title: A novel, minimally invasive access technique versus standard 18-gauge needle set for femoral access.
abstract: OBJECTIVE
  To compare access site complications with the Micropuncture 21 gauge (G) needle set to the standard 18G needle in patients undergoing percutaneous coronary intervention (PCI) using the femoral approach.
  
  
  BACKGROUND
  Vascular access site complications are the most common problems after PCI. The Micropuncture 21G needle set was recently introduced to minimize such complications.
  
  
  METHODS
  A cohort of 3,243 consecutive patients was studied. Patients receiving thrombolytics, IIb/IIIa antagonist, coumadin, or intra-aortic balloon pump were excluded. Micropuncture access was used in 544 patients and standard 18G needle in 2,699. All access sites were managed with a vascular closure device. Primary endpoints included vascular perforation or limb ischemia requiring repair, retroperitoneal bleeding, pseudoaneurysm, arteriovenous fistula, and groin hematoma (>4 cm).
  
  
  RESULTS
  Patients undergoing PCI with Micropuncture were at higher risk: they were older (65.9 ± 9 vs. 64.7 ± 11.8, P = 0.03); had lower body surface area (1.9 ± 0.2 vs. 2.0 ± 0.3, P = 0.02); more prevalent peripheral vascular disease [119 (21.9%) vs. 380 (14.1%), P < 0.001] and renal failure [106 (19.6%) vs. 318 (11.8%), P < 0.001]. Overall, there was no significant difference in the access site complications rate using Micropuncture vs. standard needle, 7 (1.3%) vs. 27 (1.0%), respectively, P = 0.54. The Micropuncture group had significantly higher retroperitoneal bleeding, 0.7% vs. 0.18%, P = 0.04. After multivariable adjustment, only age remained significantly associated with vascular complications (OR 1.03, P = 0.04).
  
  
  CONCLUSIONS
  Femoral access using the Micropuncture technique did not reduce the incidence of vascular complications and the marginally higher than expected retroperitoneal bleeding is based on very small numbers. The routine use of the Micropuncture set and its technique should be revisited.
authors.affiliation: Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Michael
authors.initials: M
authors.lastname: Mahmoudi
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Nelson
authors.initials: N
authors.lastname: Bernardo
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D004219:District of Columbia; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006489:Hemostatic Techniques / Q000295:instrumentation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D015999:Multivariate Analysis; D009339:Needles; D016017:Odds Ratio; D011677:Punctures; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome