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[Local vascular complications after iatrogenic femoral artery puncture]
J Fruhwirth1, O Pascher, H Hauser
1Klinische Abteilung für Gefässchirurgie, Universitätsklinik für Chirurgie, Graz.
Insights
Vascular complications from femoral artery catheterization occurred in 0.52% of cases, with higher rates in therapeutic procedures. Risk factors include patient characteristics and technical aspects, necessitating careful patient selection and procedural technique.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Context:
- Femoral artery catheterization is a common procedure for diagnostic and therapeutic interventions.
- Vascular complications represent a significant concern, impacting patient outcomes and healthcare costs.
Purpose:
- To analyze the incidence, types, and risk factors of vascular complications following femoral artery catheterization.
- To evaluate the management and outcomes of these complications.
Summary:
- Over 5 years, 81 vascular complications occurred in 15,460 femoral artery catheterizations (0.52% total rate).
- False aneurysms (65) were most common, followed by arterial occlusion (8), bleeding (7), and AV-fistula (1).
- Therapeutic procedures had a higher complication rate (1.03%) than diagnostic ones (0.37%).
- Risk factors included old age, female gender, arteriosclerosis, hypertension, anticoagulation, and technical factors like catheter size and multiple punctures.
- Most complications were managed conservatively or with angiography; 14.8% required surgery.
- A mortality rate of 1.2% was observed, with one death due to massive hemorrhage.
- No late complications or recurrences of peripheral arterial occlusive disease were noted during follow-up.
Impact:
- Identifies key risk factors for femoral artery catheterization complications, enabling targeted prevention strategies.
- Provides data on complication management and outcomes, informing clinical practice and improving patient safety.
- Highlights the importance of careful patient selection and procedural optimization to minimize risks associated with femoral access.
Abstract:
Over a period of 5 years 81 vascular complications after 15,460 catheterizations of the femoral artery for diagnostic (n = 11,883) or therapeutic (n = 3577) procedures were registered. The following complications were observed in declining frequency: 1. False aneurysm (n = 65), 2. arterial occlusion (dissection, embolia, thrombosis) (n = 8), 3. vascular lesion causing profuse bleeding (n = 7), 4. AV-fistula (n = 1). The total complication rate was 0.52%. The complication rate was significantly higher in therapeutical procedures (1,03%) than in diagnostic investigations (0.37%). Pseudoaneurysms were complicated by thrombosis of the femoral vein (n = 3), lymphatic fistula (n = 3) and deep wound infection (n = 9); secondary complication rate 18.5%. Risk factors for local vascular complications are old age, female gender, high grade arteriosclerosis at the puncture site, overweight, manifest arterial hypertension and medication with cumarin, acetylsalicylic acid or heparin. Further complicating factors are connected with technical risks such as duration of the procedure. French size of the catheter, the catheter sheath and multiple punctures. Vascular repair was performed by simple angiography in most cases, but in 14.8% more extensive surgical procedures were required. In patients with signs of occlusive vascular disease the external iliac artery was replaced by a PTFE-vascular access graft in 4 cases and an arterioplasty of the deep femoral artery was performed in 2 patients. 36% of the operations were undertaken as emergencies. Reintervention was necessary for a postoperative bleeding complication in 1 case (surgical complication rate 1.2%). A female patient suffering from aortic valve stenosis died during emergency operation due to massive retroperitoneal hemorrhage after cardiac catheterization (mortality rate 1.2%). Over a median follow-up period of 37 months no late complications of the intervention were recorded, nor recurrences of peripheral arterial occlusive disease.