title: Femoral angiogram prior to arteriotomy closure device does not reduce vascular complications in patients undergoing cardiac catheterization.
abstract: OBJECTIVE
  To compare the efficacy of achieving hemostasis without vascular access site complications (VCs) in patients who did not undergo femoral angiogram (FA) prior to arteriotomy closure device (ACD) placement.
  
  
  BACKGROUND
  Following coronary angiogram/percutaneous coronary intervention (CA/PCI), VCs increase morbidity and mortality. Previous studies in which an FA was highly recommended but not mandatory suggest that a predictor of VC is ACD use.
  
  
  METHODS
  We retrospectively identified consecutive patients who underwent CA/PCI and attempted ACD deployment at our institution over a three-year period. These patients' medical and procedural records, angiogram films, and subsequent hospitalization records were reviewed to identify predetermined clinical outcomes.
  
  
  RESULTS
  One thousand four hundred and twenty-two patients underwent CA/PCI from the transfemoral approach with ACD deployment. Seven hundred and eight (49.8%) patients did not undergo FA prior to ACD deployment. The use of ACD without FA guidance was not associated with an increased rate of combined measured clinical end-point; immediate ACD failure; retroperitoneal bleed; TIMI minor bleed; infectious complications; need for surgical intervention; or mortality (5.3 vs. 4.9; 2.7% vs. 2.2%; 1.4% vs. 0.9%; 0.5% vs. 0.4%; 0% vs. 0%; 0.1% vs. 0.1%; 0% vs. 0%, respectively, P = NS).
  
  
  CONCLUSIONS
  We found no evidence that performing an FA prior to ACD placement as recommended by the manufacturer had any influence on the clinical success rate of ACD placement or rates of VCs. Therefore, ACD use without FA guidance in patients undergoing CA/PCI is an equally safe and effective method in successfully obtaining hemostasis without an increased risk of VCs.
authors.affiliation: Division of Cardiology, Loyola University Medical Center, Maywood, Illinois 60153, USA. rkramana@earthlink.net
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Ramana
authors.forename: Amandeep
authors.initials: A
authors.lastname: Singh
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dieter
authors.forename: John F
authors.initials: JF
authors.lastname: Moran
authors.forename: Lowell
authors.initials: L
authors.lastname: Steen
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Lewis
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Leya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures