Author + information
- Prabhakaran Gopalakrishnan,
- Pradeep Manoharan,
- Chander Shekhar,
- Sharan Rufus Ponniah,
- Muhammad Chaudhry,
- Pradeepto Ghosh,
- Digant Bhatt,
- Ira Friedlander and
- Nagapradeep Nagajothi
Background: Mid femoral head (FH50) is used as a fluoroscopic landmark for common femoral artery (CFA) puncture. High puncture – above the nadir of inferior epigastric artery (IEAN) and low puncture – below CFA bifurcation (CFAB) increase the risk of access site complications. To evaluate the efficacy of FH50 as a fluoroscopic landmark, we analyzed the relationship of CFA to the femoral head in 500 femoral angiograms.
Methods: Femoral head was divided cranio-caudally into 3 tertiles (T1, T2 & T3) and 5 quintiles (Q1, Q2, Q3, Q4 & Q5) as fluoroscopic landmarks for CFA puncture. Tertile T75 and quintile Q75 centered on a point 3/4th from the top of the femoral head were also analyzed (Fig. 1). The vascular anatomy noted in each of these tertiles and quintiles, was divided into 4 classes: A – ideal to avoid both high and low punctures; B – risk for low puncture; C – risk for high puncture and D – risk for both high and low punctures (Fig.1).
Results: The tertile (T75) and quintile (Q75) had the highest CFA class A probability of 78% and 86% respectively. In comparison the tertile (T2) and quintile (Q3) encompassing FH50 had lower CFA class A probability – 44% and 60%. Also, T2 had a 51% chance of unfavorable class C.
Conclusions: Avoiding high and low punctures is critical, especially with use of large bore sheaths for circulatory support devices and structural heart procedures. Sticking the artery around a point 3/4th down from the top of the femoral head, instead of the midpoint, increases the likelihood of an ideal CFA puncture (78% vs. 44%).
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Vascular Access and Hemostasis Issues
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1192-119
- 2017 American College of Cardiology Foundation