Journal of Invasive Cardiology

ABSTRACT: Background. Bleeding and vascular complications remain more common in women than men undergoing invasive cardiovascular procedures. We determined the role of femoral angiographic variables in risk-stratifying women for vascular complications. Methods. Between 2004–2009, all major bleeding and vascular complications among women undergoing diagnostic or interventional cardiovascular procedures were identified at a single center. Thirty consecutive female patients (major bleeding or vascular complication) were then age- and procedure-matched to 90 controls (no vascular complications). Quantitative femoral angiography was performed on all cases and controls. Results. Smaller minimum luminal diameter was a strong univariate predictor of vascular complications in women (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.47–0.90; p = 0.009), while site of arteriotomy was not predictive of complications. The prognostic significance of smaller femoral lumen diameter was mildly attenuated after adjusting for the predictive factor of smaller patient body size, even after adjusting for the predictive factor of smaller patient body size. Finally, multivariable modeling suggests that utilization of vascular closure devices (OR 0.26, 95% CI 0.07–0.96; p = 0.04) may be protective in women. Conclusions. Women with smaller femoral arteries are at significantly higher risk for bleeding and vascular complications than women with larger femoral arteries. Risk stratification for bleeding complications among women should account for clinical, pharmacologic and femoral angiographic factors.

Key words: women, bleeding complications, femoral artery
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Over the last decade there have been significant improvements in bleeding and vascular complications (VC) among women undergoing cardiac catheterization.¹ Several observational reports show that procedure-related improvements such as use of smaller sheaths, fluoroscopy-guided access to obtain “safe-zone” arteriotomy, and improved antithrombotic therapies have been associated with a 50% reduction in VC rates.^2–5 However, when VC do occur, they continue to be associated with significant morbidity and mortality; procedure-related bleeding is among the strongest predictors of subsequent adverse cardiac events.^6–9 A recent analysis of over 37,000 patients from the Northern New England Cardiovascular Database Registry continues to show a disturbing, and largely unexplained, adjusted 2.5 fold increase risk of VC in women compared to men undergoing percutaneous coronary intervention.¹ One explanation for this persistent disparity in bleeding complications is a possible difference in femoral artery anatomy and access site suitability between the genders. While prior studies have demonstrated a difference in common femoral artery (CFA) diameters between men and women,^10,11 the role of femoral angiographic variables in predicting bleeding and vascular complications specifically among women has not been studied. Accordingly, we sought to define angiographic predictors of bleeding and vascular complications in women undergoing cardiac catheterization and coronary intervention.

Methods