Most accurate definition of a high femoral artery puncture

Aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention

Jennifer A. Tremmel, Yen Tibayan, Aiden J C O'Loughlin, Trevor Chan, William F. Fearon, Alan C. Yeung, David P. Lee

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. Methods: We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. Results: Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p <0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p <0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). Conclusions: Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.

Original languageEnglish (US)
Pages (from-to)37-42
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume80
Issue number1
DOIs
StatePublished - Jul 1 2012
Externally publishedYes

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Percutaneous Coronary Intervention
Femoral Artery
Punctures
Hematoma
Thigh
Epigastric Arteries
Odds Ratio
Confidence Intervals
Angiography
Morbidity
Mortality

Keywords

  • bleeding
  • percutaneous coronary intervention
  • retroperitoneal hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Most accurate definition of a high femoral artery puncture : Aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention. / Tremmel, Jennifer A.; Tibayan, Yen; O'Loughlin, Aiden J C; Chan, Trevor; Fearon, William F.; Yeung, Alan C.; Lee, David P.

In: Catheterization and Cardiovascular Interventions, Vol. 80, No. 1, 01.07.2012, p. 37-42.

Research output: Contribution to journalArticle

Tremmel, Jennifer A. ; Tibayan, Yen ; O'Loughlin, Aiden J C ; Chan, Trevor ; Fearon, William F. ; Yeung, Alan C. ; Lee, David P. / Most accurate definition of a high femoral artery puncture : Aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention. In: Catheterization and Cardiovascular Interventions. 2012 ; Vol. 80, No. 1. pp. 37-42.
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abstract = "Background: Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. Methods: We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. Results: Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95{\%} confidence interval [CI] 10.3-898.4; p <0.0001) compared with criterion B (OR 58, 95{\%} CI 8.9 to 372.6; p <0.0001) or C (OR 27, 95{\%} CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96{\%}; B, 97{\%}; C, 99{\%}), but the sensitivity was higher with criterion A (80{\%}) than criterion B (60{\%}) or C (20{\%}), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). Conclusions: Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.",
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T2 - Aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention

AU - Tremmel, Jennifer A.

AU - Tibayan, Yen

AU - O'Loughlin, Aiden J C

AU - Chan, Trevor

AU - Fearon, William F.

AU - Yeung, Alan C.

AU - Lee, David P.

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N2 - Background: Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. Methods: We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. Results: Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p <0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p <0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). Conclusions: Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.

AB - Background: Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. Methods: We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. Results: Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p <0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p <0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). Conclusions: Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.

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KW - percutaneous coronary intervention

KW - retroperitoneal hemorrhage

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