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[Percutaneous transluminal therapy of local arterial vascular occlusion after heart catheterization studies]
M P Heintzen1, W Motz, M Leschke
1Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität, Düsseldorf.
Insights
Vascular occlusion after cardiac catheterization is rare (0.13%). Catheter-based interventions, like balloon angioplasty, are highly effective for managing this complication, offering a primary treatment option.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- Vascular complications at arterial puncture sites can occur after cardiac catheterization.
- Peripheral vascular obstruction is a known complication following diagnostic and interventional procedures.
Purpose of the Study:
- To analyze the incidence and management strategies for arterial occlusion post-cardiac catheterization.
- To evaluate the effectiveness of catheter-based therapies for acute arterial obstruction.
Main Methods:
- Retrospective analysis of 26,245 cardiac catheterization procedures.
- Identification and classification of 35 cases of arterial occlusion.
- Comparison of surgical, conservative, and intravascular manipulation treatments.
Main Results:
- An incidence of 0.13% (35 cases) for arterial occlusion was observed.
- Surgical repair was performed in 40% of patients, conservative treatment in 9%, and intravascular manipulation in 51%.
- Percutaneous transluminal balloon dilatation, with or without thrombolysis or stenting, was successful in 16/18 patients, with no major complications.
Conclusions:
- Catheter-based therapy is a highly effective first-line treatment for acute arterial obstruction following cardiac catheterization.
- Intravascular manipulations offer a successful alternative to surgery in experienced hands.
- Prompt management with catheter-based interventions can achieve excellent outcomes.
Abstract:
We analyzed the incidence and management of a vascular occlusion at the arterial puncture site following diagnostic or interventional cardiac catheterization. During the study period 26,245 cardiac catheterization procedures were performed for diagnostic (n = 18,895) or interventional (n = 7350) purposes at our institution. A total number of 35 arterial occlusions (0.13%) was identified. In the early phase of our analysis 14 patients (40%) with peripheral vascular obstruction after cardiac catheterization underwent surgical repair. Three patients (9%) could be treated conservatively. In 18 patients (51%) acute vascular occlusion could be managed by additional intravascular manipulations: 18 patients underwent successful percutaneous transluminal balloon dilatation, in nine patients in combination with intravascular thrombolysis. In three patients additional stent-implantation was necessary in the presence of a large occlusive dissection. The procedure was primarily successful in 16/18 patients. No significant complication occurred. In two patients reocclusion led to operative thrombectomy and patch reconstruction in one and to a second catheter-based approach in the other patient. Both reinterventions were successful. Thus, in experienced hands catheter-based therapy of acute arterial obstruction following diagnostic or interventional cardiac catheterization is very effective and should be considered as therapy of first choice in these patients.