#Femoral #access #bleeding
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How to prevent and treat femoral access bleeding.
Causes:
1. High puncture
2. Back wall puncture
3. Supratherapeutic anticoagulation
4. GP IIb/IIIa inhibitors – cangrelor
5. Hypertension
6. Inadvertent perforation of renal or lumbar arteries (usually with polymer-jacketed wires)
Prevention:
1. Meticulous access technique (fluoroscopy, US, femoral angiography)
2. Radial access
3. Advance guidewires with fluoroscopic guidance
4. Control hypertension
5. Avoid supratherapeutic anticoagulation, GP IIb/IIIa inhibitors, cangrelor
Treatment:
Groin hematoma
• Manual pressure
• Rare cases: endovascular Rx – surgery
Retroperitoneal hematoma
• Conservative
• Endovascular
• Surgery
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