A Real World Experience of  Guidewire-Induced Perforations during Percutaneous Intervention and Their  Successful Management

Kasturi, Sridhar; Vilvanathan, Vinothkumar; Polasa, Srinivas; Bandimida, Shiva Kumar; Patel, K; Thakkar, Ashok

doi:10.4236/ijcm.2014.58066

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…Several risk factors have been identified for the perforation of vessels during these procedures, including all causes of increased stiffness of the medial artery (such as uncontrolled diabetes mellitus, hypertension, chronic kidney disease, and older age). 7 Abnormal anatomical features and tortuosity, more prominently in cases of using straight‐tipped wires and use of large sheaths (mainly for transcatheter aortic valve implantation and endovascular abdominal aortic repair) are risk factors that cause a higher risk of vascular perforation. 6 , 8 Another known risk factor for vessel perforation is using a catheter and leading it forward without wire.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic combined common iliac and lateral sacral artery perforation during coronary angiography: A case report and review of literature

Mehrpooya,

Ghasemi,

Ebrahimi

et al. 2024

Clinical Case Reports

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Key Clinical MessageArterial rupture is one of the rare but known and devastating complications of the angiogram, which can ultimately lead to loss of limb and life. Therefore, it is recommended that this complication be included in the consent form and that the operator and the logistics team be prepared for this scenario. Moreover, categorizing the patients based on risk factors to be more cautious during the procedure for high‐risk patients can be considered a reasonable strategy.AbstractOne of the rare but lethal complications of femoral artery catheterization for coronary angiography is arterial rupture, which can cause a range of negligible to massive retroperitoneal hemorrhage. This case presents a woman with unstable angina who underwent coronary catheterization. After arterial sheath placement, extravasation of blood from the right common iliac and lateral sacral arteries was seen, a diagnosis that has been reported rarely before. The bleeding was controlled with balloon inflation in the lateral sacral artery and a stent graft implantation in the right common iliac artery. The patient remained asymptomatic during the procedure and the short‐ and long‐term follow‐up. Interventional cardiologists and radiologists who access the femoral artery for any procedure should be aware of this possible event. Sometimes, this situation manifests with nonspecific symptoms such as weakness, lethargy, and pallor. Moreover, more logistical preparation and training are needed to overcome these unexpected conditions.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic combined common iliac and lateral sacral artery perforation during coronary angiography: A case report and review of literature

Mehrpooya,

Ghasemi,

Ebrahimi

et al. 2024

Clinical Case Reports

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“…Complication rates following percutaneous interventions have decreased over the past decade due to advancements in both interventional equipment and procedure technique [3]. Despite these advances, the risk of iatrogenic perforation still exists with associated high morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Conservative management strategy for perforation of small peripheral artery includes rapid reversal of anticoagulation or antiplatelet therapy, balloon tamponade, i.e. prolonged inflation of an angioplasty balloon proximal to or at the level of the perforation to seal the site of perforation, and if leakage persists, occlusion of the distal vessel by delivery of thrombin, collagen, polyvinyl alcohol, gelfoam, subcutaneous fat, or even autologous blood using a microcatheter at the target vessel site [5] as well as coronary artery perforation [1][2][3][4][5]. Further surgical management may be indicated if hemostasis is not achieved conservatively.…”

Section: Discussionmentioning

confidence: 99%

Angle-tipped guidewire-induced vascular perforation at branch of superior thoracic artery during sheath insertion: Case report

Uchikado

Yoshino

Ohmure

et al. 2017

Journal of Cardiology Cases

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An 84-year-old woman was admitted to our hospital because of congestive heart failure, rapid atrial fibrillation, and ischemic heart disease. Percutaneous coronary intervention (PCI) via the left radial artery was performed, and a stent was deployed successfully into left anterior descending coronary artery (LAD). She got into shock state one hour after PCI. Chest X-ray and computed tomography scan revealed increase of soft tissue around the left axilla and implied the existence of hematoma. Hemoglobin level decreased from 13.3 g/dL to 8.2 g/dL and hemorrhagic shock was suspected. Angiography of the left axillary artery demonstrated contrast extravasation, and selective angiography using a micro-catheter identified bleeding from a branch of the superior thoracic artery. Hemostasis was performed successfully by embolization using a gelatin sponge, and improvement of the general condition was obtained. Aberration of 0.025-in. angle tipped guidewire was considered to induce arterial perforation during sheath insertion.

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“…Risk factors for vessel perforation include all comorbidities that promote medial artery calcification, such as hypertension, diabetes, and chronic renal failure, which lead to increased arterial stiffness [ 4 ]. Vascular anatomic variants and tortuosity, especially when utilizing a straight tipped wire, can predispose to vascular perforation [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic Arterial Perforation During Endovascular Interventions

Rizk

Patel

Dimitri

et al. 2020

Cureus

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The use of minimally invasive endovascular procedures has increased, and as such, the frequency of associated vascular complications has also increased. Regardless of the access site location, rarely, arterial perforation can occur, which can be fatal if not properly managed. Interventionalists should be aware of the risk factors for perforation, commonly perforated vessels, and how different sites of perforation are diagnosed and managed. Rapid recognition and endovascular management reduce the need for open surgical repair, and thus reduce the morbidity and mortality of these complications. This review outlines the presentation, diagnosis, and management of iatrogenic perforations of the subclavian artery, thyrocervical trunk (TT), common carotid artery, superficial femoral artery (SFA), and external iliac artery.

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A Real World Experience of Guidewire-Induced Perforations during Percutaneous Intervention and Their Successful Management

Cited by 4 publications

References 11 publications

Iatrogenic combined common iliac and lateral sacral artery perforation during coronary angiography: A case report and review of literature

Iatrogenic combined common iliac and lateral sacral artery perforation during coronary angiography: A case report and review of literature

Angle-tipped guidewire-induced vascular perforation at branch of superior thoracic artery during sheath insertion: Case report

Iatrogenic Arterial Perforation During Endovascular Interventions

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