ABSTRACT
BACKGROUND: This is a rare case of removing an intra-arterial foreign body represented by MynxGrip polyethylene glycol (PEG) sealant as a rare complication of using the MynxGrip™ Vascular Closure Device (AccessClosure, Inc., Mountain View, CA) using a pRESET stent retriever (Phenox, Bochum, Germany) which is utilized mainly for treatment of endovascular stroke. CASE PRESENTATION: A 60-year-old female patient suffering from intermittent claudication in the right lower limb (stage IIb according to Fontaine) due to a peripheral arterial occlusive disease was presented for an elective revascularization using balloon angioplasty of a short chronic occlusion of the right superficial femoral artery. After a successful revascularization of the right superficial femoral artery using a retrograde femoral access from the left common femoral artery, the patient suffered from an acute limb ischemia in the left foot with distal popliteal embolization with involvement of BTK (below the knee) trifurcation. This is believed to be due to an intra-arterial foreign body embolism of MynxGrip polyethylene glycol sealant as a rare complication of using the MynxGrip™ Vascular Closure Device. CONCLUSIONS: Stent retrievers have been used previously in removing dislocated coils especially in the cerebral vessels. This case report however proves a high efficacy and safety of using stent retrievers in removing different and rather unusual intra-arterial foreign bodies such as MynxGrip polyethylene glycol sealant.
ABSTRACT
BACKGROUND: Transradial artery (TRA) left heart catheterization is an increasingly used technique for both diagnostic and interventional coronary procedures. This study evaluates the incidence of access site complications in the current interventional era. METHODS AND RESULTS: A total of 507 procedures were performed under standardized conditions. Each procedure was performed using high levels of anticoagulation, hydrophilic sheaths, and short post-procedural compression times. Vascular complications were assessed one day after TRA catheterization using Duplex sonography and classified according to the necessity of additional medical intervention. A simple questionnaire helped identifying upper extremity neurologic or motor complications. Vascular complications were detected in 12 patients (2.36%): radial artery occlusion was detected in 9 patients (1.77%), 1 patient developed an AV-fistula (0.19%), and 2 patients had pseudoaneurysms (0.38%). None of the patients required specialized medical or surgical intervention. Under our procedural conditions, small radial artery diameter was the only significant predictor for the development of post-procedural vascular complications (2.11 ± 0.42 mm vs 2.52 ± 0.39 mm, p = 0.001). None of the previously reported risk factors, namely, advanced renal failure, diabetes, acuteness/complexity of procedure, or sheath and catheter size significantly influenced the rate of vascular complications. No major hematoma or local neurologic or motor complications were identified. CONCLUSIONS: Using current techniques and materials, we report a very low rate of local complications associated with TRA catheterization.
ABSTRACT
BACKGROUND: Arteriovenous fistulas (AVF) and arterial pseudoaneurysms (PSA) are potentially harmful complications of diagnostic and interventional cardiac catheterisation. Incidence, risk factors and clinical outcome are not well defined yet, although important for stratification and treatment. METHODS: A total of 18,165 consecutive patients undergoing cardiac catheterisation were enrolled in our prospective registry. For the diagnosis of AVF and PSA a clinical examination was performed in every patient followed by a Duplex examination in case of clinical suspicion of AVF/PSA. The impact of the following risk factors was assessed: age, body mass index, puncture of left vs. right groin, gender, hypertension, sheath size, peripheral artery disease, coumadin therapy, glycoprotein IIb/IIIa-inhibitors, pre-treatment with thrombolytics, and emergency procedures. RESULTS: Within 3 years a total of 334 complications were found (1.8%). The incidence of AVF and PSA was 0.6% (n = 107) and 1.2% (n = 227), respectively. The following significant independent risk factors were identified: arterial hypertension (odds ratio [OR]) = 1.86, female gender (OR = 1.65), and emergency procedures (OR = 2.13). During follow-up (mean 48 +/- 10 months) only 11% of all AVF underwent operative repair due to symptoms. All PSA could be treated successfully either by manual compression, thrombin injection, or surgery. The overall mortality was 0.8%. CONCLUSION: Almost 2% of patients undergoing cardiac catheterisation acquire femoral AVF or PSA, for which patient- or procedure-related risk factors could be identified. Most of AVF and PSA could be managed conservatively or without any treatment, the overall mortality is low.
