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24.01.2018 | original article | Ausgabe 5-6/2018 Open Access

Wiener klinische Wochenschrift 5-6/2018

Femoral access site closure without prior femoral angiography

A retrospective analysis

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 5-6/2018
Autoren:
MD Christoph Brenner, Julian Margreitter, MD Alexandra Gratl, MD Josef Klocker, MD Rudolf Kirchmair, MD Peter Marschang, MD Guy Friedrich, MD Bernhard Metzler, MD Nicolas Moes

Summary

Aims and background

Although guideline recommendations have shifted towards a transradial route, femoral puncture is still an established vascular access, especially for complex coronary interventions. The FemoSeal™ vascular closure device (FVCD) helps to reduce femoral compression time and access site complications after removal of the catheter sheath. To ensure safe use, an angiography of the femoral artery prior to FVCD deployment is recommended by the manufacturer. We postulate that omitting this angiography does not relevantly increase the risk for vascular complications.

Methods and results

In this retrospective analysis of an all-comers population (n = 1923) including patients receiving a percutaneous coronary intervention (PCI), we could show that combined vascular complication rates without femoral angiography were low (primary endpoint 4.6%) and comparable to a randomized clinical trial that did perform angiography of the vascular access site in a cohort of patients receiving diagnostic coronary angiography only. In addition to this analysis, we could demonstrate that patients with an acute coronary syndrome, receiving periprocedural anticoagulation or anti-platelet therapy had an increased risk for the formation of arterial pseudoaneurysms; however, we did not observe any ischemic vascular event after FVCD deployment.

Conclusion

Closure of the femoral access site after coronary angiography using the FVCD can be safely performed without femoral angiography; however, due to an increased risk for the formation of pseudoaneurysms we recommend the transradial access in situations with increased bleeding risk.
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