Refinement of the femoral puncture technique the secret: do not transfix the artery!

Background: The femoral artery has been the standard access route for several decades. However, this access route has been associated with increased rates of vascular complications compared to the radial artery access route. The objectives of this study were to describe vascular complications at femoral access site after puncture without transfixation of the artery. Methods: This a was real-world registry (from January 2017 to August 2019) that enrolled 1000 patients (mean age 56±10years) with stable CAD and clinical indication of coronary angiography. All patients had their femoral arteries cannulated at the first attempt (not transfixed). After completion of the procedure the 6Fr introducer was removed and the hemostasis was done using a mechanical compressor (20 minutes), followed by a compressive bandage for 24 hours. Results: There were more men (656 (65.6%))than women (334 (34.4%)). The prevalence of married was 730 (73%), family income of less than 3 minimum wages 750 (75%), and elementary education, 560 (56%). At 30-day follow-up the rates of vascular complications were: hematomas < 5cm or ecchymosis = 1.8% (18 cases), hematoma ≥ 5cm = 0,9% (9 cases), and vascular surgery 0.1% (1 case). There were no death, myocardial infarction, stroke, or urgent coronary artery bypass graft surgeries related to the procedures. Conclusions: Vascular complications were low. The non-transfixing puncture technique associated with the use of a mechanical compressor may represent a cheap, safe, and efficient haemostasis strategy. Refinement of the puncture technique was critical to the results and should be sought.