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Approach to reduction of vascular complications of percutaneous valvuloplasty
1Washington University School of Medicine, Jewish Hospital, St. Louis, Division of Cardiology, MO 63110.
Insights
Large arterial sheaths in elderly patients can cause superficial femoral artery occlusion. Pre-procedure femoral arteriography can confirm common femoral artery access, reducing this risk and improving patient safety.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Geriatric Medicine
Background:
- Large-bore arterial sheaths are essential for procedures like balloon valvuloplasty and intraaortic balloon pumps.
- Their use in the superficial femoral artery (SFA) poses risks, particularly in elderly individuals, women, and those with atherosclerosis.
Observation:
- A case of complete SFA occlusion occurred due to an intravascular sheath.
- This complication necessitated surgical intervention.
Findings:
- Pre-procedure femoral arteriography using minimal contrast (e.g., <10 cc) via a small catheter (e.g., 5F) can confirm correct common femoral artery (CFA) puncture.
- Accurate CFA access prior to large sheath insertion is crucial.
Implications:
- This technique can significantly reduce the morbidity associated with large-bore sheath placement in the SFA.
- Implementing routine pre-procedure arteriography may enhance procedural safety in vulnerable patient populations.
Abstract:
The large-bore arterial sheaths required for balloon valvuloplasty and intraaortic balloon pumps may be associated with substantial morbidity when introduced into the superficial femoral artery in elderly people, especially women and those with peripheral atherosclerosis. We report a total occlusion of the superficial femoral artery by a large intravascular sheath requiring subsequent surgical intervention. A femoral arteriogram using less than 10 cc of contrast through a 5F catheter can assure placement of the puncture into the common femoral artery prior to introducing the large sheath or catheter, thus reducing morbidity.