Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre
Abstract Background Femoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-08-01
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| Series: | CVIR Endovascular |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s42155-018-0022-4 |
| _version_ | 1818546114262990848 |
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| author | Raymond Chung Alex Weller Robert Morgan Anna-Maria Belli Lakshmi Ratnam |
| author_facet | Raymond Chung Alex Weller Robert Morgan Anna-Maria Belli Lakshmi Ratnam |
| author_sort | Raymond Chung |
| collection | DOAJ |
| description | Abstract Background Femoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the influence of sheath size on overall complication rates and morbidity following femoral arterial access is not well described. This prospective single centre study reports our experience of vascular sheath size, patient and procedural factors in influencing complication rates following femoral arterial access. From April 2010 to May 2013, data was collected prospectively for all femoral arterial access procedures performed in the Interventional Radiology department of a tertiary hospital. For vascular sheath size <6-Fr, haemostasis was achieved by manual compression. For 6-Fr sheath size, a closure device was used in the absence of any contraindication. Results Of the 320 femoral access cases with eligible inclusion criteria, 52.5% had 4-Fr whilst 47.5% had 6-Fr vascular sheaths inserted. Overall post procedure complications rates were significantly higher following 6-Fr sheath (17/152 (11.2%)) versus 4-Fr systems (3/168 (1.8%)) (p=0.0007) mostly comprising self-limiting hematoma. There was no significant difference in major complications that required escalation of treatment. Conclusion No significant difference has been demonstrated between the use of either sheath systems for major complications. The practical limitations of a smaller system, combined with existing body of evidence, may not justify the routine use of 4-Fr sheath systems as the primary sheath size for all endovascular procedures. |
| first_indexed | 2024-12-12T07:48:48Z |
| format | Article |
| id | doaj.art-7bd06a0f828e436fa9676f001ea2e535 |
| institution | Directory Open Access Journal |
| issn | 2520-8934 |
| language | English |
| last_indexed | 2024-12-12T07:48:48Z |
| publishDate | 2018-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj.art-7bd06a0f828e436fa9676f001ea2e5352022-12-22T00:32:31ZengSpringerOpenCVIR Endovascular2520-89342018-08-01111710.1186/s42155-018-0022-4Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centreRaymond Chung0Alex Weller1Robert Morgan2Anna-Maria Belli3Lakshmi Ratnam4Diagnostic Radiology, Khoo Teck Puat HospitalRadiology, Northwick Park HospitalRadiology, St. George’s University Hospitals NHS Foundation TrustRadiology, St. George’s University Hospitals NHS Foundation TrustRadiology, St. George’s University Hospitals NHS Foundation TrustAbstract Background Femoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the influence of sheath size on overall complication rates and morbidity following femoral arterial access is not well described. This prospective single centre study reports our experience of vascular sheath size, patient and procedural factors in influencing complication rates following femoral arterial access. From April 2010 to May 2013, data was collected prospectively for all femoral arterial access procedures performed in the Interventional Radiology department of a tertiary hospital. For vascular sheath size <6-Fr, haemostasis was achieved by manual compression. For 6-Fr sheath size, a closure device was used in the absence of any contraindication. Results Of the 320 femoral access cases with eligible inclusion criteria, 52.5% had 4-Fr whilst 47.5% had 6-Fr vascular sheaths inserted. Overall post procedure complications rates were significantly higher following 6-Fr sheath (17/152 (11.2%)) versus 4-Fr systems (3/168 (1.8%)) (p=0.0007) mostly comprising self-limiting hematoma. There was no significant difference in major complications that required escalation of treatment. Conclusion No significant difference has been demonstrated between the use of either sheath systems for major complications. The practical limitations of a smaller system, combined with existing body of evidence, may not justify the routine use of 4-Fr sheath systems as the primary sheath size for all endovascular procedures.http://link.springer.com/article/10.1186/s42155-018-0022-4Access site related complicationsSheath sizeFemoral arterial access |
| spellingShingle | Raymond Chung Alex Weller Robert Morgan Anna-Maria Belli Lakshmi Ratnam Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre CVIR Endovascular Access site related complications Sheath size Femoral arterial access |
| title | Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre |
| title_full | Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre |
| title_fullStr | Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre |
| title_full_unstemmed | Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre |
| title_short | Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre |
| title_sort | are complication rates lower with 4 fr versus 6 fr transfemoral arterial access prospective audit at a single interventional radiology centre |
| topic | Access site related complications Sheath size Femoral arterial access |
| url | http://link.springer.com/article/10.1186/s42155-018-0022-4 |
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