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Femoral access site closure without prior femoral angiography : A retrospective analysis

Christoph Brenner1, Julian Margreitter2, Alexandra Gratl3

  • 1Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. mail@med.cbrenner.net.

Wiener Klinische Wochenschrift
|January 26, 2018
PubMed

Insights

Femoral artery closure with the FemoSeal™ vascular closure device (FVCD) is safe without pre-deployment angiography. This approach yields low complication rates, comparable to studies using angiography, but pseudoaneurysm risk warrants consideration.

Area of Science:

  • Cardiovascular Interventions
  • Vascular Access Management
  • Interventional Cardiology

Background:

  • Femoral artery access remains a key vascular access route for complex coronary interventions, despite a shift towards transradial approaches.
  • The FemoSeal™ vascular closure device (FVCD) aims to decrease compression time and access site complications post-catheter sheath removal.
  • Manufacturer guidelines recommend femoral artery angiography before FVCD deployment to ensure safety.

Purpose of the Study:

  • To evaluate the safety and efficacy of omitting pre-deployment femoral angiography before FVCD use.
  • To determine if this omission increases vascular complication rates in patients undergoing coronary interventions.

Main Methods:

  • Retrospective analysis of an all-comers population (n=1923) undergoing percutaneous coronary intervention (PCI).
  • Comparison of complication rates in patients who did not undergo pre-deployment femoral angiography with historical data from a randomized trial that included angiography.
  • Assessment of risk factors for vascular complications, including pseudoaneurysm formation.

Main Results:

  • Low combined vascular complication rates (4.6%) were observed in patients treated without femoral angiography.
  • These rates were comparable to a randomized clinical trial cohort that underwent diagnostic coronary angiography with pre-procedure angiography.
  • Patients with acute coronary syndrome, on anticoagulation or anti-platelet therapy, had a higher risk of arterial pseudoaneurysms, but no ischemic events occurred post-FVCD deployment.

Conclusions:

  • Femoral access site closure with FVCD after coronary angiography is safe without pre-deployment femoral angiography.
  • The risk of pseudoaneurysm formation is elevated in specific patient groups, necessitating careful consideration.
  • Transradial access is recommended for patients with an increased bleeding risk.
Abstract

Keywords:
Cardiac cathetersCost-benefit analysisRadiation protectionSafetyVascular system injuries

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