Peripheral Vascular Access Complications After Percutaneous Procedures: A Single-Center Experience

Posted onAuthorMarius Mihai Harpa, Ștefania Cătălina Anghel, Alexandru Stan, Ayman Elkahlout, David-Emanuel Anitei, Mircea Catalin Cosarca, Cosmin Marian Banceu, Horatiu Suciu, Hussam Al-Hussein

ABSTRACT
Background: The Seldinger technique is a fundamental method for percutaneous vascular access in cardiovascular interventions, including extracorporeal membrane oxygenation, transcatheter aortic valve implantation, percutaneous coronary intervention, and coronary angiography. Despite its critical role in hemodynamic monitoring, drug delivery, and device placement, peripheral vascular access is associated with complications such as pseudoaneurysm, hematoma, arteriovenous fistula, thrombosis, and bleeding, which may adversely impact clinical outcomes. Aim of the Study: This study aimed to evaluate the incidence, risk factors, and management strategies of severe vascular complications requiring surgical intervention following peripheral vascular access in cardiovascular procedures. Materials and Methods: A retrospective analysis was conducted on 81 patients treated at the Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureș between 2017 and 2024 for vascular complications after percutaneous interventions. From a total of 23,370 procedures, including 592 cases of transcatheter aortic valve implantation, 73 patients with femoral artery complications were analyzed. Demographic data, comorbidities, procedural history, complication type, and surgical management were recorded. Results: The cohort had a mean age of 65.7 ± 13.3 years; 60.2% were male, and 87.6% were over 50 years of age. Frequent comorbidities included cardiopathies (97.5%), anemia (67.1%), peripheral arterial disease (32.8%), and coagulopathies (28.7%). Previous vascular interventions were significantly associated with increased complication risk (p < 0.001). Pseudoaneurysm was the most prevalent complication (43.8%), followed by hematoma and arteriovenous fistula. Arterial suturing constituted the primary surgical management (67.1%). Conclusions: Femoral artery access in cardiovascular interventions carries a measurable risk of severe complications, particularly in older patients with comorbidities and prior vascular procedures. Pseudoaneurysm represents the most frequent adverse event. Optimal outcomes require meticulous patient selection, procedural planning, and early recognition of complications, supported by advanced imaging, closure devices, and prompt surgical intervention when necessary.