A (p = 0.04 and 0.016, respectively). In-hospital mortality was 8.8% (n = 3) in group A and 1.5% (n = 1) in group B (p = 0.1).ConclusionsThe femoral artery anatomy-tailored approach significantly reduces the incidence of access site complications in TAVI patients.

Sex-related outcome of atrial fibrillation ablation: Insights from the German Ablation Registry

Stratification of patients with atrial fibrillation (AF) according to mechanistic and prognostic criteria may optimize the effectiveness and safety of catheter ablation. In women, AF is associated with more severe symptoms and worse prognosis. We sought to assess sex-related differences in catheter ablation procedures and outcome in a large cohort of patients with AF. A total of 3652 patients (1198 women [33%]; 2454 men [67%]) included in the German Ablation Registry were analyzed. Periprocedural parameters and outcome at 12-month follow-up were compared between male and female patients. Women were older at the time of ablation (women: 63.6 years; men: 59.1 years; P < .0001) and exhibited a higher prevalence of paroxysmal AF (women: 72%; men: 61%; P < .0001). They were less often affected by cardiovascular disease and reduced left ventricular function. Energy application duration and overall procedure duration were shorter in women. Conversely, the rate of major inhospital complications was increased in female patients (1.9% vs 0.8%; P = .023) and mainly driven by major bleeding events. At follow-up, women experienced higher AF recurrence rates (women: 50%; men: 45%; P = .017) and more often received oral medication for rhythm and rate control. In addition, the rate of pacemaker implantation was higher in the female cohort. Women more frequently reported femoral access site complications (women: 6%; men: 3%; P < .001). Overall, male patients were more often free from AF-related symptoms and satisfied with the treatment. Catheter ablation of AF was associated with a distinct sex-related outcome and complication profile that requires consideration in clinical practice.

Percutaneous Endovascular Aortic Repair of Complex Aneurysms Using Large-Diameter Sheaths for Thoracic, Fenestrated, and Branched Endografts

This study reviewed the outcomes of percutaneous endovascular aortic repair (PEVAR) of complex aortic aneurysms using large-diameter sheaths for thoracic, fenestrated, and branched stent grafts. We reviewed the outcomes of all consecutive patients who underwent PEVAR of descending thoracic (DTA), thoracoabdominal (TAAA), pararenal (PRA) or aortoiliac aneurysms (AIAs) using large-diameter sheaths for placement of thoracic, fenestrated, or branched stent grafts. Patients treated by fenestrated and branched stent grafts were enrolled in prospective physician-sponsored investigational device exemption protocols. A percutaneous approach was selected in patients with <50% posterior, minimal anterior, or no calcification in the common femoral artery using standardized preclosure technique with two Perclose devices (Abbott Vascular Inc., Redwood City, Calif) in each femoral puncture site. End points were technical success, conversion to open femoral artery repair, 30-day mortality and major adverse events, and freedom from femoral access-site complications. There were 102 patients treated for 48 PRAs, 27 TAAAs, 19 DTAs, and 8 AIAs. A total of 171 femoral arteries were closed using preclosure technique. Transfemoral sheath size was 18F in four vessels (3%), 20F in 120 (70%), and ≥22F in 47 (27%). Eighty-three patients (81%) had visceral branch incorporation, which required brachial artery access using small incision in 48. Technical success for percutaneous transfemoral closure was 95% (162 of 171). Nine intraoperative failures were managed by open femoral conversion using primary repair in six, interposition graft in two, and patch angioplasty in one. Mean estimated blood loss was 444 ± 569 mL. There were no patients with uncontrolled puncture-related hemorrhage, retroperitoneal hematoma, or intra-operative hypotension. The 30-day mortality was 0.9% (one of 101) and 30-day rate of major adverse events was 15% (16 of 102). Spinal cord injury occurred in one patient (0.9%). Five (3%) access-related complications occurred, including femoral artery occlusion in three and hematoma or pseudoaneurysm in one each. Wound-related complications occurred in one patient (0.5%) who required open femoral artery conversion for exposure and repair. After a mean follow up of 1-year, freedom from femoral access-site complication was 97% ± 2%. PEVAR using the preclosure technique is safe and effective in select patients with complex aortic aneurysms who have minimal or no femoral calcifications and require large-diameter sheaths for thoracic, fenestrated, and branched stent grafts. Rate of puncture (3%) and wound-related complications (0.5%) is low, and no uncontrolled puncture-related hemorrhage, retroperitoneal hematoma, or systemic hypotension occurred in this series.

Pocket-Size Imaging Devices Allow for Reliable Bedside Screening for Femoral Artery Access Site Complications

The aim of this study was to validate pocket-size imaging devices (PSIDs) as a fast screening tool for detecting complications after femoral artery puncture. Forty patients undergoing femoral artery puncture for arterial access related to percutaneous coronary intervention were enrolled. Twenty-four hours after percutaneous coronary intervention, the involved inguinal region was assessed with PSIDs enabling 2-D gray-scale and color Doppler imaging. Subsequently, examination with a stationary high-end ultrasound system was performed to verify the findings of bedside examination in all patients. In 37 patients, PSID imaging had good diagnostic quality. False aneurysms (one asymptomatic) occurred in four patients, and all were recognized during bedside screening with PSID. One case of femoral artery thrombosis was confirmed with PSID and during standard ultrasonographic examination. Physical examination augmented with the quick bedside PSID examination had a sensitivity of 100% and specificity of 91%. PSID facilitated rapid bedside detection of serious access site complications in the vast majority of patients, including asymptomatic cases.

Percutaneous Closure Devices Do Not Reduce the Risk of Major Access Site Complications in Patients Undergoing Elective Carotid Stent Placement

PurposeTo examine the risk of femoral access site complications in patients undergoing carotid stent placement who were treated with a closure device compared with patients who were not treated with a closure device. Materials and MethodsA national, multihospital patient database, the Premier Perspective database, was used to identify patients hospitalized for carotid stent placement from 2006–2011. To reduce potential selection bias, a propensity score was generated for each patient using relevant clinical variables. Propensity score adjustment via 1:1 matching was performed on patients who did and did not receive a closure device. Primary outcomes were minor femoral access site complications and major complications requiring procedural intervention. Secondary outcomes included in-hospital mortality, stroke, and blood transfusion. ResultsAmong 12,287 patients who underwent carotid stent placement at 217 hospitals, 6,398 (52%) received a closure device on the day of the procedure. After propensity score matching, patients who received a closure device had a lower likelihood of minor access site complications (4.2% vs 5.4%; odds ratio = 0.77; 95% confidence interval, 0.55–0.93; P = .0071) compared with patients who did not receive a closure device; however, this difference was small and likely not clinically relevant. Both groups had a similar risk of major access site complications (P = .32), in-hospital mortality (P = .0520), and stroke (P = .31). ConclusionsUse of a closure device was not associated with a substantially reduced risk of major adverse events after carotid stent placement and was associated with only a small improvement in minor access site complications.

TCT-28 Is the rate of femoral access site complications increased in the hands of “radialists”?

TCT-28 Is the rate of femoral access site complications increased in the hands of “radialists”?

Gender Disparity in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes – Does it Still Exist in Contemporary Practice?

Prior studies have demonstrated evidence of a disparity in the treatment and outcome of male compared to female patients undergoing percutaneous coronary intervention (PCI). From a dedicated database, we retrospectively analysed all consecutive patients with acute coronary syndrome (ACS) admitted to our institution for PCI in 2008. Baseline and procedural characteristics as well as complications were then evaluated for male patients (n = 331) as compared with female patients (n = 137). Women were noted to be older at the time of presentation (66.1 +/- 10.0 vs 60.7 +/- 11.6 years, P <0.00001), the groups were otherwise well matched in terms of baseline characteristics. Female patients were treated with significantly smaller diameter stents (2.86 +/- 0.44 vs 2.96 +/- 0.50 mm, P = 0.04), though the proportion of drug-eluting stents was similar (53.7% vs 50.5%, P = 0.5). Female patients were significantly less likely to receive optimal medical therapy with lesser use of glycoprotein IIb/IIIa inhibitor (26.3% vs 55.3%, P <0.0000001), and beta-blockers (83.9% vs 90.9%, P = 0.04). At 30 days, there were no differences in the rate of major adverse cerebrovascular or cardiac events (2.9% vs 3.9%, P = 0.8), though females had a significantly higher rate of femoral access site pseudoaneurysm (4.4% vs 0.9%, P = 0.02). There remains evidence for continued gender disparity in contemporary practice; despite evidence for efficacy in ACS patients, females received a notably lower use of glycoprotein IIb/IIIa inhibitors and beta-blockers. Women are also significantly more likely to develop femoral access site complications with pseudoaneurysm development; it is important therefore to optimise procedures for sheath removal in female patients or give strong consideration to the use of radial access site.