Transfemoral Cardiac Catheterization Research Articles

Scrotal hematoma: a rare complication of transfemoral percutaneous coronary intervention

BackgroundCardiac catheterization via the transfemoral approach can be associated with access site bleeding complications such as inguinal hematoma, pseudoaneurysm, arteriovenous fistula and retroperitoneal hematoma. Scrotal hematoma is a rare presentation of bleeding complications after transfemoral cardiac catheterization. We report a case of this rare complication.Case presentationA 63-year-old male with previous coronary artery bypass surgery underwent percutaneous coronary intervention via transfemoral approach. Few hours after removal of the femoral sheath, he developed a big scrotal hematoma and hemodynamic deterioration. The patient responded successfully to conservative treatment and discharged from hospital after three days in a stable condition.ConclusionsBleeding complications after transfemoral cardiac catheterization can rarely present as scrotal hematoma. The management of this complication is usually conservative, and only few cases may require surgical treatment.

Early Mobilization after Cardiac Catheterization via Femoral Artery: A Systematic Review and Meta-Analysis.

Early mobilization is one of the essential components of enhanced recovery after surgery (ERAS) pathways and has been shown to reduce complications and optimize patient outcomes. However, the effect of early mobilization for patients who undergo trans-femoral cardiac catheterization and the time for optimal mobilization timing remains controversial. We aimed to identify the safety of early mobilization and provide the optimum timing for early mobilization for patients undergoing trans-femoral cardiac catheterization. We searched MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases of systematic reviews, CINAHL, SCOPUS, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Chinese Science and Technology Periodical Database (VIP) comprehensively for randomized controlled trials associated with early mobilization, to explore its effects on patients after a trans-femoral cardiac catheterization. The risk of bias and heterogeneity of studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and index, respectively. The comprehensive Meta-analysis (CMA) was adopted to perform the meta-analysis. We identified 14 trials with 2653 participants. Early mobilization was associated with significant decrease in back pain (mean difference (MD) = 0.634, 95% CI: 0.23-1.038; p = 0.002), especially in patients receiving instruction for early mobilization in 3 h~4 h versus 5 h~6 h (MD = 0.737, 95% CI: 0.431-1.043; p = 0.000) and 12 h versus 24 h (OR = 5.504, 95% CI: 1.646-18.407; p = 0.006) categories. The results of subgroup analysis also showed a significant risk reduction in urinary retention by early mobilization in 12 h versus 24 h (OR = 5.707, 95% CI: 1.859-17.521; p = 0.002) category. Early mobilization has not been shown to increase the risk of bleeding, hematoma, pseudoaneurysm, urinary retention, and pain at the puncture site after trans-femoral cardiac catheterization. Early mobilization is a practical initiative in ERAS, and it may be safe and feasible to advance the mobilization to 2 h~4 h.

Effects of time of bed rest on vascular complications after cardiac catheterization in pediatric patients with congenital heart disease: A randomized controlled trial

BackgroundPediatric cardiac catheterization, which is performed by accessing the femoral vessel, requires immobilization and bed rest for 4–6 h to prevent vascular complications. Studies in adults suggest that the immobilization time for the same access can be safely reduced to approximately 2 h after catheterization. However, it is unclear whether bed-rest time can be safely decreased after catheterization in children. ObjectiveTo assess the effects of bed-rest duration on bleeding, vascular complications, pain level, and the use of additional sedatives after transfemoral cardiac catheterization in children with congenital heart disease. MethodsThis study was an open-label, randomized, controlled, posttest-only design, including 86 children who underwent cardiac catheterization. Children were allocated to receive either 2 h of bed rest (n = 42) in the experimental group or 4 h of bed rest (n = 42) in the control group following catheterization. ResultsThe mean age of children was 3.93 (±3.82) years in the experimental group and 5.63 (±3.97) years in the control group. There was no difference in site bleeding incidence (P = 0.214), vascular complication score (P = 0.082), pain level (P = 0.445), or additional sedation use (P = 1.000) between the two groups. ConclusionsThere were no significant hemostatic complications after 2 h of bed rest following pediatric catheterization; therefore, 2 h of bed rest was as safe as 4 h of bed rest. (Trial registration: KCT0007737).

Bed rest duration and complications after transfemoral cardiac catheterization: a network meta-analysis.

To assess the effects of bed rest duration on short-term complications following transfemoral catheterization. A systematic search was carried out in MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, Scopus, SciELO, and in five registries of grey literature. Randomized controlled trials and quasi-experimental studies comparing different duration of bed rest after transfemoral catheterization were included. Primary outcomes were hematoma and bleeding near the access site. Secondary outcomes were arteriovenous fistula, pseudoaneurysm, back pain, general patient discomfort and urinary discomfort. Study findings were summarized using a network meta-analysis (NMA).Twenty-eight studies and 9217 participants were included (mean age 60.4 years). In NMA, bed rest duration was not consistently associated with either primary outcome, and this was confirmed in sensitivity analyses. There was no evidence of associations with secondary outcomes, except for two effects related to back pain. A bed rest duration of 2-2.9 hours was associated with lower risk of back pain (RR 0.33, 95%CI 0.17-0.62), and a duration over 12 hours with greater risk of back pain (RR 1.94, 95%CI 1.16-3.24), when compared to the 4-5.9 hours interval. Post-hoc analysis revealed an increased risk of back pain per hour of bed rest (RR 1.08, 95%CI 1.04-1.11). A short bed rest was not associated with complications in patients undergoing transfemoral catheterization; the greater the duration of bed rest, the more likely patients were to experience back pain. Ambulation as early as 2 hours after transfemoral catheterization can be safely implemented. URL: https://www.crd.york.ac.uk/prospero. Identifier: PROSPERO CRD42014014222.

Characteristics of Heart Failure With Preserved Ejection Fraction Across the Range of Left Ventricular Ejection Fraction.

Recent trial data suggest that stratification of patients with heart failure with preserved ejection fraction (HFpEF) according to left ventricular ejection fraction (LVEF) provides a means for dissecting different treatment responses. However, the differential pathophysiologic considerations have rarely been described. This prospective, single-center study analyzed consecutive symptomatic patients with HFpEF diagnosed according to the 2016 European Society of Cardiology heart failure guidelines. Patients were grouped into LVEF 50% to 60% and LVEF >60% cohorts. All patients underwent cardiac magnetic resonance imaging. Transfemoral cardiac catheterization was performed to derive load-dependent and load-independent left ventricular (LV) properties on pressure-volume loop analyses. Fifty-six patients with HFpEF were enrolled and divided into LVEF 50% to 60% (n=21) and LVEF >60% (n=35) cohorts. On cardiac magnetic resonance imaging, the LVEF >60% cohort showed lower LV end-diastolic volumes (P=0.019) and end-systolic volumes (P=0.001) than the LVEF 50% to 60% cohort; stroke volume (P=0.821) did not differ between the cohorts. Extracellular volume fraction was higher in the LVEF 50% to 60% cohort than in the LVEF >60% cohort (0.332 versus 0.309; P=0.018). Pressure-volume loop analyses demonstrated higher baseline LV contractility (end-systolic elastance, 1.85 vs 1.33 mm Hg/mL; P<0.001) and passive diastolic stiffness (β constant, 0.032 versus 0.018; P=0.004) in the LVEF >60% cohort. Ventriculo-arterial coupling (end-systolic elastance/arterial elastance) at rest was in the range of optimized stroke work in the LVEF >60% cohort but was impaired in the LVEF 50% to 60% cohort (1.01 versus 0.80; P=0.005). During handgrip exercise, patients with LVEF >60% had higher increases in end-systolic elastance (1.85 versus 0.82 mm Hg/mL; P=0.023), attenuated increases in indexed end-systolic volume (-1 versus 7 mL/m²; P<0.004), and more exaggerated increases in LV filling pressures (8 vs 5 mm Hg; P=0.023). LV stroke volume decreased in the LVEF >60% cohort (P=0.007) under exertion. Patients with HFpEF in whom LVEF ranged from 50% to 60% demonstrated reduced contractility, impaired ventriculo-arterial coupling, and higher extracellular volume fraction. In contrast, patients with HFpEF and a LVEF >60% demonstrated a hypercontractile state with excessive LV afterload and diminished preload reserve. A LVEF-based stratification of patients with HFpEF identified distinct morphologic and pathophysiologic subphenotypes.

Effect of Gradual Sitting Position on Recovery and Satisfaction of Patients Post Trans-Femoral Cardiac Catheterization

Effect of Gradual Sitting Position on Recovery and Satisfaction of Patients Post Trans-Femoral Cardiac Catheterization

Safety and effectiveness of strategies to reduce radiation exposure to proceduralists performing cardiac catheterization procedures: a systematic review.

The objective of this systematic review was to synthesize the best available evidence on the effect of various radiation protection strategies on radiation dose received by proceduralists performing cardiac catheterization procedures involving fluoroscopy. Cardiac catheterization procedures under fluoroscopy are the gold standard diagnostic and treatment method for patients with coronary artery disease. The growing demand of procedures means that proceduralists are being exposed to increasing amounts of radiation, resulting in an increased risk of deterministic and stochastic effects. Standard protective strategies and equipment such as lead garments reduce radiation exposure; however, the evidence surrounding additional equipment is contradictory. Randomized controlled trials that compared the use of an additional radiation protection strategy with conventional radiation protection methods were considered for inclusion. The primary outcome of interest was the radiation dose received by the proceduralist during cardiac catheterization procedures. A three-step search was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library (CENTRAL). Trials published in the English language with adult participants were included. Trials published from database inception until July 2019 were eligible for inclusion. The methodological quality of the included studies was assessed using the JBI critical appraisal checklist for randomized controlled trials. Quantitative data were extracted from the included papers using the JBI data extraction tool. Results that could not be pooled in meta-analysis were reported in a narrative form. Fifteen randomized controlled trials were included in the review. Six radiation protection strategies were assessed: leaded and unleaded pelvic or arm drapes, transradial protection board, remotely controlled mechanical contrast injector, extension tubing for contrast injection, real-time radiation monitor, and a reduction in frame rate to 7.5 frames per second. Pooled data from two trials demonstrated a statistically significant decrease in the mean radiation dose (P < 0.00001) received by proceduralists performing transfemoral cardiac catheterization on patients who received a leaded pelvic drape compared to standard protection. One trial that compared the use of unleaded pelvic drapes placed on patients compared to standard protection reported a statistically significant decrease (P = 0.004) in the mean radiation dose received by proceduralists.Compared to standard protection, two trials that used unleaded arm drapes for patients, one trial that used a remotely controlled mechanical contrast injector, and one trial that used a transradial protection board demonstrated a statistically significant reduction in the radiation dose received by proceduralists.Similarly, using a frame rate of 7.5 versus 15 frames per second and monitoring radiation dose in real-time radiation significantly lowered the radiation dose received by the proceduralist. One trial demonstrated no statistically significant difference in proceduralist radiation dose among those who used the extension tubing compared to standard protection (P = 1). This review provides evidence to support the use of leaded pelvic drapes for patients as an additional radiation protection strategy for proceduralists performing transradial or transfemoral cardiac catheterization. Further studies on the effectiveness of using a lower fluoroscopy frame rate, real-time radiation monitor, and transradial protection board are needed.

Evaluation of calibration factor of OSLD toward eye lens exposure dose measurement of medical staff during IVR

The eye lens is a sensitive organ of which an x‐ray exposure dose should be managed during interventional radiology (IVR). In the actual situations, the eye lens is exposed to scattered x‐rays; they have different from the standard x‐ray energies which are used for general dose calibration of the dosimeter. To perform precise dose measurement, the energy dependence of the dosimeter should be properly accounted for when calibrating the dosimeter. The vendor supplies a calibration factor using 80‐kV diagnostic x‐rays under a free‐air condition. However, whether it is possible to use this calibration factor to evaluate the air kerma during the evaluation of the eye lens dose is unclear. In this paper, we aim to precisely determine calibration factors, and also examine the possible application of using a vendor‐supplied calibration factor. First, the x‐ray spectrum at the eye lens position during fluoroscopy was measured with a CdTe x‐ray spectrometer. We mimicked transfemoral cardiac catheterization using a human‐type phantom. Second, we evaluated the doses and calibration factors at three dosimetric points: front and back of protective goggles, and the front of the head (eye lens position). We used the measured x‐ray spectrum to determine the incident photon distribution in the eye lens regions, and x‐ray spectra corresponding to the dosimetric points around the eye lens were estimated using Monte Carlo simulation. Although the calibration factors varied with dosimetric positions, we found that the factors obtained were similar to the vendor‐supplied calibration factor. Furthermore, based on the experiment, we propose a practical way to calibrate an OSL dosimeter in an actual clinical situation. A person evaluating doses can use a vendor‐supplied calibration factor without any corrections for energy dependences, only when they add a systematic uncertainty of 5%. This evidence will strongly support actual exposure dose measurement during a clinical study.

Effects and safety of body positioning on back pain after transcatheter arterial chemoembolization in people with hepatocellular carcinoma: A randomized controlled study

BackgroundPeople with hepatocellular carcinoma who undergo transcatheter arterial chemoembolization usually experience back pain due to lie supine for at least 4 hours to avoid bleeding and hematoma. Body positioning is an effective and safe method for decreasing back pain in people with transfemoral cardiac catheterization; however, its effects and safety among patients with high bleeding tendency are unknown. ObjectiveTo investigate whether body positioning could decrease back pain without increasing the chance of bleeding after transcatheter arterial chemoembolization. DesignA single-blind randomized controlled trial (ClinicalTrials.gov No.: NCT03784469). MethodsA total of 78 people with liver cancer who had undergone chemoembolization through the femoral artery were enrolled. Each person was randomly assigned to either the control or intervention group (each consisted of 39 participants). The control group received the usual care, remaining flat and lying in a supine position, whereas the intervention group had their positions changed in the second and fourth hour after chemoembolization. Participants’ pain level was rated by using numerical rating scale -11 (score from 0 to 10), bleeding was measured by using volume of blood (cc.) in gauze and hematoma size in diameter (cm), and satisfaction was self-rated from 1 to 5. Repeated-measure analysis of variance (ANOVA) was used to compare the difference in pain levels over time within each group and independent t test to compare the mean difference of pain between groups at 5 endpoints, both methods with Bonferroni adjustment. Independent t test, chi-squared test, and Fisher's exact test compared postembolization discomfort, puncture sites bleeding, satisfaction between groups. ResultsSignificant changes of pain levels over time in both intervention [F(2.93, 111.20)=7.64, p<.001] and control groups [F(2.66, 101.17)=20.55, p<.001]. The intervention group had a significantly lower mean pain score in the second hour (t = −2.838, p = .006) and fourth hour (t = −4.739, p < .001) when patients turning to the side than did the control group lying supine. Furthermore, patients in the intervention group had significantly higher satisfaction than did those in the control group (t = −2.422, p = .018). No hematoma and significant difference of post-procedural bleeding between groups. ConclusionChanging patients’ body positions in bed after transcatheter arterial chemoembolization is a safe and effective method of decreasing back pain, and increasing patients’ satisfaction, without increasing the complications of bleeding and hematoma. Clinicians should change the positions of people with hepatocellular carcinoma 2 hours after they receive transcatheter arterial chemoembolization.

Shared Decision-Making in Femoral Versus Radial Cardiac Catheterization

Shared decision-making is a strategy to assist with patient involvement in medical decisions. One of its pillars is patient knowledge and understanding of the risks and benefits associated with specific procedures. We studied patient knowledge about transradial (TRA) and transfemoral (TFA) cardiac catheterization. A prospective study was conducted in 100 patients hospitalized following diagnostic and therapeutic cardiac catheterization-TRA in 71% of patients and remaining TFA. All patients were presented a standard balanced informed consent outlining risks and benefits. Following catheterization, patients were verbally administered an 11-item open-ended questionnaire to assess knowledge of cardiac catheterization and the associated risks and benefits. A patient knowledge index (PKI) was developed with 1 point given for: identifying the procedure; correctly describing the procedure; identifying at least 1 risk of TRA; and/or TFA; and at least 1 benefit of TRA; and/or TFA. Maximum PKI score was 6. The mean PKI score was 2.6 ± 1.1. A PKI score ≥4 was observed in 21% of patients with only 1 patient obtaining the maximum 6 points. Over 80% of patients were unable to recall procedure risks provided at the time of informed consent. The majority of patients were unable to discriminate between TRA and TFA risks and benefits, PKI 2.52 versus 2.60, respectively (p = 0.718). On multivariate analysis, higher education levels were correlated with increased PKI scores (odds ratio = 0.65, p = 0.014) whereas black race was associated with lower PKI scores (odds ratio = -0.48, p = 0.045). In conclusion, patient retention of information from the informed consent was low. The majority of patients had no preference or deferred to their physician's expertise when deciding TRA compared with TFA. This study identifies challenges with implementing shared decision-making and the need for improved patient education and involvement regarding cardiac catheterization.

Acute Kidney Injury Post Cardiac Catheterization: Does Vascular Access Route Matter?

Background: Acute Kidney Injury as a complication of cardiac catheterization is associated with increased length of hospital stay and mortality. In recent years, the use of the radial artery for cardiac catheterization is increasing in frequency.Objective: The objective of this concise review was to evaluate the method of cardiac access site and its impact on Acute Kidney Injury following cardiac catheterization.Methods: After a thorough search on Medline, Google Scholar and PubMed, we included all the literature relevant to Acute kidney injury following transradial and transfemoral cardiac catheterization.Results: While acute kidney injury was caused due to a variety of reasons, it was important to consider each case on an individual basis. We found a trend towards increased use of transradial approach in patients at high risk of developing kidney injury. However, limitations such as operator experience, anatomical challenges and so on do exist with this approach.Conclusion: Transradial access offers several advantages to a patient at high risk of acute kidney injury undergoing cardiac catheterization. Further large studies are needed to establish this trend in the years ahead.

100.74 Shared Decision-Making in Cardiac Catheterization: Race and Education Level as Predictors of Patient Knowledge of Risks and Benefits

Shared decision-making (SDM) has become a cornerstone of patient-centered medicine. In order to better understand SDM related to arterial access site choices, we studied patient understanding of risks and benefits associated with transradial (TRA) and transfemoral (TFA) cardiac catheterization. A

The impact of operator experience during institutional adoption of trans-radial cardiac catheterization.

We studied the impact of operator experience on trans-radial (TR) cardiac catheterization performance in contemporary practice. TR cardiac catheterization offers advantages over trans-femoral (TF) cardiac catheterization, but the TR approach has been slowly adopted in the United States. We reviewed all cases of attempted TR cardiac catheterization at a single tertiary care medical center from May 2008 until April 2015. We classified the attending operator TR case experience at the time of each case, and the control group constituted cases performed by operators with >300 TR cases. Study endpoints were TR cannulation failure, TF cross-over, contrast medium dose, and fluoroscopy time. Over the study period, 4177 attempted TR cardiac catheterization cases were performed. The percentage of TR cases performed with percutaneous coronary intervention (PCI) increased from 14.0% in 2009 to 30.2% in 2015 (P-trend <0.001). The rate of TR cannulation failure decreased from 4.3% in 2009 to 2.0% in 2015 (P-trend = 0.071), and the rate of TF cross-over decreased from 4.3% in 2009 to 3.2% in 2015 (P-trend = 0.034). Operators with over 100 cases had the lowest odds of TR cannulation failure, while operators with over 200 cases had the lowest odds of TF cross-over. Operators with over 200 cases used the lowest mean contrast medium dose and mean fluoroscopy time. Increasing operator TR experience is associated with lower odds of TR cannulation failure and TF cross-over, as well as lower contrast medium dose and fluoroscopy time. © 2016 Wiley Periodicals, Inc.

Effect of Low Fowler's Position on Back Pain and Vascular Complications following Trans-Femoral Cardiac Catheterization: A Randomized Controlled Trial

Effect of Low Fowler's Position on Back Pain and Vascular Complications following Trans-Femoral Cardiac Catheterization: A Randomized Controlled Trial

Bed rest for preventing complications after transfemoral cardiac catheterisation: a protocol of systematic review and network meta-analysis.

BackgroundTransfemoral cardiac catheterisation is an invasive medical procedure used for therapeutic or diagnostic purposes. Postoperative bed rest can prevent a number of complications such as bleeding and haematoma formation and can result in side effects such as back pain and urinary discomfort. Currently, there is no consensus regarding the optimal length of bed rest. Our objective is to assess the effects of post-catheterisation length of bed rest on bleeding and haematoma, other vascular complications, patient symptoms and patient discomfort, among patients who underwent transfemoral cardiac catheterisation.MethodsWe wrote this protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. We defined the search query by using the PICO framework (Population: Patients undergoing cardiac catheterisation; Intervention: early mobilisation; Comparison: late mobilisation; Outcomes: early and late complications). We will search six biomedical databases and five online registries to obtain both published and unpublished studies. We will include randomised controlled trials and quasi-randomised controlled trials, and their quality will be independently appraised with the Cochrane Effective Practice and Organisation of Care criteria for quality assessment. We will carry out a pairwise meta-analysis and network meta-analysis to estimate the overall intervention effects from both direct and indirect comparisons.DiscussionThis review may have considerable implications for practice and help to achieve an effective and efficient management of patients who underwent cardiac catheterisation. This review will be grounded in an expanded search of 11 resources and will employ innovative statistical methods such as network meta-analysis.Systematic review registrationPROSPERO registration number: CRD42014014222.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0036-0) contains supplementary material, which is available to authorized users.

Abstract 145: Rates of Transfusion and Progression to End-Stage Renal Disease in Chronic Kidney Disease Patients Undergoing Transradial Versus Transfemoral Cardiac Catheterization - An Analysis from the VA CART Program

Background: Patients with chronic kidney disease (CKD) are at increased risk of bleeding and transfusion after cardiac catheterization. Whether rates of these complications or progression to new dialysis are increased in this high-risk population undergoing transradial (TR) access compared to transfemoral (TF) access is unknown. Methods: From the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program between 10/2007-09/2012 we identified 40,160 CKD patients undergoing cardiac catheterization with baseline glomerular filtration rate (GFR) ≤ 60 ml/min. We used multivariable Cox modeling to determine the independent association between TR access and post-procedure transfusion as well as progression to new dialysis using TF as the reference. Results: Overall, 3,828 (9.5%) of CKD patients underwent TR access and tended to be slightly younger but overall had similar rates of CKD severity compared with TF patients (GFR 45-60 ml/min: 77.0% vs. 77.0%; GFR 30-44 ml/min: 19.7% vs. 19.3%; GFR 15-29 ml/min: 3.3% vs. 3.7%, p=0.35). TR patients had longer fluoroscopy times (8.1 vs 6.9 minutes, p=&lt;0.0001) but decreased contrast use (90.0 vs 100.0 ml, p=&lt;0.0001). Among the 31,692 patients with a full year of follow-up, 42 (1.7%) of TR patients and 545 (1.9%) of TF patients progressed to new dialysis within 1 year (p=0.64). However, only 33 (0.9%) of TR patients compared with 570 TF patients (1.6%) needed post-procedure blood transfusion (p=0.0006). After multivariable adjustment, there was no significant difference in progression to ESRD between TR and TF patients but TR was associated with a significant decrease in transfusion (Figure). Conclusion: Among CKD patients undergoing cardiac catheterization in the VA health system, TR access is associated with a decreased risk for post-procedure transfusion compared with TF access. There was no significant difference between the two approaches with respect to progression to ESRD. These data suggest that TR is a reasonable option for patients with any level of CKD undergoing cardiac catheterization.

The incidence of vascular complications after coronary angiography: evaluation of results and risk factors

Introduction: The aim of this study was to present the incidence of the vascular complications that had to be surgically treated during the two-year period of transfemoral cardiac catheterization procedure and to identify the risk factors associated with the complications.Methods: A retrospective two-year study of post-catheterization complications with the six-month postoperative follow-up and analysis of risk factors was done. Patients with cardiovascular diseases who underwent therapeutic or diagnostic coronary angiography in the period of 2012-2013 were included in the study. A total of 1320 patients were subjected to catheterization for coronary angiography, of which 24 had vascular complications that had to be surgically treated. Indications for operative treatment included rapid growth of pseudoaneurysm, hemorrhage, large hematoma, hemodynamic instability, failure of the targeted compression therapy.Results: Twenty-four patients experienced some kind of post-operative complication. Infection and dehiscence of surgical wound were the two most common complications. There were no fatalities. The average length of a hospitalization was 4 days. The important risk factors are gender (women more than man), obesity, concomitant use of anticoagulation therapy and antiplatelet therapy after catheterization.Conclusion: Insufficient length of the compression of the punctured place and increased risks of a pseudoaneurysm formation, such as female gender, obesity, and use of a combined anticoagulant therapy are the main causes of these complications. Late vascular complications are not uncommon.

PW156 Comparison of Patient Selection and Radiation Exposure in Transradial and Transfemoral Cardiac Catheterisation

La lithiase de l’enfant au Maroc est une pathologie peu étudiée mal explorée. Dans le but d’établir un état de lieu de la lithiase pédiatrique dans notre région, nous avons proposé une étude rétrospective afin d’approcher les paramètres épidémiologiques et les caractéristiques de cette maladie chez l’enfant marocain.Les données collectées pour cette étude rétrospective étaient enregistrées à partir des registres des hôpitaux et également à partir de dossiers de tous les chirurgiens pédiatres de la ville de Meknès. La période de l’étude était de 12 ans (2000–2012).Au cours de cette étude, 43 enfants lithiasiques ont été recensés. Leur distribution selon les paramètres étudiés a montré : une prédominance masculine avec un sex-ratio de 4,3. L’âge moyen était de 8 ± 3,8 ans, la localisation vésicale est observée dans environ 37 % des cas. L’infection urinaire est présente dans 31 % des cas, la chirurgie ouverte demeure encore le moyen le plus utilisé. Malgré les limites de cette étude, nous avons pu calculer une fréquence cumulée de 0,25 % et un taux moyen d’incidence hospitalière qui peut être estimé à 21 pour 100 000 (service de chirurgie pédiatrique, hôpital régional de la ville de Meknès). Ces paramètres sont vraisemblablement sous-estimés.La comparaison de nos résultats avec ceux de la littérature internationale montre que le profil de nos enfants lithiasiques est intermédiaire entre les pays industrialisés et les pays en voie de développements. La proportion des enfants lithiasique doit être connue avec plus de précision, une collaboration est nécessaire entre les médecins des différents services (chirurgie, consultation, radiologie) travaillant dans les deux secteurs privé et public. L’analyse du calcul par des techniques physiques fiables doit être proposée systématiquement pour déterminer le profil étiologique et pour améliorer la prise en charge de cette pathologie.The stones of the child in Morocco are little studied pathology and poorly explored. In order to establish a state instead of pediatric urolithiasis in our region, we have proposed an approach to retrospective epidemiological parameters and characteristics of the disease in Moroccan children.The data collected for this retrospective study were recorded from hospital records and also from records of all pediatric surgeons in the city of Meknes. The study period was 12 years (2000–2012).In this study, 43 children were identified calculi. Their distribution according to the parameters studied showed: a male predominance with a sex ratio of 4.3. The mean age was 8 ± 3.8 years, bladder localization is observed in approximately 37% of cases. Urinary tract infection is present in 31% of cases, open surgery remains the most used. Despite the limitations of this study, we were able to calculate a cumulative frequency of 0.25% and an average hospital incidence of which can be estimated to 21/100 000 (service of Pediatric Surgery, Regional Hospital of Meknes). These parameters are likely underestimated.Comparing our results with those of the international literature shows that the profile of our children lithiasis is intermediate between the industrialized countries and countries in development. The proportion of children gallstone must be known more accurately, a collaboration is needed between physicians of different services (surgery, consultation, radiology) working in both private and public sectors. The analysis of the calculation of reliable physical techniques should be offered routinely to determine the etiologic profile and improve the management of this disease.

Transradial Cardiac Catheterization in Liver Transplant Candidates

Transradial (TR) cardiac catheterization is effective and offers lower rates of vascular complications and bleeding compared with transfemoral cardiac catheterization. We sought to describe the safety and feasibility of TR cardiac catheterization in liver transplant candidates (LTCs). We retrospectively reviewed 1,071 consecutive cases of TR cardiac catheterization in 1,045 patients from May 2008 to December 2011 at a single institution. The primary end point was radial approach failure. Ten percent of TR cases (n = 107) were performed in LTCs and 90% (n = 964) were performed in non-LTCs. The LTC group had lower rates of cardiovascular diseases and cardiovascular risk factors. The LTC group had a significantly lower platelet count (75,000 vs 237,000/mm(3), p <0.01), higher international normalized ratio (1.7 vs 1.1, p <0.01), and lower mean arterial pressure (78 vs 89 mm Hg, p <0.01). The mean Model for End-Stage Liver Disease score was 21 in LTCs. Percutaneous coronary interventions were performed in 4% of LTCs and 15% of non-LTCs (p <0.01). The radial approach failure rate was 10% in LTCs and 7% in non-LTCs (p = 0.15). In conclusion, radial approach failure was similar between the LTC and non-LTC groups. Despite significant differences in platelet count and international normalized ratio, there was no difference in the incidence of adverse events between the groups, suggesting that TR cardiac catheterization is safe and effective in LTCs.

Effect of Low Fowler's Position on Back Pain and Local Vascular Complications with in Six Hours, among Patients who have Undergone Trans-femoral Cardiac Catheterization

Effect of Low Fowler's Position on Back Pain and Local Vascular Complications with in Six Hours, among Patients who have Undergone Trans-femoral Cardiac Catheterization