Vascular complications occurring after diagnostic cardiac catheterization and percutaneous coronary interventions. incidence and management

ABSTRACT

This study was conducted on 48 patients [32 males and 16 females] with access site complications requiring vascular surgical consultation to evaluate the incidence and surgical management of arterial injuries resulting from diagnostic cardiac catheterization and percutaneous coronary interventions. The total number of patients underwent cardiac catheterization and percutaneous coronary interventions [PCI] were 822. The work was done at the Chest Hospital in the state of Kuwait during a 2-year period from December 1, 2004 to November 30, 2006. Thirty nine patients [81.2%] were ischaemic heart disease, thirty five [72.9%] were hypertensive, thirty [62.5%] were smokers, eleven [22.9%] were diabetics, twenty two [45.8%] were hyperlipidaemic and nineteen [39.5%] had a previous myocardial infarction. The reported complications were- femoral artery pseudo aneurysm in 24 patients [50%], acute arterial thrombosis in 9 patients [18.7%], haematoma at the groin in 7 patients [14.5%], retroperitoneal haematoma in 2 patients [4.1%], intraperitoneal haemorrhage in one patient [2%], bleeding from the catheter puncture site in 3 patients [6.2%] and arteriovenous fistula [A/V fistula] in two patients [4.1%]. All patients were carefully evaluated by history taking and physical examination in addition to urgent routine laboratory investigations. Duplex study was performed in thirty one patients [64.5%], twenty four patients [50%] with femoral artery pseudo aneurysm and seven patients [14.5%] with groin haematoma. Abdominal ultrasound was carried out in three patients [6.2%], in two of them a massive retroperitoneal haematoma was documented while in the 3[rd] patient an intraperitoneal haemorrhage was detected. Blood transfusion needed urgently in 8 patients [16.6%] for patient's resuscitation before surgery due to massive blood loss. Of total 48 complications following diagnostic cardiac catheterization and PCI fourteen patients [29.1%] underwent successful ultrasound guided pseudo aneurysm compression and 34 patients required surgical interventions. These surgical interventions were performed under local anaesthesia in 31 patients [91.1%], and under general anaesthesia in 3 patients [8.8%]. Of ten patients [20.8%] with femoral artery pseudo aneurysm [not responding to ultrasound guided compression], 7 patients [14.5%] of them underwent primary arterial repair, in the remaining three patients [6.2%] saphenous vein patches were used. Groin haematomas were evacuated in 7 patients [14.5%]. In 3 patients [6.2%] with severe catheter site bleeding primary repair was performed. In 9 patients [18.7%] with acute lower limb ischaemia, successful thrombectomy was performed in 5 patients [10.4%]. In 2 patients [4.1%] thrombectomy was performed and the arteriotomy closed with saphenous vein patches. While in the remaining 2 patients femoro-popliteal synthetic bypass graft was performed. In 2 patients [4.1%] with A/V fistulas direct repair of femoral artery and vein were performed. In 3 patients [6.2%] with massive retroperitoneal haematoma and intraperitoneal haemorrhage, ileo-femoral bypass grafting was performed due to exsanguinating arterial perforation and extensive intimal dissections. All patients were followed up at 1-, 3, 5-, 9- and 12 months after surgery as regard to the lower limb vascularity and graft patency which was determined by Doppler study. During the period of follow up no mortality occurred. But wound infection was documented in two patients [4.1%] after evacuation of groin haematoma. Diagnostic cardiac catheterization and PCI are associated with a low but significant risk of access site complications which is higher during PCI than with diagnostic procedures. Early recognition and management is very important to minimize the risk of these complications