Femoral artery complications after cardiac catheterization: a study of patient profile.
BACKGROUND
Femoral artery complications after cardiac catheterization range from simple events to severe complications requiring invasive techniques or surgery with significant economic costs. This study evaluated early femoral arterial complications from percutaneous arterial access during diagnostic and interventional cardiac catheterizations in an era of widespread use of closure devices and intense anticoagulation.


METHODS
Patients undergoing percutaneous cardiac catheterization via the femoral artery between August 2005 and December 2005 were identified using an ICD-9 patient database. Forty-six data points were extracted by retrospective chart review, including demographics, comorbidities, type of anticoagulation, procedural details, and postprocedural complications. Univariable analysis and binary logistic regression were used to determine factors associated with complications.


RESULTS
Eighty-two of 579 patients (14%) suffered complications. The most common complications were hematomas (51 patients, 10%) and active bleeding (14 patients, 2.4%). Closure devices were used in 470 patients. After multivariable correction, use of preprocedural (odds ratio [OR]=5.65, 95% confidence interval [CI] 2.58-12.3, p<0.001) and intraprocedural (OR=4.88, 95% CI 1.95-12.3, p<0.001) antithrombotic agents (antiplatelet and/or anticoagulants), intraprocedural clopidogrel (OR=2.98, 95% CI 1.21-7.30, p=0.017), and postprocedural heparin (OR=29.4, 95% CI 3.56-250, p=0.002) were associated with increased risk. Coronary artery disease was associated with increased risk (OR=11.1, 95% CI 4.78-25.6, p<0.001), while use of a closure device (OR=0.263, 95% CI 0.125-0.553, p<0.001), male gender (OR=0.421, 95% CI 0.220-0.805, p=0.009), and prior catheterization (OR=0.033, 95% CI 0.012-0.095, p<0.001) were protective.


CONCLUSIONS
With increasing numbers of complex coronary endovascular procedures and widespread use of high-dose multidrug antithrombotic therapy, femoral artery injuries will continue to be a significant risk for patients. Postprocedural monitoring with a high level of suspicion and use of vascular closure devices in high-risk patients may decrease the incidence of femoral artery complications. The use of vascular closure devices after low-risk procedures in male patients or those with previous ipsilateral catheterization might not be warranted but needs further study.
Castillo-Sang
Mario
M
The University of Toledo Health Science Campus, Toledo, OH 43614, USA. mcastillosang@utnet.utoledo.edu
Tsang
Albert W
AW
Almaroof
Babatunde
B
Cireddu
James
J
Sferra
Joseph
J
Zelenock
Gerald B
GB
Engoren
Milo
M
Kasper
Gregory
G
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D005263:Femoral Artery; D006406:Hematoma / Q000209:etiology* / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006489:Hemostatic Techniques / Q000295:instrumentation; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011677:Punctures / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine