Background
Chronic total occlusion (CTO) revascularisation has a crucial role in contemporary
percutaneous coronary intervention (PCI). Procedural success is influenced by disease
complexity, calcific burden and patient characteristics but has substantially improved
with the implementation of novel hybrid strategies. However, vascular-access related
complications remain a cause of morbidity and mortality. This study aimed to assess
the effectiveness of fluoroscopic-guided femoral arterial puncture to minimise this
risk during CTO PCI.
Methods
Standardised data were retrospectively collected from four high-volume UK CTO centres
between September 2011 and November 2013. Demographic, clinical and procedural data
(vascular access site, sheath size, anticoagulation use) was collated. The anatomical
location of the femoral puncture in relation to the femoral bifurcation, femoral head
position and inferior epigastric artery were recorded. Adverse events related to vascular
access were documented.
Results
A total of 528 patients were included (676 femoral punctures) with the majority being
male (n=432, 81.8%). Large sheaths (8F) were used in 81.2% of cases. Fluoroscopy-enabled
punctures were made in the ‘safe zone’ in over > 93% of cases. Vascular closure devices
(VCD) were used in 88.3% of cases. The adverse event rate per puncture was 0.89%.
Conclusions
This study demonstrates an extremely low incidence of vascular-access complications
in CTO PCI when fluoroscopic guidance is used to obtain femoral arterial access by
default radial operators.
Keywords
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Article info
Publication history
Published online: May 07, 2016
Accepted:
April 2,
2016
Received in revised form:
February 24,
2016
Received:
September 3,
2015
Identification
Copyright
© 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
