Rate and Predictors of Transfemoral Access Site Complications: A Large Single-center Cohort

Introduction: The transfemoral approach has been the conventional access route for neuroendovascular procedures for the past decade. With the technological advancements in neuroendovascular equipment, safety and efficacy have remained the main pillars of patient care.
In this study, we provide the rate and predictors of access site complications using the transfemoral access route in a large cohort.

Methods: This is a single-center retrospective study of patients presenting for elective transfemoral procedures between 2017 and 2022.

Results: : The study cohort comprised of 1516 patient with a mean age of 55 years  15. 45.6% patients presented with hypertension, 84.9% with diabetes, 93.2% with coronary artery disease (CAD), 95.8% with peripheral vascular disease, 8.8% had prior percutaneous interventions (PCI), and the mean Body Mass Index (BMI) was 28.7  6.77. The rate of access site complications was 0.9% (n=14) divided into 0.6% retroperitoneal hematoma and 0.3% femoral artery occlusion. Also, the rate of crossover to trans radial route was 1.6%. On multivariate analysis, increasing age (OR: 0.951), p=0.006) and BMI (OR:0.892, p=0.045) were associated with decreased rate of access site complications while CAD (OR: 7.168, p=0.011) and prior neuroendovascular intervention (OR: 3.52, p=0.048) were independent predictors of access site complications.

Conclusion : The conventional transfemoral approach for neuroendovascular procedures has maintained its safety profile with a low rate of major access site complications over time. Increasing age and BMI are associated with decreased rate of access site complications, while CAD and prior prior endovascular procedures are risk factors for access site complications.