Mortality, Length of Stay, and Cost Implications of Procedural Bleeding After Percutaneous Interventions Using Large-Bore Catheters

Abstract

Periprocedural bleeding was common among patients who underwent transcatheter intervention using large-bore catheters and was associated with a statistically significant increase in mortality, length of stay, and cost.

Large bore occlusive sheath management

“…Small caliber common femoral and iliac arteries with severe PAD significantly increase the risk for vascular complications. That risk increases greatly as the larger bore sheaths are used …”

“…That risk increases greatly as the larger bore sheaths are used. [18][19][20][21] Insertion of large bore sheath may result in complete vessel occlusion and acute limb ischemia that may threaten limb viability. It is therefore important to ensure adequate perfusion to the limb by careful assessment of the iliofemoral artery prior to insertion of large bore sheath.…”

Ex‐vivo percutaneous bypass: Limb perfusion in the setting of occlusive large bore sheath

“…These new and advanced technologies in the catheterization laboratory require large‐bore arterial accesses . Small caliber of common femoral and iliac arteries with significant peripheral vascular disease (PVD) increase the risk for vascular complications and the risk increases greatly as the larger bore sheaths are used . Large‐bore sheaths also associated with blood flow obstruction resulting in limb ischemia especially in the setting of PVD.…”

“…1,2 Small caliber of common femoral and iliac arteries with significant peripheral vascular disease (PVD) increase the risk for vascular complications and the risk increases greatly as the larger bore sheaths are used. [3][4][5][6] Large-bore sheaths also associated with blood flow obstruction resulting in limb ischemia especially in the setting of PVD. In cases of small iliac and femoral arteries that are large enough to accommodate the sheath but does not allow distal flow beyond the access point, certain interventions can be done to assure sufficient perfusion to maintain limb perfusion and viability.…”

Antithrombotic treatment following transcatheter valve replacement: current considerations

“…Interestingly, bleeding events have been proven to outweigh significantly cerebrovascular events, as major bleedings are correlated with worse outcomes and even increased mortality post TAVR procedures (20)(21)(22). Bleeding complications could be attributed to both of the great invasive nature of TAVR as well as the high risk profile and fragility of elderly patients undergoing the procedure.…”