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Venous contrast extravasation during digital subtraction angiography
Insights
Contrast extravasation during intravenous digital subtraction angiography is a serious complication. Understanding catheter type, placement in the superior vena cava, and respiratory phase can help reduce risks.
Area of Science:
- Cardiovascular Imaging
- Interventional Radiology
Background:
- Intravenous digital subtraction angiography (DSA) is a key diagnostic tool.
- Contrast extravasation is a rare but serious complication during DSA procedures.
Observation:
- Six episodes of contrast extravasation occurred in 5 patients within 9 months during intravenous DSA.
- Extravasations involved the mediastinum, pericardium, and right atrial wall.
- All events utilized 5.0 F catheters of various configurations (Katzen, pigtail, straight).
Findings:
- Catheter-related factors, including 5.0 F size, recoil, and jet stream effect from high-pressure injections, contribute to extravasation.
- Improper catheter positioning in the superior vena cava is a significant risk factor.
- The respiratory phase during injection critically influences the likelihood of extravasation.
Implications:
- Awareness of these contributing factors can guide procedural adjustments.
- Implementing strategies to mitigate catheter-related risks, optimize positioning, and consider respiratory phase may decrease extravasation events.
- This understanding is crucial for enhancing patient safety during DSA procedures.
Abstract:
Six episodes of contrast extravasation occurred in 5 patients during intravenous digital subtraction angiography in a period of 9 months. The extravasations were into the mediastinum (3), pericardium (1), and right atrial wall (2). These occurred using a variety of catheters, all the same size (5.0 F--1.67 mm). Three were Katzen catheters, one had a pigtail configuration, and two were straight catheters. We believe that the extravasations are due to three main factors. The first is catheter-related, owing to the small size (5.0 F) creating recoil and marked jet stream effect due to the large volume and pressure that must be delivered through the side holes. The second factor is related to positioning of the catheter in the superior vena cava. Finally, the respiratory phase at the time of injection becomes crucial. Understanding of these factors may help to decrease this potentially serious complication.