Femoral Vascular Access Complications in Adult Congenital Heart Disease Patients: Audit from a Single Tertiary Center Colin D. Chue, MBChB (Hons),* Lucy E. Hudsmith, MD,* Oliver Stumper, MD, † Joseph De Giovanni, MD, † Sara A. Thorne, MD,* and Paul Clift, MD* *Department Of Grown-Up Congenital Heart Disease, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK, and † Department Of Cardiology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK ABSTRACT Objective. To determine the rate of vascular access complications in patients with adult congenital heart disease (ACHD). Background. Complications of femoral access following coronary angiography or percutaneous coronary interven- tion have been studied extensively, but the complication rate following catheterization and intervention in ACHD patients is poorly documented. Design, Setting, and Outcome Measures. We present a retrospective audit of vascular access complications in a large tertiary ACHD center over a 12-month period. Complications were defined as any clinically significant hematoma, pseudoaneurysm, arteriovenous fistula, or bleeding resulting in the need for imaging, transfusion, vascular or radiological intervention, or delayed discharge. Results. Of 197 procedures (102 interventions and 95 cardiac catheterizations), a complication rate of 3.6% was identified, comparable to that of coronary angiography and percutaneous coronary intervention. The main com- plications were femoral artery pseudoaneurysm and hematoma resulting in delayed discharge by a mean of 2 2 /3 days (range 1–4 days). Predictors of risk for vascular complications include female sex, history of diabetes, and anti- coagulation; larger sheath sizes and obesity were not associated with higher complication rate. Conclusions. Adult congenital heart disease patients represent a unique and ever-growing population with a higher incidence of catheterization as children, surgical cut-down scars and anatomical variants. We present a low incidence of femoral access complications in interventional and diagnostic procedures in a large series of ACHD patients over a 12-month period. Patients with risk factors for vascular complications may be considered for device closure of the venous access site. Key Words. Adult Congenital Heart Disease; Vascular Access Complications; Cardiac Catheterization Introduction V ascular complications may cause significant morbidity following cardiac catheterization. Although many studies have assessed the risk of femoral arterial access complications associated with diagnostic coronary angiography and percu- taneous coronary intervention (PCI) in the adult population, 1,2 the rate of vascular access compli- cations associated with diagnostic and interven- tional cardiac catheterization in adult congenital heart disease (ACHD) has not been reported. As more patients with congenital heart disease are surviving into adulthood, more procedures are being performed each year in this expanding specialty. 3 In such procedures, large venous and arterial sheaths may be used for deployment of percutaneous devices and vascular stents, and both arterial and venous access is routinely per- formed in diagnostic catheterization. Mechanical compression rather than a closure device is the preferred technique for achieving both arterial and venous hemostasis. We carried out a retro- spective audit to determine the true rate of vas- cular complications among adults with congenital heart disease undergoing these procedures. Methods During the 12-month period from June 1, 2006 to May 31, 2007, details of all complications of 336 © 2008 Copyright the Authors Journal Compilation © 2008 Wiley Periodicals, Inc. Congenit Heart Dis. 2008;3:336–340