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Peripheral vascular complications of coronary angioplasty
J D Richardson1, M A Shina, F B Miller
1Department of Surgery, University of Louisville, KY 40292.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) can cause serious vascular injuries in 2% of patients. Early evaluation for peripheral arterial disease is crucial to mitigate these potentially disastrous complications.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is increasingly utilized for coronary artery disease.
- PTCA requires larger access sheaths than standard cardiac catheterization, potentially elevating peripheral vascular injury risk.
Observation:
- A review of 295 PTCA procedures over 18 months identified six major vascular injuries (2%).
- Early complications included femoral or iliac artery thrombosis/laceration; late complications involved femoral artery aneurysm or iliac vein thrombosis.
- All injured patients required emergency surgery, often multiple procedures, with one death and three amputations.
Findings:
- Severe peripheral arterial disease was present in five of six patients with vascular complications.
- Major cardiac complications were rare, but prolonged hospital stays and high costs were significant.
- The incidence of arterial complications is low, but consequences can be severe.
Implications:
- Thorough pre-procedural assessment for peripheral arterial disease is strongly recommended before elective PTCA.
- Informed consent must include the possibility of extremity complications.
- The potential for severe outcomes and associated costs necessitates careful consideration in evaluating PTCA's overall effectiveness.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) is being employed with increasing frequency for the treatment of coronary artery disease. PTCA involves the use of a larger sheath and catheter assembly than does cardiac catheterization, potentially increasing the risk of injury to the peripheral vessels used for access. Over an 18-month period, 295 angioplasty procedures resulted in six major vascular injuries (2%). The peripheral vascular complications that were recognized early included thrombosis of the common or superficial femoral artery in two patients and laceration of the iliac artery in two additional cases. Late complications included one superficial femoral artery aneurysm and one common iliac vein thrombosis. All patients required emergency operation at the time of recognition of their vascular complication, and five of six required multiple operative procedures. At operation, all but one patient had severe peripheral arterial disease. There was one death, three amputations, and multiple major complications. Although persistent dysrhythmias were common, major cardiac complications were unusual. These patients had prolonged hospital stays and high hospital costs. Although the incidence of arterial complications with PTCA is low, the consequences are potentially disastrous when they occur. Greater attention to basic evaluation for arterial disease is strongly recommended before elective PTCA, and informed consent about possible extremity complications is mandatory. These untoward results, with their prolonged stays and high costs, must be considered when evaluating the results of "nonoperative" treatment of coronary artery disease.