Angiographic predictors of vascular complications among women undergoing cardiac catheterization and intervention

Bleeding and vascular complications remain more common in women than men undergoing invasive cardiovascular procedures. We determined the role of femoral angiographic variables in risk-stratifying women for vascular complications.

Between 2004-2009, all major bleeding and vascular complications among women undergoing diagnostic or interventional cardiovascular procedures were identified at a single center. Thirty consecutive female patients (major bleeding or vascular complication) were then age- and procedure-matched to 90 controls (no vascular complications). Quantitative femoral angiography was performed on all cases and controls.

Smaller minimum luminal diameter was a strong univariate predictor of vascular complications in women (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.47-0.90; p = 0.009), while site of arteriotomy was not predictive of complications. The prognostic significance of smaller femoral lumen diameter was mildly attenuated after adjusting for the predictive factor of smaller patient body size, even after adjusting for the predictive factor of smaller patient body size. Finally, multivariable modeling suggests that utilization of vascular closure devices (OR 0.26, 95% CI 0.07-0.96; p = 0.04) may be protective in women.

Women with smaller femoral arteries are at significantly higher risk for bleeding and vascular complications than women with larger femoral arteries. Risk stratification for bleeding complications among women should account for clinical, pharmacologic and femoral angiographic factors.