Fluoroscopy-guided femoral artery puncture reduces the risk of PCI-related vascular complications.
BACKGROUND
In previous work by the Northern New England Cardiovascular Study Group, risk factors for vascular access site complications in percutaneous coronary intervention (PCI) were identified and a regional effort to reduce these complications was initiated. As part of this effort we considered making a regional recommendation that location of the femoral head as seen on fluoroscopy (fluoro) be used to help determine the site of femoral artery puncture. Therefore, we assessed the use of fluoro to determine whether it actually reduced the rate of vascular complications and shortened length of stay.


METHODS
Data were collected prospectively on 2,651 consecutive PCIs at Eastern Maine Medical Center from 2000 to 2003 including use of fluoro, vascular access site complications (bleeding, pseudoaneurysm formation, hematoma, embolic event or thrombus, A-V fistula), and length of stay.


RESULTS
Use of fluoro among eight interventionists was variable: 3 < 20%, 3 35-50%, 2 > 70%. Among all interventions, 48% were performed with fluoro to guide vascular access. The use of fluoro was associated with a significantly lower incidence of pseudoaneurysms (0.3% vs. 1.1%, P = 0.017) and any arterial injury (0.7% vs. 1.9%, P < 0.01). There was no significant difference in bleeding (1.6% vs. 1.8%, P = 0.69). For each physician, there were fewer vascular injuries when fluoro was used. Average length of stay was significantly lower among patients in the fluoro group (2.1 days vs. 2.4, P < 0.01).


CONCLUSIONS
We conclude that using fluoro to guide vascular access leads to lower complication rates and a shorter length of stay. This approach may become our regional standard of care.
Fitts
James
J
Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. james.m.fitts@hitchcock.org
Ver Lee
Peter
P
Hofmaster
Patricia
P
Malenka
David
D
D017541:Aneurysm, False / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000293:injuries; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects / Q000379:methods*; D012306:Risk