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Published on: August 16, 2021
Minimizing femoral artery access complications during percutaneous coronary intervention: a comprehensive review
Michael S Lee1, Bob Applegate, Sunil V Rao
1Division of Cardiology, UCLA Medical Center, Los Angeles, California.
Insights
Minimizing major bleeding after percutaneous coronary intervention (PCI) involves proper femoral artery access technique and pharmacotherapy. Using smaller sheaths and closure devices can further reduce bleeding and vascular complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Major bleeding complications following percutaneous coronary intervention (PCI) significantly increase patient morbidity, hospital stay, costs, and reduce survival.
- Transfemoral access remains a preferred method due to familiarity and ease of use, especially for large bore access.
- Effective management of femoral artery access is crucial for patient outcomes.
Purpose of the Study:
- To review strategies for reducing bleeding and vascular complications associated with transfemoral access during PCI.
- To highlight the role of imaging, technique, pharmacotherapy, sheath size, and closure devices in mitigating risks.
- To identify areas for future research and clinical trials.
Main Methods:
- Review of current practices and evidence regarding transfemoral access in PCI.
- Discussion of multimodality imaging (fluoroscopy, ultrasonography, angiography) for common femoral artery puncture.
- Analysis of pharmacotherapy, sheath management, and vascular closure device utilization.
Main Results:
- Proper femoral artery puncture technique and vascular access site closure, combined with appropriate pharmacotherapy, reduce bleeding and vascular complications.
- Avoiding arterial sheaths larger than 6 French is associated with a lower risk of bleeding.
- Vascular closure devices, when used appropriately, may further reduce complications and are synergistic with bivalirudin.
Conclusions:
- Optimizing technique, pharmacotherapy, sheath selection, and closure devices are key to minimizing bleeding after PCI via transfemoral access.
- Further randomized trials are needed to confirm the efficacy of these strategies.
- Adherence to best practices can improve patient safety and outcomes.
Abstract:
Major bleeding complications after percutaneous coronary intervention (PCI) increase patient morbidity, prolong the hospital stay and costs, and are associated with reduced survival. Transfemoral access is still preferred at many centers given its familiarity and ease of use and is necessary in cases where large bore access is needed. Multimodality imaging with fluoroscopy, ultrasonography, and angiography can facilitate proper puncture of the common femoral artery. A proper technique (which includes femoral artery puncture and vascular access site closure) associated with adequate pharmacotherapy (both during PCI and peri-procedural, for the treatment of the underlying coronary artery disease) has been shown to reduce the risk of bleeding and vascular complications associated with femoral artery access. Avoiding the use of arterial sheaths >6 French may further reduce the risk of bleeding. Data with vascular closure devices as a bleeding avoidance strategy are evolving but when used appropriately may further reduce the risk of bleeding and vascular access complications, and in this regard are synergistic with bivalirudin. Randomized trials to confirm these recommendations are needed.
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