Letter to the Editor

September 11, 2008 Dear Editor, RE: Article by Jackson Thatcher, MD, FACC, entitled “Groin Bleeds and Other Hemorrhagic Complications of Cardiac Catheterization: A List of Relative Issues” (Cath Lab Digest March 2008, Volume 16.) Available online in the March 2008 issue: https://cathlabdigest.com/issues/89 As one who has been doing interventional radiology since before the term was coined in the late 70’s, I would like to thank Dr. Thatcher for his kind comments regarding interventional radiologic physicians and their lack of significant groin complications. Dr. Thatcher’s comments regarding the procedure for puncturing, monitoring and successfully closing a groin puncture are excellent, and I would agree that the way for the staff to improve their technique is by doing systemic reviews. I would like to add a few things not discussed in Dr. Thatcher’s article that I have been doing the past several years and that I feel add an extra measure of safety in my practice. 1. I definitely agree with the use of fluoroscopy to find the center of the femoral head for best possible puncture site. I would add two other reasons for using fluoroscopy: a. If sufficient calcification is present, the use of fluoroscopic guidance makes puncture quick and easy. It is important to magnify and cone down, and keep the hands out of the field, however. b. A contraindication for many closure devices is the presence of calcification and it is therefore important to note its presence. 2. The routine use of ultrasound: a. The bifurcation of the common femoral artery can be located and the puncture can definitely be made above the bifurcation. b. It is easier to hit the artery dead center, which is better for the use of a closure device. c. Its use also helps to obviate a double wall puncture. 3. Routine use of a micropuncture set. It is felt that the micropuncture needle cuts a smaller amount of the vessel wall with the rest of the entry site simply being stretched. If the patient is obese, it is important to use a micropuncture set that has a stiffener contained within it. 4. If a standard femoral puncture needle is used in an obese patient, the routine use of a stiff guide wire makes placement of sheaths much easier, with probably less damage to the vessel wall. 5. I have routinely used a C-arm device (CompressAR from Advanced Vascular Dynamics, Vancouver, WA) for years.1 Regardless of how one holds the groin, it is very important to monitor distal pulses to be certain they are not obliterated while holding. I have never had a neuropathy as a result of prolonged pressure using this device and monitoring the peripheral pulse. The proper use of this device virtually obviates the rare but serious complication of thrombosis and necessary reconstructive vascular surgery seen with closure devices. In my experience, hematomas are rare indeed. Sincerely, G. David Dixon, MD, FSIR, FACR, FAHA Interventional Radiologist Saint Luke’s Hospital Kansas City, Missouri ddixon@saint-lukes.org

1. Dixon GD. “Letter to the Editor. Re: Use of the CompressAR femoral compression device.” Cath Lab Digest 2005;13:42,44.