Closing the loop: the role of audit in reducing groin complications associated with coronary angiography.
BACKGROUND
Local vascular complications of coronary angiography present a significant but often ignored clinical problem. This audit was performed because of a perception that the number of false aneurysms requiring surgical repair was increasing.


METHODS
An acceptable incidence of false aneurysm was derived from series in which ultrasound examinations were only performed if a false aneurysm was suspected (0.06-0.7%). The success rate of ultrasound (US) directed compression ranged from 50% to 93%.
Data were retrieved from cardiology, radiology and vascular surgery databases in addition to case note review. The incidence of false aneurysm was significantly higher than that of historical control groups from the authors' institution (1.5% vs 0.5%, P < 0.05) and in published series used as the standard. The success rate of US directed compression was also poor compared to historical controls (25% vs 55%,P < 0.05) and previously published series.
Recommended changes included the use of fluoroscopy to identify the femoral head to avoid low puncture, strict adherence to the existing protocol for sheath removal and the use of adequate analgesia and sedation prior to attempted US compression.
The incidence of false aneurysm fell to that of the standard set by previous studies. US directed compression was successful in 100%.


CONCLUSIONS
The audit was successful in that the incidence of false aneurysm fell and the success rate of US directed compression increased, but the specific reasons for the improvements remain unclear.
McCleary
A J
AJ
Department of Vascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia. alistair.mccleary@ukgateway.net
Raptis
S
S
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003250:Constriction; D017023:Coronary Angiography / Q000009:adverse effects* / Q000592:standards; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D008485:Medical Audit / Q000379:methods; D014463:Ultrasonography