Vascular access complications: diagnosis and management

Area of Science:

• Cardiovascular Interventions
• Vascular Access Management

Background:

• Vascular access site complications range from 0.8% to 1.8% for diagnostic cardiac catheterization and up to 9% for percutaneous coronary interventions (PCI).
• Femoral vessels are the primary access site for many cardiovascular interventions.
• Emerging endovascular procedures like EVAR, TEVAR, and TAVR necessitate larger sheaths (18Fr-24Fr), increasing complication risk.

Purpose of the Study:

• To highlight the potential underestimation of vascular access site complications.
• To emphasize the need for prompt identification and management of these complications.
• To discuss the impact of increasing sheath size in endovascular interventions on access site safety.

Main Methods:

• Review of existing literature on vascular access site complications.
• Analysis of complication rates associated with diagnostic and interventional cardiac procedures.
• Consideration of the evolving landscape of endovascular interventions and their access requirements.

Main Results:

• The true incidence of access site complications, particularly from non-coronary interventions, is unknown and likely underestimated.
• Larger sheath sizes required for advanced endovascular procedures increase the risk of vascular access complications.
• Current methods like vascular closure devices and imaging guidance have not eliminated these complications.

Conclusions:

• Vascular access site complications are a significant concern, potentially underestimated in current literature.
• Cardiovascular specialists must be vigilant in identifying and managing access site issues.
• Further research and improved techniques are needed to mitigate risks associated with larger access sheaths in endovascular procedures.