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Closing the loop: the role of audit in reducing groin complications associated with coronary angiography
1Department of Vascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia. alistair.mccleary@ukgateway.net
Insights
Implementing protocol changes significantly reduced false aneurysms after coronary angiography. Ultrasound-guided compression for these vascular complications became 100% successful, improving patient outcomes.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Imaging
Background:
- Local vascular complications, such as false aneurysms, are a significant issue following coronary angiography.
- An audit was initiated due to a perceived increase in false aneurysms requiring surgical intervention.
Purpose of the Study:
- To assess the incidence of false aneurysms post-coronary angiography and the effectiveness of ultrasound-guided compression.
- To implement and evaluate changes in practice to reduce complication rates.
Main Methods:
- Retrospective data retrieval from cardiology, radiology, and vascular surgery databases.
- Comparison of local complication rates against historical controls and published series.
- Evaluation of ultrasound-directed compression success rates before and after protocol changes.
Main Results:
- The incidence of false aneurysms was significantly higher locally (1.5%) compared to historical controls (0.5%).
- Initial ultrasound-directed compression success rate was poor (25%) compared to published data (55%).
- Following protocol changes, the false aneurysm incidence decreased to standard levels, and ultrasound-directed compression success reached 100%.
Conclusions:
- The audit successfully reduced the incidence of false aneurysms and improved the success of ultrasound-guided compression.
- Specific factors contributing to the observed improvements require further investigation.
Background:
Local vascular complications of coronary angiography present a significant but often ignored clinical problem. This audit was performed because of a perception that the number of false aneurysms requiring surgical repair was increasing.
Standard:
An acceptable incidence of false aneurysm was derived from series in which ultrasound examinations were only performed if a false aneurysm was suspected (0.06-0.7%). The success rate of ultrasound (US) directed compression ranged from 50% to 93%.
Assessment Of Local Practice:
Data were retrieved from cardiology, radiology and vascular surgery databases in addition to case note review. The incidence of false aneurysm was significantly higher than that of historical control groups from the authors' institution (1.5% vs 0.5%, P < 0.05) and in published series used as the standard. The success rate of US directed compression was also poor compared to historical controls (25% vs 55%,P < 0.05) and previously published series.
Implementation Of Change:
Recommended changes included the use of fluoroscopy to identify the femoral head to avoid low puncture, strict adherence to the existing protocol for sheath removal and the use of adequate analgesia and sedation prior to attempted US compression.
Reassessment Of Local Practice:
The incidence of false aneurysm fell to that of the standard set by previous studies. US directed compression was successful in 100%.
Conclusions:
The audit was successful in that the incidence of false aneurysm fell and the success rate of US directed compression increased, but the specific reasons for the improvements remain unclear.
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