Incidence and results of arterial complications among 16,350 patients undergoing cardiac catheterization

Abstract

A total of 16,350 patients underwent cardiac catheterization from January 1981 to December 1987. The brachial artery was used in 10,500 patients (group I), and the femoral artery was used in 5850 patients (group II). Surgical intervention for complications was necessary in 60 (0.57%) of the group I patients and in 14 (0.23%) of the group II patients. Hand ischemia in group I and bleeding in group II were the most frequent indications for operation. Procedures performed were segmental resection, vein interposition, and long bypass in group I, and simple suture and angioplasty were performed in group II. Fifty-six patients of the total of 74 underwent early repair (within 48 hours), and 18 patients underwent delayed intervention. Only one (1.7%) of the 56 patients who had early repair had a complication. Five of the 18 patients (28%) with delayed intervention suffered significant complications. Cardiac catheterization by the brachial or femoral route has a low incidence of complications. Delayed intervention is associated with high morbidity despite adequate restoration of circulation. Although there were fewer complications in the femoral group, they were far more serious with respect to life-or limbthreatening events.

Ultrasound-Guided Percutaneous Thrombin Injection for Post-Catheterization Pseudoaneurysm

“…These observations may be supported by the Babu et al study, which showed that the brachial approach has a greater complication rate than the femoral approach: that is, surgical intervention for complications was necessary in 60 (0.57%) of brachial approach patients and in 14 (0.23%) of femoral approach patients. 24 In contrast, at Kokura Memorial Hospital, the incidence of brachial PSA was lower than that of femoral PSA. This may be because the incidence of PSA is possibly influenced by the difference in hemostatic methods used after removing the sheath, for example, manual compression of the femoral artery vs. a Tometa-Kun TM compression device 25 in the brachial artery.…”

Femoral Arterial Access and Closure

“…The Angio-Seal device consists of (1) a delivery device composed of a biodegradable anchor and a collagen plug; (2) an insertion sheath and arteriotomy locator, which is a modified dilator; and (3) a 0.035-or 0.038-inch 70-cm J-tip guidewire. A femoral angiogram should be obtained before the procedure to ensure that there are no contraindications (as discussed above).…”

“…1 It is an often underestimated but important aspect of the procedure, and is the single most frequent cause of complications during coronary angiography and intervention. 2 Hyperlinked to this article is a video that shows a PVI procedure performed at VA Boston Healthcare System, West Roxbury Campus. Most vascular complications are preventable by following good access technique, starting with a thorough history and physical examination.…”

Color duplex sonographically guided obliteration of pseudoaneurysm

“…We have found that thrombosis with obliteration of the pseudoaneurysm can be carried out successfully in patients who are fully anticoagulated. Thrombus formation in the hematoma may occur despite anticoagulation owing to two factors; (1) lack of endothelial surface, and (2) blockade of fresh arterial inflow. The complete thrombosis of the pseudoaneurysmcavity promotes stability of the platelet.…”