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dc.contributor.authorCastle, EVen_US
dc.contributor.authorRathod, KSen_US
dc.contributor.authorGuttmann, OPen_US
dc.contributor.authorJenkins, AMen_US
dc.contributor.authorMcCarthy, CDen_US
dc.contributor.authorKnight, CJen_US
dc.contributor.authorO'Mahony, Cen_US
dc.contributor.authorMathur, Aen_US
dc.contributor.authorSmith, EJen_US
dc.contributor.authorWeerackody, Ren_US
dc.contributor.authorTimmis, ADen_US
dc.contributor.authorWragg, Aen_US
dc.contributor.authorJones, DAen_US
dc.date.accessioned2019-11-08T17:40:15Z
dc.date.available2018-09-14en_US
dc.date.issued2019-03en_US
dc.identifier.urihttps://qmro.qmul.ac.uk/xmlui/handle/123456789/61267
dc.description.abstractTransradial access is increasingly used for coronary angiography and percutaneous coronary intervention, however, femoral access remains necessary for numerous procedures, including complex high-risk interventions, structural procedures, and procedures involving mechanical circulatory support. Optimising the safety of this approach is crucial to minimize costly and potentially life-threatening complications. We initiated a quality improvement project recommending routine fluoroscopic guidance (femoral head), and upfront femoral angiography should be performed to assess for location and immediate complications. We assessed the effect of these measures on the rate of vascular complications. Data were collected prospectively on 4534 consecutive patients undergoing femoral coronary angiographic procedures from 2015 to 2017. The primary end-point was any access complication. Outcomes were compared pre and post introduction including the use of an Interrupted Time-Series (ITS) analysis. 1890 patients underwent angiography prior to the introduction of routine fluoroscopy and upfront femoral angiography and 2644 post. All operators adopted these approaches. Baseline characteristics, including large sheath use, anticoagulant use and PCI rates were similar between the 2 groups. Fluoroscopy-enabled punctures were made in the 'safe zone' in over 91% of cases and upfront femoral angiography resulted in management changes i.e. procedural abandonment prior to heparin administration in 21 patients (1.1%). ITS analysis demonstrated evidence of a reduction in femoral complication rates after the introduction of the intervention, which was over and above the existing trend before the introduction (40% decrease RR 0.58; 95% CI: 0.25-0.87; P < 0.01). Overall these quality improvement measures were associated with a significantly lower incidence of access site complications (0.9% vs. 2.0%, P < 0.001). Routine fluoroscopy guided vascular access and upfront femoral angiography prior to anticoagulation leads to lower vascular complication rates. Thus, study shows that femoral intervention can be performed safely with very low access-related complication rates when fluoroscopic guidance and upfront angiography is used to obtain femoral arterial access.en_US
dc.format.extent419 - 426en_US
dc.languageengen_US
dc.language.isoenen_US
dc.relation.ispartofHeart Vesselsen_US
dc.subjectFemoral accessen_US
dc.subjectFemoral angiographyen_US
dc.subjectFluoroscopyen_US
dc.subjectPercutaneous coronary interventionen_US
dc.subjectAgeden_US
dc.subjectCoronary Angiographyen_US
dc.subjectCoronary Artery Diseaseen_US
dc.subjectFemaleen_US
dc.subjectFemoral Arteryen_US
dc.subjectFluoroscopyen_US
dc.subjectFollow-Up Studiesen_US
dc.subjectHumansen_US
dc.subjectIncidenceen_US
dc.subjectMaleen_US
dc.subjectPercutaneous Coronary Interventionen_US
dc.subjectProspective Studiesen_US
dc.subjectRisk Factorsen_US
dc.subjectSurgery, Computer-Assisteden_US
dc.subjectTime Factorsen_US
dc.subjectUnited Kingdomen_US
dc.subjectVascular System Injuriesen_US
dc.titleRoutine use of fluoroscopic guidance and up-front femoral angiography results in reduced femoral complications in patients undergoing coronary angiographic procedures: an observational study using an Interrupted Time-Series analysis.en_US
dc.typeArticle
dc.identifier.doi10.1007/s00380-018-1266-6en_US
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/30264266en_US
pubs.issue3en_US
pubs.notesNot knownen_US
pubs.publication-statusPublisheden_US
pubs.volume34en_US
dcterms.dateAccepted2018-09-14en_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US


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