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Vascular access complications: diagnosis and management

Raghu Kolluri1, Brian Fowler, Shailesh Nandish

  • 1Prairie Cardiovascular & Prairie Heart Institute, 319 East Mason St, Springfield, IL, 62702, USA, Rkolluri@prairieheart.com.

Current Treatment Options in Cardiovascular Medicine
|February 5, 2013
PubMed

Insights

Vascular access site complications occur in 0.8-1.8% of diagnostic cardiac catheterizations and up to 9% of percutaneous coronary interventions. These complications are likely underestimated, especially with new endovascular procedures requiring larger sheaths.

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.
Abstract

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