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Peripheral vascular complications after conventional and complex percutaneous coronary interventional procedures
D W Muller1, K J Shamir, S G Ellis
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
Insights
Complex cardiovascular interventions increase vascular access site complications, though overall incidence remains low. Factors like longer procedures and larger sheaths heighten risks, emphasizing careful patient selection and management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Vascular access site complications are a concern in cardiac catheterization.
- The impact of complex interventional procedures on these complications requires further investigation.
Purpose of the Study:
- To assess the association between complex cardiovascular interventional procedures and vascular access site complications.
- To identify risk factors for these complications.
Main Methods:
- Prospective screening of 2,400 cardiac catheterization procedures over 12 months.
- Comparison of complication rates between diagnostic, conventional angioplasty, and complex interventional procedures.
- Univariate analysis to identify predictors of vascular complications.
Main Results:
- Overall complication rate was 1.6% (39/2400), with complex interventions showing a significantly higher incidence (6.0%) compared to diagnostic (0.6%) and conventional angioplasty (2.6%).
- Key predictors included periprocedural heparin or fibrinolytic therapy, arterial sheath size ≥8Fr, patient age ≥65 years, and peripheral vascular disease.
- Complications were more frequent in procedures >2 hours or with arterial sheaths in situ >24 hours.
Conclusions:
- The incidence of vascular access site complications is low but significantly increases with complex cardiovascular interventional procedures.
- Patient age, comorbidities, procedural duration, sheath size, and antithrombotic therapy are important risk factors.
Abstract:
To determine whether complex cardiovascular interventional procedures (including coronary stent implantation, directional atherectomy, aortic valvuloplasty, and the use of an intraaortic balloon pump or cardiopulmonary bypass support) are associated with an increased likelihood of vascular access site complications, 2,400 consecutive cardiac catheterization procedures were prospectively screened over a 12-month study period. Complications occurred in 35 patients after 39 procedures (1.6%) and included the need for vascular surgical repair (17 patients), blood transfusion (28 patients) and systemic antibiotic therapy (7 patients). The incidence of complications after 1,519 diagnostic studies was 0.6%, after 698 conventional coronary balloon angioplasties 2.6%, and after 183 complex interventions 6.0% (p less than 0.0001); 43% of the complications occurred after procedures of greater than 2 hours' duration and 14% occurred in patients in whom arterial sheaths remained in situ for greater than 24 hours. Detailed demographic and procedural characteristics were compared between the 35 patients with vascular complications and 150 patients randomly drawn from a computerized database of the uncomplicated procedures performed during the screening period. By univariate analysis with correction for multiple comparisons, variables predicting the likelihood of vascular complications included: periprocedural use of heparin (p less than 0.001) or fibrinolytic therapy (p less than 0.001), arterial sheath size greater than or equal to 8Fr (p less than 0.001), patient age greater than or equal to 65 years (p = 0.01), and the presence of peripheral vascular disease (p = 0.03). The results of this study suggest that the overall incidence of access site complications is low but increases with the use of complex cardiovascular interventional procedures.(ABSTRACT TRUNCATED AT 250 WORDS)