Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: Interventional versus diagnostic procedures

• Published in: Journal of vascular surgery Vol. 13; no. 5; pp. 593 - 600
• Main Authors: Messina, Louis M., Brothers, Thomas E., Wakefield, Thomas W., Zelenock, Gerald B., Lindenauer, S.Martin, Greenfield, Lazar J., Jacobs, Lloyd A., Fellows, Elaine P., Grube, Susan V., Stanley, James C.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01-05-1991; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm - etiology; Aneurysm - surgery; Angiography - adverse effects; Angioplasty, Balloon - adverse effects; Aortic Valve - surgery; Biological and medical sciences; Cardiac Catheterization - adverse effects; Cardiac Catheterization - statistics & numerical data; Cardiopulmonary Bypass - adverse effects; Catheterization - adverse effects; Coronary Vessels - surgery; Diseases of the cardiovascular system; Female; Hemorrhage - etiology; Hemorrhage - surgery; Humans; Male; Medical sciences; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - surgery; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Thromboembolism - etiology; Thromboembolism - surgery; Vascular Diseases - etiology; Vascular Diseases - surgery; Heart; Human; Catheterization; Instrumentation therapy; Cardiovascular disease; Complication; Exploration
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/0741-5214(91)90341-Q

The purpose of this report is to define the clinical characteristics and outcome of surgical management of vascular complications after interventional cardiac catheterization and to contrast them to those after diagnostic cardiac catheterization. From October 1985 to December 1989, 101 patients were treated for 106 vascular complications after 1866 interventional and 5046 diagnostic cardiac catheterizations at the University of Michigan Medical Center. Interventional catheterizations resulted in 69 vascular complications in 64 patients (frequency 3.4%). The most common interventions included coronary angioplasty (34), of which 10 required percutaneous partial cardiopulmonary bypass, intraaortic balloon pump placement (14), and aortic valvuloplasty (11). Interventional catheter-related complications included hemorrhage (33), arterial thrombosis (18), pseudoaneurysm formation (12), catheter embolization (2), thromboembolism (2), as well as arteriovenous fistula, pseudoaneurysm, and arterial dissection (1 each). Fifteen of these 69 patients (24%) had suffered acute myocardial infarction just before their catheterization. Surgical repair was performed under local anesthesia in 70% of patients. Major vascular reconstructions were required in 9% of patients. Three percent of the involved lower extremities had to be amputated because of complications occurring after arterial puncture. Eight percent of the patients incurring vascular complications after interventional procedures died after operation. Diagnostic catheterizations resulted in 37 vascular complications in 37 patients (frequency 0.7%). In contrast to diagnostic cardiac catheterization, vascular complications after interventional cardiac catheterization occurred more frequently, were most often due to hemorrhage at the vascular access site, and occurred in high-risk, critically ill patients. Refinements in catheter construction and insertion technique are necessary to reduce the frequency of these serious complications. In addition, optimal patient care mandates careful coordination between the responsible cardiologist, vascular surgeon, and anesthesiologist.