Sridhar K, Fischman D, Goldberg S, Zalewski A, Walinsky P,
Porter D, Fenton S, Gupta B, Rake R, Gebhardt S, Savage M.
Peripheral vascular complications after intracoronary stent placement: prevention
by use of a pneumatic vascular compression device.
Cathet Cardiovasc Diagn 1996 Nov;39(3):224-9

Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.

Peripheral vascular complications are a significant source of morbidity after
coronary artery stent implantation. The goal of this study was to assess the
incidence, risk factors, and management of vascular complications after stent
placement. The study population consisted of 101 consecutive patients who
underwent stent placement for either elective or bailout indications. All
patients received a standardized anticoagulation regimen of aspirin,
dipyridamole, low molecular weight dextran, heparin, and warfarin. Peripheral
vascular access sites were examined daily until hospital discharge. Vascular
complications occurred in 16 of 101 (16%) patients, including femoral artery
pseudoaneurysm (n = 11), hematoma requiring transfusion or surgery (n = 4), and
arteriovenous fistula (n = 1). Intervention was required in 14 of 16 (88%)
patients with complications. These included transfusion (n = 7),
ultrasound-guided compression (n = 8), and/or vascular surgery (n = 7). Length of
hospital stay was prolonged in patients with complications (14 +/- 9 vs. 8 +/- 5
d, P < 0.001). The development of peripheral vascular complications did not
correlate with clinical or procedural variables such as age, cardiovascular risk
factors, arterial sheath size, or elective vs. bailout indication. After the
introduction of a pneumatic vascular compression device (FEMOSTOP, C.A. Bard,
Billerica, MA), a significant reduction in vascular complications was observed.
Complications occurred in only 1 of 41 (2.4%) patients in whom the compression
device was used in contrast to 13 of 58 (22.4%) patients compressed manually (P <
0.01). Thus peripheral vascular complications are frequent after coronary artery
stent placement and are associated with serious morbidity and prolongation of
hospital stay. These complications are significantly reduced by the use of a
pneumatic vascular compression device despite intensive systemic anticoagulation.