Author + information
- Hari Bogabathina,
- Sampath Singireddi,
- Runhua Shi,
- Nachiket Apte,
- Khagendra Dahal,
- Aditya Hendrani,
- Liam Morris,
- Abdulrahman Abdulbaki,
- Henock Zabher,
- Pavan Katikaneni and
- Kalgi Modi
Femoral arterial access (FAA) in Coronary Angiography (CAG), and Percutaneous Coronary Interventional (PCI) is associated with 2-6% vascular complication (VC) rate. FEMORIS randomized study comparing 21-gauge Micropuncture technique (MPT) with 18-gauge failed to demonstrate statistical superiority in reducing VCs. We initiated a quality improvement project in our cardiac catheterization laboratory to reduce the FA access site complications via utilization of MPT.
We utilized MPT on all of our FAA non-emergent cases starting in September 2016 in addition to collecting data since April 2016 retrospectively. Anatomic localization of FA and fluoroscopic marking of femoral head were utilized in all cases. VCs were defined as any hematoma>3cm, major bleeding requiring PRBCs or Hb drop > 2gm, retroperitoneal bleed, pseudoaneurysm, AV fistula, arterial thrombosis, distal embolism, dissection, transient limb ischemia, and access site infection. Chi-Square and Fisher’s exact test with p<0.05, as well as multiple logistic regression analysis were utilized.
A total of 647 patients (M 357, F 290; MPT 333) were included in the analysis. MPT as compared to regular 18-gauge needle access did not demonstrate a reduction in VC rate (2.4% vs. 2.2%; p=1.0). On multivariate analysis, the only variable that was associated with a reduction in VCs is the utilization of VCDs, when adjusted for parameters listed in Table 1. Manual compression (MC) for hemostasis is associated with 4.1 times the odds of VCs as compared to VCD use (95% CI 1.111-15.574).
Utilization of MPT did not contribute to statistically significant reduction in VC rate. The only factor that correlated with reduction in VC rate is the utilization of VCDs. Further large randomized studies are required to demonstrate benefit if any, in utilizing MPT on a routine basis.
|Multivariate Variables||Odds Ratio||95% Wald CI_Lower limit||95% Wald CI_Upperlimit|
|Race, Age, Gender, BMI, Sheath size, CAG vs. PCI, h/o HTN, HLD, DM, CKD, Smoking, CAD, PCI, CABG, PAD, intra/peri-procedural use of Aspirin, Clopidogrel, Brilinta, Heparin, Bivalirudin (Not Significant)||Not Significant|
|18-gauge vs. Micropuncture technique||1.18||0.37||3.71|
|ManualHemostasis vs. Vascular Closure Device||4.15||1.11||15.57|