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Surgical treatment of brachial artery injuries after cardiac catheterization
R M Kline1, N R Hertzer, E G Beven
1Department of Vascular Surgery, Cleveland Clinic Foundation, OH 44195-5272.
Insights
Local thrombectomy and arterial repair effectively restored pulses in 97% of patients after transbrachial cardiac catheterization. Prompt surgical intervention minimized recurrent thrombosis risk, especially for women.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
Background:
- Transbrachial cardiac catheterization can lead to iatrogenic brachial artery injuries.
- Local thrombectomy and arterial repair are potential treatments for these complications.
Purpose of the Study:
- To evaluate the outcomes of local thrombectomy and arterial repair following transbrachial cardiac catheterization.
- To identify factors associated with treatment success and failure.
Main Methods:
- Retrospective review of 532 patients undergoing local thrombectomy and arterial repair after 34,291 transbrachial catheterizations (1980-1988).
- Analysis of procedural success, need for reoperation, and long-term outcomes.
- Comparison of outcomes based on surgical delay and specific surgical techniques.
Main Results:
- 97% of patients achieved normal distal pulses after a single procedure.
- Surgical delay >1 day was linked to higher recurrent thrombosis rates (12% vs 2%, p=0.025).
- Segmental arterial resection and overnight heparin reduced early failure, particularly in women (6% vs 25%, p=0.0004).
Conclusions:
- Local thrombectomy and arterial repair are highly effective for brachial artery injuries post-catheterization.
- Timely surgical intervention is crucial to prevent recurrent thrombosis.
- Specific surgical techniques and anticoagulation improve outcomes, especially in female patients.
Abstract:
A consecutive series of 532 patients (1.5%) required local thrombectomy and arterial repair after 34,291 transbrachial cardiac catheterizations performed at the Cleveland Clinic from 1980 to 1988. A total of 514 patients (97%) were discharged from the hospital with normal radial pulses and/or normal ulnar pulses after a single surgical procedure. Fourteen others (3%) each required one additional procedure to regain a distal pulse, and four patients either underwent two reoperations, received thrombolytic therapy, and/or remained pulseless. Surgical delay of more than 1 day after catheterization was associated with a higher incidence of recurrent thrombosis (12% vs 2%, p = 0.025). In comparison to our previous experience with iatrogenic brachial injuries, the liberal use of segmental arterial resection and overnight heparin anticoagulation seem especially to reduce the risk for early failure in all patients, but improvement was particularly marked in women (25% vs 6%, p = 0.0004).