Influencing factors of bleeding at femoral artery puncture site after neurointervention / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the risk factors for bleeding at femoral artery puncture site after neurointervention and to compare the effectiveness of different hemostatic methods.Methods:Patients underwent whole brain angiography and cerebrovascular interventional therapy in the Department of Neurology, the Fourth Affiliated Hospital of Nanjing Medical University from November 2017 to May 2019 were collected retrospectively. According to the situation of femoral artery puncture site after sheath removal, the patients were divided into bleeding group and non-bleeding group. The baseline data, laboratory tests, and intraoperative data were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for bleeding at femoral artery puncture site. The hemostasis time of different diameter vascular sheath (5 F, 6 F or 8 F) under different hemostasis schemes (manual compression, vascular stapler, and vascular occluder) were analyzed. Results:A total of 721 patients performed neurointervention were included, including 264 interventional therapy and 457 whole brain angiography. Forty-six patients (6.4%) had bleeding at the puncture site after procedure, including 25 patients (3.5%) with oozing of blood, 18 (2.5%) with hematoma, and 3 (0.4%) with pseudoaneurysm. Multivariate logistic regression analysis showed that intraoperative systolic blood pressure (odds ratio [ OR] 1.025, 95% confidence interval [ CI] 1.004-1.047; P=0.021), number of punctures ( OR 1.075, 95% CI 1.053-1.097; P<0.001), heparin dose ( OR 2.142, 95% CI 1.638-3.471; P<0.001), operation time ( OR 3.727, 95% CI 2.025-6.860; P<0.001) and manual compression ( OR 3.449, 95% CI 1.230-9.669; P=0.019) were the independent risk factors for bleeding at the puncture site after operation. No matter which hemostasis scheme was used, the hemostasis time would be prolonged with the increase of the diameter of the vascular sheath, but there was a significant statistical difference in hemostasis time of different vascular sheath diameter groups only when using manual compression ( P<0.05). In addition, no matter what the diameter of vascular sheath was, the hemostasis time of using vascular stapler and vascular occluder was significantly shorter than that of manual compression, and there was statistical significance between the groups ( P<0.05). Conclusion:Reducing the number of punctures, shortening the operation time, and using different hemostatic methods for different diameter vascular sheaths can reduce the incidence of bleeding at the femoral artery puncture site.