Femoral Complications Research Articles

Evaluation of the Learning Curve When Transitioning From Posterolateral to Direct Anterior Hip Arthroplasty: A Consecutive Series of 1000 Cases

BackgroundThe direct anterior approach (DAA) for primary hip replacement has been gaining more attention and widespread use in recent years. There are a number of published studies evaluating the learning curve when a surgeon changes technique; these studies typically look at complications during the initial cases. This study examines procedure and total operating room (OR) time along with all complications for a surgeon transitioning from the posterolateral approach (PA) to DAA. MethodsA retrospective review of a single surgeon series of 1000 initial DAA procedures. Total OR time, procedure time, and complications were collected and analyzed. One-way analysis of variance and post hoc least significant difference tests were used for statistical analysis. ResultsThere was an initial increase in both procedure and OR times compared with the mature PA, by 34% and 30%, respectively. The procedure time became statistically equivalent to the mature PA time after the 400th DAA case, and significantly shorter after the 850th case. The total OR time became statistically equivalent after the 900th DAA case. There were 18 early (<90 days) and 18 late reoperations performed in this series with a nonsignificant trend toward femoral complications occurring early in the series. Minimum follow-up time was 2 years. ConclusionThere was an initial increase in both total OR time and procedure time when an experienced surgeon introduced the DAA. By the end of the series, procedure time was significantly shorter and total OR time was equivalent. Complications overall were low and femoral complications decreased with time.

The patient-specific Triflange acetabular implant for revision total hip arthroplasty in patients with severe acetabular defects: planning, implantation, and results.

AimsFew reconstructive techniques are available for patients requiring complex acetabular revisions such as those involving Paprosky type 2C, 3A and 3B deficiencies and pelvic discontinuity. Our aim was to describe the development of the patient specific Triflange acetabular component for use in these patients, the surgical technique and mid-term results. We include a description of the pre-operative CT scanning, the construction of a model, operative planning, and surgical technique. All implants were coated with porous plasma spray and hydroxyapatite if desired.Patients and MethodsA multicentre, retrospective review of 95 complex acetabular reconstructions in 94 patients was performed. A total of 61 (64.2%) were female. The mean age of the patients was 66 (38 to 85). The mean body mass index was 29 kg/m2 (18 to 51). Outcome was reported using the Harris Hip Score (HHS), complications, failures and survival.ResultsThe mean follow-up was 3.5 years (1 to 11). The mean HHS improved from 46 (15 to 90) pre-operatively to 75 (14 to 100). A total of 21 hips (22%) had at least one complication with some having more than one; including dislocation (6%), infection (6%), and femoral complications (2%). The implant was subsequently removed in five hips (5%), only one for suspected aseptic loosening.ConclusionThe Triflange patient specific acetabular component provides predictable fixation with complication rates which are similar to those of other techniques.Cite this article: Bone Joint J 2018;100-B(1 Supple A):50–4.

Mismatch of long Gamma intramedullary nail with bow of the femur: Does radius of curvature of the nail increase risk of distal femoral complications?

IntroductionAnterior cortical penetration of the distal nail tip is a recognized complication of intra-medullary nailing of the femur particularly in the geriatric population. This has been attributed to a mismatch between the femoral bow and the radius of curvature (ROC) of the femoral nail. We wanted to see if there was a reduction of this risk comparing cephalomedullary nails with ROC of 200 cm and 150 cm. Methods52 patients were split into 2 groups similar with respect to age, sex and comorbidities. Group A with 25 patients used a nail with a ROC of 200 cm and Group B with 27 patients used a 150 cm ROC nail. Lateral radiographs of the distal femur were evaluated to note the position of the nail tip in relation to the femoral canal. The diameter of the femur at the tip of the nail was divided into 3 equal zones. The anterior one-third was designated as Zone1, the middle one-third as Zone 2 and the posterior one-third as Zone 3. Results80% of the cases with a 200 cm ROC nail had the tip of the nail in the anterior one-third of the canal (zone 1). Fracture of the anterior femoral cortex distally by the nail tip was seen in 2 patients.Only 18.5% of cases with a 150 cm ROC nail had the tip of the nail in anterior one-third of the canal (zone 1). There were no incidences of complications such as fractures and anterior cortical perforation. ConclusionsA cephalomedullary nail with a ROC of 150 cm had its distal tip more towards the center of the femoral canal when compared to a nail with ROC of 200 cm. No case of anterior femoral penetration was seen when using a nail with an ROC of 150 cm.

Impact of Femoral Stem Design on Failure After Anterior Approach Total Hip Arthroplasty

BackgroundAn increased rate of complications related to femoral component failure has been described with less invasive total hip arthroplasty (THA). This study evaluated the incidence of femoral complications associated with the direct anterior approach for THA. MethodsRetrospective review was performed of the initial 1120 consecutive patients who underwent direct anterior THA by 2 surgeons. ResultsA total of 899 patients (80.3%) had a 2-year follow-up (range, 2-8 years). Complications within 90 days occurred in 20 patients (1.8%): 10 calcar fractures, 1 greater trochanter fracture, 1 canal perforation, 3 hematomas, 2 dislocations, 2 superficial, and 1 deep infection. Nine patients (1%) underwent revision: 5 for aseptic femoral loosening (0.55%), 1 for periprosthetic joint infection, 1 for dislocation, 1 for hip flexor irritation, and 1 for a damaged polyethylene liner.Of the 5 patients with aseptic femoral loosening, 3 had a short, mediolateral tapered stem, 1 cemented stem, and 1 S-ROM stem placed to bypass a canal perforation. There were no revisions for aseptic loosening in the collared, fully hydroxyapatite (HA)-coated compaction broached or triple tapered proximal fit and fill stem designs (70.6% of all stems). Revision rate for femoral loosening was significantly higher for tapered wedge over HA-coated, compaction broached stems (P < .005). ConclusionPain and function improved predictably with a 0.55% rate of femoral loosening at 2-year follow-up. Among collared, fully HA-coated and triple taper fit and fill femoral stems, there were no instances of revision for aseptic loosening vs 3 in the short stem, collarless mediolateral tapered group.

P1065Use of routine fluoroscopic screening results in a reduction in femoral complications during coronary angiographic procedures

P1065Use of routine fluoroscopic screening results in a reduction in femoral complications during coronary angiographic procedures

Surgical Treatment Strategies of Iatrogenic Giant Femoral Artery Pseudoaneurysms

Background: The aim of this study was to evaluate the technical and clinical results, following surgical treatment of iatrogenic giant femoral artery pseudoaneurysms. Methods and findings: Among 1850 patients 60 (3.25%) of them diagnosed with an iatrogenic giant femoral artery pseudoaneurysms. All patients underwent surgical repair and were followed up for one month, three month and six month respectively using Duplex ultrasound sound and/or CT angiography. There were 40 male and 20 female, aged 30-70 years (Mean age 49.06 years ± 11.03). There were 66.7% n=40 patients presented with groin pain, pulsatile mass associated with lower extremity ischemia, infected pseudoaneurysm in 16.7% (n=10), pending ruptured pseudoaneurysm in 8.3% (n=5), and large wide pseudoaneurysm neck confirmed by Doppler ultrasound (8.3%) n=5. Primary repair was done for 30 patients; repair with vein batch angioplasty for 15 patients, interposition reversed saphenous vein graft for 10 patients, and interposition synthetic Dacron graft for 5 patients. Technical success was achieved in 100% of cases. There is neither limb loss nor intra-operative or postoperative mortality. Distal extremity ischemia was completely resolved after surgical repair. Postoperative complications included one groin wound infection, which was controlled by antibiotic treatment and debridement. Conclusion: Open surgical repair of femoral pseudoaneurysms is technically feasible, first-line treatment for iatrogenic giant femoral artery pseudoaneurysmsassociated complications.

Unchanged Femoral Complication Rate in the Radial Era: Ten-Year Experience

Unchanged Femoral Complication Rate in the Radial Era: Ten-Year Experience

Distal Extension of the Direct Anterior Approach to the Hip: A Cadaveric Feasibility Study

BackgroundThe direct anterior approach (DAA) is becoming more popular as the standard surgical approach for primary total hip arthroplasty. However, femoral complications of up to 2.8% have been reported. Therefore, it is important for surgeons to understand the periarticular neurovascular anatomy in order to safely deal with intraoperative complications. MethodsAnatomic dissections were performed on 20 cadaveric hips. The neurovascular structures anterior to the femur and distal to the intertrochanteric line were dissected and its position was described in relation to anatomic landmarks easily identified through the DAA: anterior superior iliac spine (ASIS), the insertion of the gluteus minimus (GM), and the lesser trochanter (LT). ResultsTwo clearly distinguishable neurovascular bundles running to the vastus lateralis were seen in 17 of 20 specimens. The average distances to the landmarks were as follows: ASIS–1st bundle = 12.3 cm (range, 9.7-14.5); GM–1st bundle = 3.2 cm (range, 2.2-4); LT–1st bundle = 1.6 cm (range, 0.7-2.8); 1st bundle–2nd bundle = 3.3 cm (range, 1.8-6.1). ConclusionA consistent pattern of 2 clearly distinguishable neurovascular bundles was seen in 85% of the specimens. Knowledge of the position of these neurovascular bundles in relation to the anatomic landmarks makes distal femoral extension of the DAA feasible. Further clinical studies are needed to confirm the safety of the extensile anterior approach.

A Novel Form of High Intensity Interval Training for Improving Cardiorespiratory Fitness in CAD Patients

sought to identify reasons for femoral approaches and discuss whether it is safe to further decrease femoral numbers Methods: Retrospective data was collected for all access approaches in a 12 month period. Results: Radial access accounted for 1756 of cases and 197 were femoral cases. Of these femoral cases, 83 were post coronary artery bypass graft cases (CABG), 37 had failed radials, 28 were renal dialysis patients and 29 were at operator discretion. 3 femoral haematomas were recorded and there were 6 complications related to the radial approach. Conclusion:Despite lowprevalenceof femoral accessutility (<11%), in our case there was no increase in femoral complications (1.5%) which differs from recent literature which suggested that increases in radial access numbers actually increased vascular access site complications with femoral access. In this group the femoral access use could arguably be limited to failed radial approaches or strong technical indications. Post CABG patients could have radial angiography using dedicated catheters and renal dialysis does not preclude radial angiography.

89 Radiofrequency Ablation of the Interventricular Septum to Treat Left Ventricular Outflow Tract Gradients in HOCM: Novel Use of Cartosound Technology to Guide Ablation

Introduction Septal reduction is required for HOCM patients with severe LVOT gradients and symptoms refractory to medications. Myectomy cannot be performed in all due to operative risk and patient choice. Alcohol ablation cannot be performed in 5–15% due to technical difficulties and reliance on septal coronary anatomy. A method of delivering percutaneous damage to the basal septum that is not reliant on coronary anatomy is desirable. Methods 5 patients underwent RF ablation; we describe follow up at 6 months in 4. CARTOsound technology (Intracardiac echocardiography (ICE) merged with the electroanatomic mapping system, CARTO) was used to create a virtual shell of the LV and aorta (Figure 1 (F1), panel A). The precise SAM-septal contact area is ascertained from realtime ICE images and is superimposed onto the CARTO LV shell (pink area, F1, B). This pink area becomes the target for RF energy delivery. Left bundle branch conduction tissue is mapped and superimposed (F1, C). Intravenous heparin is given to keep activated clotting time >250 s. A mean of 31.7 (28–36) minutes of RF energy (50W, 60o) was delivered to the target area using retrograde aortic access and an irrigated 4 mm SmartTouch D-curve ablation catheter (F1, D) Results Peak resting gradient improved from 64.25 (±50.60) to 12.25 (±2.50) mmHg. Valsalva/exercise gradient improved from 93.50 (±30.88) to 23.25 (±8.30) mmHg. SAM improved in all patients. IVSd reduced from 18.25 (±1.89)mm to 16.75 (±2.5)mm. All patients improved NYHA class from 3 to 2. CPEX data was available in 3. Pre-procedural peak VO2 measured 15.48 (±2.27) mL/min/Kg, this improved to 16.53 (±5.16). Total exercise time increased from 558 (±129) to 730 (±63)secs. EQ5D-5L quality of life index value increased from 0.57 (±0.17) to 0.65 (±0.18). Health score improved from 44 (±18.93) to 70 (±3.54). Two patients had CMR post ASA. Scar can be seen upto 8 mm depth at the endocardial surface of the LV target myocardium (Figure 2). Scar measured 6.3 and 2.2 g respectively, representing 2.4 and 1.1% of total LV mass. LV mass prior to ablation measured 259 and 198 g. This reduced to 236 and 160 g, representing a 9 and 19% reduction. Patient 4 died following femoral artery access point bleeding complications. Hypotension was poorly tolerated leading to cardiac arrest. The artery was repaired surgically but deterioration over the subsequent 48 h lead to multi-organ failure. Patient 5 had a paradoxical increase in LVOT gradients post procedure requiring unplanned ITU care. Conclusions Radiofrequency ablation to treat LVOT gradients in HOCM using CARTOsound shows significant promise. The unprecedented accuracy of damage reduces SAM and results in improvements in LVOT gradients, symptoms and quality of life in this preliminary group. A small amount of damage at the correct location can lead to significant LV mass regression. This indicates part of the hypertrophy in HCM is afterload dependent

What is the survivorship of fully coated femoral components in revision hip arthroplasty?

Femoral revision using fully coated femoral components offers distinct advantages in patients with notable bone loss. With the increasing concerns being raised about the problems of stem modularity, the results and complications of revision arthroplasty using devices with limited modularity are important. We therefore asked: (1) What is the frequency of infection, aseptic loosening, and reoperations after use of these components? (2) What is the frequency of intraoperative fracture of the femur when using these components and are there any identifiable factors related to these fractures? (3) What is the 10-year survivorship of these components, and are there any identifiable factors related to survival and rerevision? We retrospectively reviewed prospectively obtained data on 96 patients undergoing 104 revisions with fully coated components of two different manufacturers; six patients had died (6%) and six were lost to followup (6%) before 2 years. Data on intraoperative fracture, aseptic loosening, and reoperation were analyzed. Ninety-two hips, with a minimum followup of 2 years (mean, 8 years; range, 2-16 years), were evaluated for radiographic evidence of loosening. Intraoperative fracture frequency and Kaplan-Meier survivorship was calculated to 10 years for the entire cohort of 104 hips. Demographic, radiographic, and operative factors associated with implant survival and intraoperative fracture were analyzed using chi-square and Wilcoxon tests. There were three infections, nine hips (10%) had femoral component loosening (six rerevised), and there were seven other reoperations. Intraoperative complications in 17 hips (17%; 11 diaphyseal fractures, four perforations, two proximal fractures) were treated with allograft strut and cable fixation in 14 hips. Intraoperative femoral complication was more likely with the use of a curved stem [17 of 76, 22% curved; 0 of 28 straight stems (p=0.005)]. With failure defined as femoral component revision for aseptic loosening or radiographic evidence of loosening, implant survival was 88% at 10 years. Those femurs with Paprosky Grades 3B and 4 defects had a higher risk of loosening (3 of 10 for Grades 3B and 4 versus 6 of 94 hips [6%] for Grades 1, 2, 3A; p=0.03). As concerns about stems with more modularity become more prominent, we find the durability of the approach using fully coated femoral components reassuring, but we will continue to follow these patients in the longer term. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

The effect of early vs. late ambulation on femoral vascular complication and patients' discomfort after percutaneous coronary intervention

The effect of early vs. late ambulation on femoral vascular complication and patients' discomfort after percutaneous coronary intervention

Comparison of tissue characteristic between left main and non-left main coronary artery lesions — Assessment using integrated backscatter intravascular ultrasound

systematic review. Circulation 2008;118:1828–36. [28] Kandzari DE, Berger PB, Kastrati A, et al. Influence of treatment durationwith a 600mg dose of clopidogrel before percutaneous coronary revascularization. J Am Coll Cardiol 2004;44:2133–6. [29] Claeys MJ, Van der Planken MG, Bosmans JM, et al. Does pre-treatment with aspirin and loading dose clopidogrel obviate the need for glycoprotein IIb/IIIa antagonists duringelective coronary stenting?A focus onperi-proceduralmyonecrosis. EurHeart J 2005;26:567–75. [30] Heestermans AA, van Werkum JW, Taubert D, et al. Impaired bioavailability of clopidogrel in patients with a ST-segment elevation myocardial infarction. Thromb Res 2008;122:776–81. [31] Montalescot G, Wiviott SD, Braunwald E, et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 2009;373:723–31. [32] CannonCP,HarringtonRA, James S, et al. Comparisonof ticagrelorwith clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study. Lancet 2010;375:283–93. [33] Stone GW, Witzenbichler B, Guagliumi G, et al. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 2008;358:2218–30. [34] Feit F, Voeltz MD, Attubato MJ, et al. Predictors and impact of major hemorrhage on mortality following percutaneous coronary intervention from the REPLACE-2 Trial. Am J Cardiol 2007;100:1364–9. [35] Ndrepepa G, Berger PB, Mehilli J, et al. Periprocedural bleeding and 1-year outcome after percutaneous coronary interventions: appropriateness of including bleeding as a component of a quadruple end point. J Am Coll Cardiol 2008;51:690–7. [36] Doyle BJ, Ting HH, Bell MR, et al. Major femoral bleeding complications after percutaneous coronary intervention: incidence, predictors, and impact on longterm survival among 17,901 patients treated at the Mayo Clinic from 1994 to 2005. JACC Cardiovasc Interv 2008;1:202–9.

Experience with Four French Catheters for Outpatient Coronary Angiography.

Previous studies have demonstrated the efficacy and safety of outpatient cardiac catheterization on stable patients at low risk. We present our experience with four French catheters in 104 patients (72 male, 32 female, mean age 51 years old) with coronary angiography done as an outpatient procedure. No heparin was given during the procedure. After initial hemostasis had been attained, the patients returned to day center with vital signs monitored regularly. Patients were allowed ambulation after 4 hours' bed rest and were discharged the same afternoon. Normal coronary angiogram study was found in 76% of the study population. Single-vessel disease, double-vessel disease, triple-vessel disease, and left-main disease were found in 12%, 9.6%, 2%, and 1%, respectively. Nearly all of the patients demonstrated normal ventricular contraction (99%). Average procedural time was 20.2 +/- 4.4 minutes. Average hemostatic time was 8.4 +/- 3.1 minutes. No mortality directly attributed to the catheterization occurred in our study population. Moreover, there were no myocardial infarction, acute pulmonary edema, severe allergic reaction, and cerebrovascular accident. Femoral puncture site complication was only limited to superficial skin bruise. Quality of the cineangiogram was good in majority of the patients. Therefore, this study demonstrates that outpatient cardiac catheterization using four French Judkins catheter is a safe and cost-effective procedure.

Endovascular management of an unusual troubling femoral access complication: common femoral artery thrombotic occlusion precipitated by sheath occlusive effect and low cardiac output

Endovascular management of an unusual troubling femoral access complication: common femoral artery thrombotic occlusion precipitated by sheath occlusive effect and low cardiac output

Cortical windowing of the femoral diaphysis for cement/plug removal in hip revision surgery

To analyze the results of cortical windowing of the femoral diaphysis for well-fixed cement/plug removal during hip revision surgery. From May 2005 to June 2009, 14 patients (14 hips) were undergone revision total hip arthroplasty (THA), window was cut into the cortex of the femur, and the well-fixed cement/plug distal to the window was removed under the direct vision. After reimplanted the cementless revision stem, the cortical lids were replanted and fixed with 2 to 3 cerclage wires. Six patients who had suffered from osteoporosis were undergone morselized bone graft to the osteotomy site. Postoperatively, the patients were maintained at partial weight-bearing (touchdown) for 6 weeks and then advanced as they were able. The length of the cortical windows varied from 2.5 to 6.0 cm (mean, 3.4 cm), the width ranged from 0.8 to 1.4 cm (mean, 1.2 cm). In one patient the window was enlarged during the procedure to facilitate the cement/plug removal. The mean radiologically healing time for the windows was 19 weeks. There was no intraoperative femoral perforation during cement/plug removal. One femoral fracture during the revision stem was implanted. No postoperative periprosthetic fracture and other complications such as infection, implant subsidence occurred during the fellow-up. There was no femoral thigh pain or implant loosening with femoral window. The cortical windowing technique is very helpful to facilitate the well-fixed cement/plug distal to the prosthesis tip removal and the windows heal rapidly and decrease the femoral complications associated with revision THA.

117 The potential benefits of using the Zwolle risk score in identifying patients suitable for early discharge following primary angioplasty: Abstract 117 Table 1

<h3>Introduction</h3> With the drive to reduce cost and length of hospital stay, there is a need for risk scoring tools to identify patients who can be discharged early. One tool that has been validated in primary percutaneous coronary intervention (PPCI) is the Zwolle Risk Score (see Abstract 117 Table 1). Independent predictors of 30-day mortality included in the score are age, anterior infarct, Killip class, ischaemia time, TIMI flow and the presence of triple vessel disease. A score of ≤3 out of 16 has been shown to confer low risk, with one large study showing mortality of 0.1% at 2 days and 0.2% between 3 and 10 days. Proponents of the Zwolle risk score advocate early discharge (at 48 h) in patients with a score of ≤3, however this has not yet been universally accepted in the UK. We sought to review whether implementation of this risk score would identify a significant number of patients for early discharge without compromising patient care. We also analysed projected savings in bed days and cost. <h3>Method</h3> We retrospectively evaluated 100 consecutive patients taken to the catheter laboratory as part of the PPCI pathway since starting our 24 h service. Data were collected from a dedicated angioplasty database and cross-referenced with the MINAP database and case notes. Baseline patient characteristics were collected and individual risk scores were calculated using the Zwolle criteria. Patients were considered as being potentially suitable for early discharge if they had a score of ≤3. Outcomes at 30 days were documented. <h3>Results</h3> Eighty-one out of the 100 patients admitted via the PPCI pathway went on to have coronary intervention. The mean age of the cohort was 67+/−13 years; 57 male (70.4%), 11 diabetic (13.6%), 27 hypertensive (33.3%), 34 hypercholesterolaemic (42%) and 28 smokers (34.6%). The median Zwolle score was 3 (IQR 2–4), with 55 patients (67.9%) being potentially eligible for early discharge by having a score of ≤3. Of these, 22 (40%) were actually discharged at 48 h, with the rest staying a total of 55 bed days. A bed day at University Hospital is currently estimated to cost £110. By applying the Zwolle criteria for early discharge in all eligible patients, £6050 could have been saved. All complications required re-admission (n=5) and occurred at a mean of 9.2 days after intervention. The earliest complication was at 3 days for stent thrombosis secondary to clopidogrel omission. The remaining complications occurred after 9 days (femoral complication n=2, chest pain n=2). <h3>Conclusion</h3> The use of the Zwolle risk score in patients undergoing PPCI identifies a significant proportion of patients who would be candidates for early discharge. This does not appear to compromise patient safety and the widespread implementation of this policy in the NHS has the potential for both substantial cost savings and reduced length of inpatient stay.

TCT-221: Femoral Access Site Complication Rates After Percutaneous Coronary Intervention In 2517 Groin Punctures Undergoing Vascular Closure By Either Manual Compression Or the Perclose® Vascular Closure Device

TCT-221: Femoral Access Site Complication Rates After Percutaneous Coronary Intervention In 2517 Groin Punctures Undergoing Vascular Closure By Either Manual Compression Or the Perclose® Vascular Closure Device

Femoral vascular complications following catheter ablation of atrial fibrillation

Femoral vascular complications remain a significant complication of catheter ablation of atrial fibrillation as a result of peri-procedural anticoagulation protocols. We investigated the effect of three different anti-coagulation regimens on the incidence of femoral vascular complications following AF ablation over a 4 year period. We performed 603 catheter ablations in 539 patients from January 2004 to January 2008. All patients were started on coumadin immediately after procedure and received enoxaparin at 1 mg/kg 4 h post procedure and again 12 h later. Three protocols for enoxaparin, administered 12 hourly, were used post-procedure: Protocol A--1 mg/kg x ten doses; Protocol B--1 mg/kg x six doses, and Protocol C--0.5 mg/kg x six doses. We documented occurrence of femoral vascular complications prior to discharge and at the 1 month post-op visit using a prospective database. A femoral vascular complication was defined as hematoma requiring prolonged hospitalization, blood transfusion or surgical intervention. There were 21 femoral vascular complications during the study period. The rate of complication fell from 5.7% (protocol A) to 1.6% (protocol C) (p < 0.03). We attribute the decrease in complication rate to the shorter anticoagulation protocol, as the reduction remained significant regardless of variation in catheter sizes. There were no new cerebral vascular events with the lower enoxaparin protocols. A shorter course of post procedure anticoagulation protocol can reduce femoral complications without contributing to increased risk of thromboembolic events.

Routine Femoral Head Fluoroscopy to Reduce Complications in Coronary Catheterization

We tested whether routine preprocedure fluoroscopy of the femoral head would improve sheath placement or reduce the incidence of groin complications. Patients were randomized to receive either fluoroscopy or “blind” sheath placement using palpation alone. The location of the femoral sheath was established by femoral artery angiography. Sheath placement in relation to the femoral head, arterial location, and complication rates were compared. Placement was considered “ideal” if the sheath was in the common femoral artery and in the top or middle third of the femoral head. A total of 256 patients were enrolled. There was no difference in average age, body mass index (BMI), or rate of anticoagulation between the groups. There was no major bleeding in either group. The overall risk of minor bleeding was not statistically different. The treatment group showed higher “ideal” placement relative to the femoral head. In patients who had a BMI ≥30 kg/m2, the difference between the groups was statistically significant (treatment 69% vs control 50%). In conclusion, routine femoral fluoroscopy prior to sheath placement in coronary angiography and angioplasty did not significantly alter bleeding or complication rates but did increase the likelihood of ideal placement, especially in obese patients.