Inapparent Double Puncture of the Femoral Artery and Vein An Important Complication of Temporary Cardiac Pacing by the Transf emoral Approach

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Abstract
This report describes three cases of inapparent double puncture of the femoral artery and vein as a complication of the transfemoral approach for temporary cardiac pacing. This complication may lead to the passage of a pacing catheter to the right ventricle by way of the femoral artery and vein and may remain undiagnosed until the rigid outer sheath of the introducer set is withdrawn over the pacing catheter. Therefore, we recommend immediate withdrawal of the rigid outer sheath as soon as the catheter lies freely in the iliac vein or the inferior vena cava. If double puncture has occurred, arterial blood will leak around the pacing catheter. Control of arterial bleeding by local compression should not be attempted without removal of the pacing catheter.