Key result
Proper technique, multimodality imaging, adequate pharmacotherapy, and vascular closure devices may reduce the risk of bleeding and vascular complications during transfemoral percutaneous coronary intervention.
Why the study?
Do specific techniques and strategies reduce bleeding and vascular complications in patients undergoing PCI via transfemoral access?
Do specific techniques and strategies reduce bleeding and vascular complications in patients undergoing PCI via transfemoral access?
A comprehensive approach including imaging guidance, proper technique, optimal pharmacotherapy, and vascular closure devices can minimize bleeding and vascular complications during transfemoral PCI.
May guide strategies to reduce complications in transfemoral PCI; leaves open need for randomized confirmation.
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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Lee et al. (2014) conducted a review in Percutaneous coronary intervention. Femoral artery access complication minimization strategies was evaluated. Proper technique, multimodality imaging, adequate pharmacotherapy, and vascular closure devices may reduce the risk of bleeding and vascular complications during transfemoral percutaneous coronary intervention.
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