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[Diagnosis of iatrogenic vascular injuries with color-coded duplex ultrasound]
J Schweizer1, H J Florek, A Bunk
1II. Medizinische Klinik, Städtisches Klinikum Dresden-Friedrichstadt.
Insights
Coronarography can cause local complications like hematomas and fistulas in 3% of patients. Oral anticoagulants increase complication risk, often necessitating surgery. Color duplex sonography aids in assessing surgical need for cardiac patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Coronarography is a common procedure for diagnosing heart conditions.
- Iatrogenic lesions at the catheter entry site are potential complications.
- Oral anticoagulants are frequently used in patients undergoing coronarography.
Purpose of the Study:
- To investigate the incidence and nature of iatrogenic lesions following coronarography.
- To assess the role of oral anticoagulants in the development of these complications.
- To evaluate the utility of color duplex sonography in managing these lesions.
Main Methods:
- Retrospective analysis of 1052 patients who underwent coronarography.
- Examination for local complications such as hematomas, aneurysms, and arteriovenous fistulas.
- Correlation of complications with oral anticoagulant use and assessment via color duplex sonography.
Main Results:
- A 3% incidence of local complications (hematomas, aneurysms, fistulas) was observed.
- 75% of patients with complications were on oral anticoagulants.
- Over half of patients with complications on anticoagulants required surgery.
Conclusions:
- Iatrogenic lesions post-coronarography are infrequent but significant.
- Oral anticoagulants are associated with an increased risk of local complications.
- Color duplex sonography is a valuable, repeatable tool for surgical decision-making in cardiac patients.
Abstract:
Between January 1991 and October 1992, 1052 patients who had previously undergone coronarography were examined for iatrogenic lesions around the catheter entry point. Some 3% of them were found to have local complications in the form of haematomas, aneurysms, and arteriovenous fistulas. At the time of investigation 75% of patients with local complications were on oral anticoagulants. In over half of those who had complications on oral anticoagulants there was no alternative to surgical treatment. Colour duplex sonography has the advantage that it can be repeated as often as possible; thus, in cooperation with the cardiac surgeon, the necessity and urgency of surgical intervention in cardiac risk patients can be assessed on an ongoing basis.