Endovascular management of access site complications

This chapter focuses on the practical management of common access site complications after percutaneous coronary or endovascular interventions. The most common femoral artery related complications include local bleeding, retroperitoneal hematomas, femoral artery pseudoaneurysms (PSA), arteriovenous fistulae (AVF), and lower extremity ischemia due to thrombosis or embolization. Access site bleeding in patients undergoing percutaneous coronary intervention is the most common periprocedural complication. In the case of access site bleeding, balloon tamponade is often sufficient to achieve hemostasis. Covered stent placement may be used to exclude PSAs from the circulation in cases not treatable by percutaneous compression of thrombin injection, and can be a good alternative to surgery. An AVF refers to an abnormal communication between an adjacent artery and vein. The incidence of femoral AVF after cardiac catheterization has been cited to be less than <1%.