Peripheral vascular complications of coronary angioplasty by the femoral and brachial techniques

Abstract

In order to monitor the incidence and types of peripheral vascular complications in a single institution, we prospectively entered 1,579 coronary angioplasty cases into a computer data base during the years 1991 and 1992. Various periprocedural risk factors were analyzed. The patients were followed closely to identify complications that occurred outside the laboratory or after discharge from the hospital. Peripheral vascular complications occurred in 37 patients (2.37%) and included hematoma 20 (1.27%), retroperitoneal bleeding 7 (.44%), false aneurysm 6 (.38%), occlusion 1 (.06%), infection 2 (.13%), and cholesterol emboli 1 (.06%). Risk factors for complications by multivariate analysis were older age, female gender, and clinical evidence of peripheral vascular disease. Other factors potentially related to vascular trauma or bleeding tendency that were not risk factors in this series were clinical presentation, use of heparin or thrombolytic agents, blood clotting parameters, and arterial sheath size. There was no significant difference between the femoral and brachial approaches in frequency of complications (2.5% vs. 1.6%), but femoral complications tended to carry greater morbidity.

Cholesterol Embolization Syndrome

“…In a prospective study of 1579 patients undergoing coronary angioplasty in the United States, clinical evidence of cholesterol embolization was found in 1 patient (0.06% of cases). 29 Interestingly, in a prospective study of 1000 patients undergoing percutaneous revascularization procedures via the femoral approach, plaque debris was retrieved from Ͼ50% of all guiding catheters. 30 Surgical manipulation of the aorta and its major branches carries the highest risk of cholesterol emboli.…”

Risk of Acute Kidney Injury After Percutaneous Coronary Interventions Using Radial Versus Femoral Vascular Access

“…Angiography is responsible for 80% of the iatrogenic cases of renal cholesterol embolization, and 0.06% to 1.8% of patients undergoing coronary angiography develop this complication. [4][5][6][7] Therefore, although the main focus for prevention of AKI after PCI lies on intravenous volume expansion and minimization of contrast volume, 8,9 the route of vascular access for PCI might also play a role.…”

Doença renal ateroembólica: uma causa de insuficiência renal aguda pouco explorada

“…A DRAE é uma entidade que pode ser definida como uma insuficiência renal secundária à oclusão das artérias renais, arteríolas e capilares glomerulares por placas de gordura advindas da aorta 1-5. A liberação de êmbolos de colesterol dessas placas erosadas para a circulação sistêmica pode ocorrer espontaneamente ou, mais frequentemente, em decorrência de um evento precipitante, como a manipulação de grandes artérias em procedimentos endovasculares tais como a arteriografia, a angioplastia e após o uso de anticoagulantes e, com maior frequência, trombolíticos 3,7,[10][11][12][13] . Pode, ainda, apresentar-se de forma espontânea em 25% dos casos 1 .…”