Related Experiment Videos
Postcatheterization vascular complications associated with percutaneous transluminal coronary angioplasty
S W Oweida1, G S Roubin, R B Smith
1Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Insights
Vascular complications after percutaneous transluminal coronary angioplasty (PTCA) occurred in 1% of patients. Pseudoaneurysm was the most common issue, but surgical outcomes were favorable.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Interventional Cardiology
Background:
- Percutaneous arterial catheterization, especially complex interventional techniques, carries a risk of vascular complications.
- A significant number of percutaneous transluminal coronary angioplasty (PTCA) procedures are performed, necessitating an understanding of associated risks.
Purpose of the Study:
- To evaluate the incidence and types of iatrogenic vascular complications following PTCA.
- To assess the outcomes of surgical interventions for these complications.
- To identify risk factors associated with vascular complications after PTCA.
Main Methods:
- Retrospective analysis of 4988 PTCA procedures performed between January 1985 and June 1988.
- Inclusion of all patients who received heparin and had a catheter introducer left in place post-procedure.
- Documentation of all iatrogenic vascular complications and subsequent surgical treatments.
Main Results:
- A total of 55 vascular complications (1%) occurred in 52 patients, requiring 54 corrective operations.
- Pseudoaneurysm was the most frequent complication (35 patients, 64%), followed by arteriovenous fistula (8 patients, 15%).
- Surgical therapy yielded acceptable outcomes with no operative mortality or extremity amputations, and a 7.4% complication rate.
Conclusions:
- Vascular complications after PTCA are infrequent but can be serious, with pseudoaneurysm being the most common.
- Advanced age, female gender, thrombolytic therapy, and postprocedural anticoagulation are associated with increased risk.
- Surgical management of these complications is effective with low morbidity and mortality.
Abstract:
The threat of a vascular complication exists in association with any percutaneous arterial catheterization, but is greater in the more complex interventional techniques. During a 3 1/2-year period from January 1985 through June 1988, 4988 percutaneous transluminal coronary angioplasty procedures were performed at Emory University Hospital. All patients were given heparin during the cardiac intervention, and all had a catheter introducer left in place for several hours after completion of the procedure. Fifty-five iatrogenic vascular complications developed in 52 patients (1%), resulting in 54 corrective operations. Pseudoaneurysm, the most frequent complication, was seen in 35 patients (64%). This was followed by arteriovenous fistula in eight (15%), uncontrolled hemorrhage in six (11%), arterial thrombosis in three (6%), peripheral embolization in two (4%), and bowel ischemia in one patient. The outcome of surgical therapy in the entire group was quite acceptable with no operative mortality, no extremity amputation, and a 7.4% complication rate. Variables that correlated with an increased risk of peripheral vascular problems after percutaneous transluminal coronary angioplasty included advanced age, female gender, thrombolytic therapy, and postprocedural anticoagulation. Variables that did not appear to correlate were hypertension, diabetes, prior percutaneous transluminal coronary angioplasty, antiplatelet therapy, or the size of the guiding catheter used.