Division of Cardiology, University of New Mexico, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA.
J Thromb Thrombolysis. 2013 Jul;36(1):84-90. doi: 10.1007/s11239-012-0847-y.
Women undergoing cardiac catheterization have an increased risk of vascular complications (VC) compared to men. Whether this is due to gender differences in common femoral artery (CFA) anatomy remains unknown. Therefore, we examined angiographic features of CFA to identify differences in predictors of VC between the genders. A case control study design enrolled 59 (30 women and 29 men) consecutive patients with VC and 59 age, gender and procedure matched controls from 2004 to 2009. VC were defined as hematoma >6 cm, any access site related bleeding requiring transfusion or injury requiring mechanical intervention. Quantitative angiography was performed on all femoral angiograms. Univariate and multivariate regression was performed to define clinical and angiographic predictors of VC. Among all patients, cases had significantly lower BMI than controls (28.4 ± 7.7 vs. 32.0 ± 6.7, p ≤ 0.01) and were more than twice likely to have CFA reference vessel diameter <5.5 mm (p = 0.04). This finding was entirely driven by the inverse relationship between BMI, CFA and VC among women. On multivariate analysis, BMI was a potent predictor of VC (OR 0.94; 95 % CI 0.89-0.99; p = 0.04). When comparing men and women, BMI and CFA size were predictors of VC among women only. Among men, site of arteriotomy and diabetes mellitus predicted risk of VC. Smaller BMI correlates with smaller CFA diameter and both are predictive of increased risk of VC. This may explain the female predisposition to VC. Risk stratification for bleeding and VC should address these gender specific findings.
与男性相比，接受心导管检查的女性发生血管并发症（VC）的风险增加。这是否是由于股总动脉（CFA）解剖结构的性别差异所致尚不清楚。因此，我们检查了 CFA 的血管造影特征，以确定性别之间 VC 的预测因素的差异。一项病例对照研究设计纳入了 2004 年至 2009 年间连续 59 例（30 例女性和 29 例男性）VC 患者和 59 例年龄、性别和手术匹配的对照组患者。VC 定义为血肿＞6cm，任何需要输血的入路部位相关出血或需要机械干预的损伤。对所有股动脉造影均进行定量血管造影。进行单变量和多变量回归分析，以确定 VC 的临床和血管造影预测因素。在所有患者中，病例组的 BMI 明显低于对照组（28.4±7.7 vs. 32.0±6.7，p≤0.01），且 CFA 参考血管直径＜5.5mm 的可能性是对照组的两倍多（p=0.04）。这一发现完全是由女性 BMI、CFA 和 VC 之间的反比关系驱动的。多变量分析显示，BMI 是 VC 的一个有力预测因子（OR 0.94；95%CI 0.89-0.99；p=0.04）。当比较男性和女性时，BMI 和 CFA 大小仅与女性的 VC 预测因素相关。在男性中，动脉切开部位和糖尿病预测 VC 的风险。较小的 BMI 与较小的 CFA 直径相关，两者都预示着 VC 风险增加。这可能解释了女性易患 VC 的倾向。出血和 VC 的风险分层应考虑到这些性别特异性发现。
