Study Measures Femoral Access Site Complications among 18,165 Patients


June 1, 2009

June 1, 2009 - A new study shows about 2 percent of 18,165 patients undergoing cardiac catheterization had femoral vascular complications.

The study conducted by the Bad Berka Central Clinic, Department of Cardiology in Germany, appears in the June 12 issue of the International Journal of Cardiology (Volume 135, June 12, 2009, Issue 1, Pages 66-71).

The affected patients acquired femoral arterio-venous fistulas (AVF) and arterial pseudoaneurysms (PSA), for which patient- or procedure-related risk factors could be identified. Most of AVF and PSA could be managed conservatively or without any treatment, the overall mortality is low, researchers said.

The study was conducted because the incidence, risk factors and clinical outcome of femoral access complications are not well defined, although important for stratification and treatment.

A total of 18,165 consecutive patients undergoing cardiac catheterization were enrolled in the prospective registry. For the diagnosis of AVF and PSA a clinical examination was performed in every patient followed by a Duplex examination in case of clinical suspicion of AVF/PSA. The impact of the following risk factors was assessed: age, body mass index, puncture of left vs. right groin, gender, hypertension, sheath size, peripheral artery disease, coumadin therapy, glycoprotein IIb/IIIa-inhibitors, pretreatment with thrombolytics, and emergency procedures.

Within three years a total of 334 complications were found (1.8 percent). The incidence of AVF and PSA was 0.6 percent (n=107) and 1.2 percent (n=227), respectively. The following significant independent risk factors were identified: arterial hypertension (odds ratio [OR])=1.86, female gender (OR=1.65), and emergency procedures (OR=2.13). During follow-up (mean 48±10 months) only 11 percent of all AVF underwent operative repair due to symptoms. The study found PSA could be treated successfully either by manual compression, thrombin injection, or surgery. The overall mortality was 0.8 percent, the study found.

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