title: Most accurate definition of a high femoral artery puncture: aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention.
abstract: BACKGROUND
  Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown.
  
  
  METHODS
  We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified.
  
  
  RESULTS
  Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p < 0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p < 0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19).
  
  
  CONCLUSIONS
  Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California 94305, USA. jtremmel@stanford.edu
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Tremmel
authors.forename: Yen D
authors.initials: YD
authors.lastname: Tibayan
authors.forename: Aiden J C
authors.initials: AJ
authors.lastname: O'Loughlin
authors.forename: Trevor
authors.initials: T
authors.lastname: Chan
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.forename: Alan C
authors.initials: AC
authors.lastname: Yeung
authors.forename: David P
authors.initials: DP
authors.lastname: Lee
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D002140:California; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006406:Hematoma / Q000209:etiology*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011677:Punctures; D011859:Radiography; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors