{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T01:26:56Z","timestamp":1787102816561,"version":"build-2736575974"},"reference-count":14,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vascular access site complications (VASCs) remain an important source of morbidity following percutaneous interventions. Although the sheath\u2010to\u2010femoral artery ratio is a recognized risk factor in transcatheter aortic valve implantation (TAVI), its role across a broader range of femoral procedures is less well defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between the sheath\u2011to\u2011artery diameter (SHAD) ratio and early VASCs in patients undergoing femoral percutaneous interventions with sheaths\u2009&gt;\u20096\u2009Fr.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nested case\u2013control study was performed within a retrospective cohort of 2660 consecutive patients. A total of 177 patients who developed VASCs within 7 days were identified and compared with 353 propensity score\u2013matched controls without complications. The propensity score included age, sex, body mass index, hypertension, diabetes mellitus, peripheral artery disease, and prior femoral access. The SHAD ratio was calculated using pre\u2011procedural computed tomography angiography (CTA). Inter\u2011observer agreement for arterial diameter was excellent (intraclass correlation coefficient 0.94). Receiver operating characteristic analysis identified the optimal cutoff (Youden index), and multivariable logistic regression with backward stepwise selection was internally validated by bootstrap. Anatomical factors (calcification, tortuosity) were examined as potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching, all baseline characteristics were well balanced (standardized differences\u2009&lt;\u20090.10). The SHAD ratio was significantly higher in patients with VASCs than in controls (1.26 vs. 0.75;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). A SHAD ratio\u2009\u2265\u20091.07 optimally predicted complications (AUC 0.83, 95% CI 0.80\u20130.87; sensitivity 82%; specificity 78%). In the final multivariable model, SHAD\u2009\u2265\u20091.07 remained the strongest independent predictor (OR 6.71, 95% CI 3.87\u201311.64;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Dual femoral access (OR 2.95, 95% CI 1.65\u20135.28) and procedural urgency (OR 1.98, 95% CI 1.18\u20133.32) also increased risk. Ultrasound\u2011guided puncture (OR 0.15, 95% CI 0.08\u20130.28) and fluoroscopy\u2011guided access (OR 0.14, 95% CI 0.07\u20130.26) were strongly protective. Anterior wall calcification was associated with a higher complication risk in univariable analysis but did not remain significant after adjustment for SHAD. Bootstrap internal validation yielded an optimism\u2011corrected AUC of 0.91 (95% CI 0.89\u20130.93), indicating good discrimination.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A SHAD ratio\u2009\u2265\u20091.07 is a robust predictor of early VASCs across multiple large\u2011bore femoral interventions. Maintaining a sheath\u2011to\u2011artery relationship\u2009\u2264\u20091.0, together with image\u2011guided access, may substantially reduce complications. The incorporation of SHAD assessment into pre\u2011procedural planning is supported, pending external validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70808","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:18:40Z","timestamp":1787077120000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sheath\u2010to\u2010Artery Diameter Ratio: A Robust Predictor of Early Access\u2010Site Adverse Events in Percutaneous Procedures"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1050-8005","authenticated-orcid":false,"given":"Eduardo Ismael Arteaga","family":"Chan","sequence":"first","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico UNAM Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Lerma","sequence":"additional","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico UNAM Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7719-251X","authenticated-orcid":false,"given":"Adriana","family":"Torres\u2010Machorro","sequence":"additional","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico UNAM Mexico City Mexico"},{"name":"Departments of Vascular Surgery and Molecular Biology Instituto Nacional de Cardiolog\u00eda Ignacio Ch\u00e1vez Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"issue":"5","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"368","DOI":"10.3109\/00016925309136722","article-title":"Catheter Replacement of the Needle in Percutaneous Arteriography","volume":"39","author":"Seldinger S. I.","year":"1953","journal-title":"Acta Radiologica"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.05.019"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2007.12.006"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.28560"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2011.09.020"},{"issue":"2","key":"e_1_2_11_7_1","first-page":"173","article-title":"Predictability and Outcome of Vascular Complications After Transfemoral Transcatheter Aortic Valve Implantation","volume":"25","author":"Uguz E.","year":"2016","journal-title":"The Journal of Heart Valve Disease"},{"issue":"1","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/ccd.30918","article-title":"Computed Tomography Derived Anatomical Predictors of Vascular Access Complications Following Transfemoral Transcatheter Aortic Valve Implantation","volume":"103","author":"Androshchuk V.","year":"2024","journal-title":"Catheterization and Cardiovascular Interventions"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa799"},{"issue":"5","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1002\/ccd.25488","article-title":"Predicting Vascular Complications During Transfemoral Transcatheter Aortic Valve Replacement Using Computed Tomography","volume":"84","author":"Krishnaswamy A.","year":"2014","journal-title":"Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.ijcard.2019.09.063","article-title":"Impact of Diabetes Mellitus on Short Term Vascular Complications After TAVR","volume":"297","author":"Goel R.","year":"2019","journal-title":"International Journal of Cardiology"},{"issue":"7","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"E1058","DOI":"10.1002\/ccd.29960","article-title":"Impact of Diabetes Mellitus on Outcome After Transcatheter Aortic Valve Replacement","volume":"98","author":"Matsumoto S.","year":"2021","journal-title":"Catheterization and Cardiovascular Interventions"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2020.07.013"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13051514"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000362536"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70808","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70808","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70808","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T01:10:34Z","timestamp":1787101834000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70808"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":14,"alternative-id":["10.1002\/ccd.70808"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70808","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"assertion":[{"value":"2026-01-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ccd.70808"}}