Incidence and outcome of femoral vascular complications among 18,165 patients undergoing cardiac catheterisation.
BACKGROUND
Arteriovenous fistulas (AVF) and arterial pseudoaneurysms (PSA) are potentially harmful complications of diagnostic and interventional cardiac catheterisation. Incidence, risk factors and clinical outcome are not well defined yet, although important for stratification and treatment.


METHODS
A total of 18,165 consecutive patients undergoing cardiac catheterisation were enrolled in our 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, pre-treatment with thrombolytics, and emergency procedures.


RESULTS
Within 3 years a total of 334 complications were found (1.8%). The incidence of AVF and PSA was 0.6% (n = 107) and 1.2% (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% of all AVF underwent operative repair due to symptoms. All PSA could be treated successfully either by manual compression, thrombin injection, or surgery. The overall mortality was 0.8%.


CONCLUSIONS
Almost 2% of patients undergoing cardiac catheterisation acquire femoral AVF or 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.
Ohlow
Marc-Alexander
MA
Zentralklinik Bad Berka, Department of Cardiology, Robert-Koch-Allee 9, 99437 Bad Berka, Germany. m.ohlow.kar@zentralklinik-bad-berka.de
Secknus
Maria-Anna
MA
von Korn
Hubertus
H
Neumeister
Axel
A
Wagner
Andreas
A
Yu
Jiangtao
J
Lauer
Bernward
B
D000368:Aged; D017541:Aneurysm, False / Q000453:epidemiology* / Q000209:etiology; D001164:Arteriovenous Fistula / Q000453:epidemiology* / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000706:statistics & numerical data*; D003331:Coronary Vessels / Q000293:injuries; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome