Incidence and Predictors of Post-catheterisation Femoral Artery Access Vascular Complication in North Indian Population

Introduction: Vascular access-site complications following percutaneous interventions done using femoral approach, are an important cause of mortality, morbidity, prolonged stay and greater cost burden. Aim: To study the incidence and the factors which predict femoral artery access vascular complication after catheterisation in North Indian population. Materials and Methods: This was a prospective longitudinal observational study conducted at Department of Cardiology SMS Medical College at Jaipur, Rajasthan ,India between April 2016 to November 2017. All patients (n=11200) who underwent catheterisation from the femoral approach from April 2016 till November 2017 in the study institute were included. Duplex ultrasound was performed in cases with clinical suspicion of vascular complications. Clinical data and procedural variables were compared with a control group of 100 randomly selected patients. Univariate analysis and a logistic regression model for multivariate analysis for predicting independent variable was performed. Results: Femoral artery access vascular complication incidence rate was 2.05% (230). Complications rate was higher for interventional procedures (3.6%) than diagnostic procedures (1.25%). The most common vascular complication was haematoma which was seen in 1.29% (145) patients, other complication were femoral artery venous fistula seen in 0.37% (42) patients, pseudo-aneurysm in 0.41% (46) patients, acute limb ischemia in 0.1 % (12) and infection in 0.09% (11) patients. It was found that advanced age (>60 years), female gender, obesity and hypertension were predictors of complication. Patients who received thrombolytic agent or low molecular weight heparin prior to procedure, use of large sheath size (7F v/s 6F) and multiple puncture to achieve femoral artery access were also independent predictors of vascular complication. Diabetes mellitus and duration of manual compression had no impact on vascular complication. Conclusion: Femoral artery access vascular complication is not uncommon following diagnostic or interventional cardiac catheterisation. The strongest predictors of vascular complication were advanced age (>60 year), female gender, overweight & obesity, hypertension, use of thrombolytic agent or anticoagulant prior to procedure, large size sheath 7F, and multiple puncture. Use of smaller sheaths, improved access techniques, safer antithrombotic therapy and use of vascular closure devices may be helpful for prevention of these vascular complications.