Related Experiment Videos
[Factors related to the appearance of peripheral vascular complications after taneous cardiovascular interventions]
F Navarro1, A Iníguez, M Córdoba
1Unidad de Hemodinámica y Cardiología Intervencionista, Fundación Jiménez Díaz, Madrid.
Insights
Peripheral vascular complications after cardiac catheterization are low but linked to procedural factors. Cardiologist experience in hemostasis is a key predictor, highlighting the need for targeted training to reduce risks.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Percutaneous cardiac procedures carry risks of peripheral vascular complications.
- These complications lead to increased patient treatment, longer hospital stays, and higher costs.
- Predictors of complications are known, but the impact of operator experience was unclear.
Purpose of the Study:
- To determine the incidence and types of peripheral vascular complications.
- To identify predictors of these complications.
- To assess the influence of operator experience and procedure complexity on complication rates.
Main Methods:
- Prospective study of 1,008 patients undergoing percutaneous cardiovascular procedures (diagnostic and therapeutic).
- Data collected on patient demographics, procedures, and complications over one year.
- Multivariate analysis used to identify independent predictors of vascular complications.
Main Results:
- A total of 5.6% vascular complications occurred (3.6% hematomas, 1.4% pseudoaneurysms).
- Severe complications were 2.8%.
- Independent predictors included operator hemostasis experience, aspirin use, left femoral puncture, prolonged sheath time, and prolonged hemostasis duration.
Conclusions:
- The rate of vascular complications after percutaneous cardiovascular procedures is low.
- Complications are often linked to procedural variables and are potentially preventable.
- Training policies should focus on modifying identified risk factors, particularly operator experience in hemostasis.
Background:
Percutaneous diagnostic and therapeutic cardiac catheterization procedures carries some risks, most of them related to the appearance of peripheral vascular complications. These complications imply additional treatments for the patient including vascular surgery, longer hospital stays and increased costs. Some clinical and procedural variables have been pointed out as independent predictors of appearance of vascular complications. Nevertheless, no information have been reported concerning to the influence of the experience of the cardiologist who performs the procedure or provides the local hemostasia and the rate of vascular complications.
Objective:
To characterise the type and incidence of peripheral vascular complications in patients undergoing a percutaneous cardiac procedure, to identify the predictors and to determine the influence of the professional experience and the complexity of the technique in the complications rate.
Methods And Results:
Within 1-year (1994 to 1995) period, 1,008 consecutive patients undergoing a percutaneous cardiovascular procedure (750 diagnostic and 258 therapeutic) were prospectively included. Seventy percent were male. Mean age was 63 +/- 2 years. A total of 55 vascular complications were demonstrated (5.6%): 36 (3.6%) hematomas, 14 (1.4%) pseudoaneurysms, 2 (0.2%) arteriovenous fistula, 2 (0.2%) episodes of limb ischemia and 1 (0.1%) retroperitoneal hematoma. Only 28 (2.8%) were severe complications. By multivariate analysis, only experience to perform hemostasis (OR: 3.36; 95% CI: 1.37-8.22), previous treatment with aspirin (OR: 2.69; 95% IC: 1.31-5.52), left femoral artery puncture (OR: 2.53; 95% IC: 1-1.02), sheath removal later than 60 minutes (OR: 1.02; 95% IC: 1.01-1.04) and hemostasis which lasted > 30 minutes (OR: 1.01; 95% IC: 1-1.02), were independent predictors of vascular complications.
Conclusions:
Vascular complications rate after percutaneous cardiovascular procedures was low. Most of them associated to procedural variables and potentially avoidable, with promotion of a well planned policy of training in order to modify the factors involved.