From the Guidelines
Complications of femoral approach coronary catheterization can be minimized by using radial artery access, which is recommended to reduce bleeding and vascular complications, as well as mortality rate, especially in patients with acute coronary syndromes or stable ischemic heart disease 1.
Common Complications
The most common complications of femoral approach coronary catheterization include:
- Access site related complications, such as hematoma formation, retroperitoneal hemorrhage, pseudoaneurysm, arteriovenous fistula, and femoral artery thrombosis or dissection
- Non-vascular complications, including contrast-induced nephropathy, allergic reactions to contrast, stroke, myocardial infarction, arrhythmias, and rarely death
Risk Factors
Risk factors for complications include:
- Advanced age
- Female gender
- Low body weight
- Renal insufficiency
- Anticoagulation therapy
- Operator inexperience
Prevention Strategies
Prevention strategies include:
- Proper patient selection
- Careful technique during arterial puncture
- Appropriate sheath size selection
- Meticulous post-procedure care
- Manual compression for 15-20 minutes after sheath removal or vascular closure devices to reduce bleeding complications
- Post-procedure monitoring, including frequent vital sign checks and access site examination for at least 6 hours
- Advising patients to limit activity for 24 hours and avoid heavy lifting for 5-7 days to prevent late bleeding complications, as supported by studies such as 1 and 1.
Key Considerations
It is essential to note that the use of radial artery access can significantly reduce the risk of complications, as stated in the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization 1. Therefore, radial artery access is the preferred approach for patients undergoing percutaneous coronary intervention, especially those with acute coronary syndromes or stable ischemic heart disease.
From the Research
Complications of Femoral Approach Coronary Catheterization
- The femoral approach for coronary catheterization is associated with various complications, including hematomas, active bleeding, and retroperitoneal bleeding 2, 3.
- The use of antithrombotic agents, such as antiplatelet and anticoagulants, increases the risk of complications 2.
- The location of the femoral arteriotomy site is a predictor of life-threatening complications, with arteriotomy above the most inferior border of the inferior epigastric artery increasing the risk of retroperitoneal bleeding 3.
- Vascular closure devices can reduce the incidence of femoral artery complications, but their use may not be warranted in low-risk patients or those with previous ipsilateral catheterization 2.
Comparison with Radial Approach
- The radial approach for coronary catheterization is associated with a lower risk of complications, including major bleeding and vascular complications, compared to the femoral approach 4, 5, 6.
- The radial approach reduces the risk of death, major bleeding, and vascular complications, but increases the risk of procedural failure 6.
- The benefits of radial access are consistent regardless of clinical characteristics or whether coronary angiography is performed with or without percutaneous coronary intervention (PCI) 5.