Ischemic complications of percutaneous femoral artery catheterization

Ischemic injuries following percutaneous femoral artery catheterization are uncommon but have been associated with vascular closure devices (VCDs). The purpose of this study was to retrospectively compare ischemic and hemorrhagic complications of femoral artery catheterization and to identify factors associated with ischemic injuries. The operative registries of the attending vascular surgeons at one academic and two community hospitals were retrospectively reviewed to identify all complications of femoral artery catheterization requiring operative intervention. Demographic, clinical, procedural, operative, and outcome data were compared between patients who sustained ischemic and hemorrhagic complications. From January 2001 to December 2006, 95 patients required operative management of complications related to femoral artery catheterization including 40 patients who experienced ischemic (group 1) and 55 patients who experienced hemorrhagic (group 2) complications. Compared to those sustaining hemorrhagic complications, ischemic complications were more frequently associated with younger age, smoking, VCD deployment, and, when controlling for VCD use, female gender. Time to presentation was also significantly longer in patients experiencing ischemic complications. Ischemic complications are increasingly recognized following femoral artery catheterization. Vascular surgeons should anticipate a new pattern of injury following femoral artery catheterization, one that often requires complex arterial reconstruction.     

Surgical treatment of femoral artery pseudoaneurysms after cardiac catheterization

AIM: To report a clinical experience about surgical treatment of iatrogenic peripheral artery pseudoaneurysms (FPA).\METHODS: This is a retrospective review of 90 consecutive patients (46 males, 44 females, mean age 66.2 years, range 33-86) with FPA complicating coronary angiography or angioplasty, observed between October 1990 through June 2006. \RESULTS: A 3 cm pseudoaneurysm or larger was confirmed by duplex ultrasound scanning in 90 out of 21 454 cardiac patients (0.42%), occurring more frequently in interventional (59/3 983) rather than diagnostic (31/17 471) procedures (1.48% vs 0.17%). The surgical treatment consisted in direct closure with polypropilene suture and occasionally, patch angioplasty or bypass. No limb loss occurred. There were 4 wound complications (4.4%), one pulmonary embolism (1.1%), 3 deaths (3.3%).\CONCLUSION: Classical results reported in literature demonstrate that the surgical repair of femoral pseudoaneurysms following cardiac catheterization is safe, effective and durable. In these series, although low major morbidity (1.1%) and no cases of limb loss were reported, the authors observed 3 death (4.4%), resulting from the severity of cardiac disease in 2 cases and from the vascular repair itself in one case (femoral endoarteritis). These results substantiate the common observation that patients who actually require invasive coronary diagnosis and treatment are often affected by advanced cardiovascular disease and suffer the occurrence of complications, having a high risk of death. Therefore, any surgical treatment should be performed with strict adherence to sound vascular surgical principles.     

10043例次经股动脉穿刺插管相关并发症分析

目的　总结经股动脉穿刺插管介入治疗的临床经验 ,并对各并发症发生的原因进行分析。　方法　采用Seldinger技术对 5 90 8例肝胆疾病患者共经股动脉穿刺插管行介入治疗 10 0 4 3例次。年龄5岁～ 86岁 ,平均 4 5 7岁 ,经股动脉穿刺插管 1次～ 13次 ,人均 1 7次。其中伴明显动脉粥样硬化 10 7例 ,双侧髂动脉严重钙化狭窄 2例。　结果　股动脉穿刺插管成功率为 99 8% ,首次插管第一针穿刺成功率为 95 % ,多次插管后第一针穿刺成功率为 76 %。并发症 2 78例 ,股动脉穿刺处局部出血或血肿 2 11例 (2 1% ) ;导丝或导管进入血管周围间隙 13例 ,进入下腔静脉 17例 ;动脉夹层 11例 ;术中股动脉痉挛 5例 ;导管未送入 18例 ,改对侧股动脉穿刺插管成功 16例 ,2例因双侧髂动脉严重钙化狭窄改肱动脉穿刺插管成功 ;下肢深静脉血栓形成 3例。未发生严重并发症及操作死亡。　结论　经股动脉穿刺插管是安全、便捷的有效途径 ,熟练掌握穿刺插管技术是减少各项并发症的关键。     

ｌＯ０４３例次经股动脉穿刺插管相关并发症分析

目的　总结经股动脉穿刺插管介人治疗的临床经验，并对各并发症发生的原因进行分析。方法　采用Ｓｅｌｄｉｎｇｅｒ技术对５９０８例肝胆疾病患共经股动脉穿刺插管行介人治疗１００４３例次。年龄５岁—８６岁，平均４５．７岁，经股动脉穿刺插管１次—１３次，人均１．７次。其中伴明显动脉粥样硬化１０７例，双侧髂动脉严重钙化狭窄２例。结果股动脉穿刺插管成功率为９９．８％，首次插管第一针穿刺成功率为９５％，多次插管后第一针穿刺成功率为７６％。并发症２７８例，股动脉穿刺处局部出血或血肿２１１例（２．１％）；导丝或导管进人血管周围间隙１３例，进人下腔静脉１７例；动脉夹层ｌｌ例；术中股动脉痉挛５例；导管未送人１８例，改对侧股动脉穿刺插管成功１６例，２例因双侧髂动脉严重钙化狭窄改肱动脉穿刺插管成功；下肢深静脉血栓形成３例。未发生严重并发症及操作死亡。结论　经股动脉穿刺插管是安全、便捷的有效途径，熟练掌握穿刺插管技术是减少各项并发症的关键。     

Late complications after femoral artery catheterization in children less than five years of age

Fifty-eight children who underwent diagnostic femoral artery catheterization before 5 years of age, from 5 to 14 years before the study, were randomly selected from approximately 300 surviving patients undergoing diagnostic femoral artery catheterization at our institution during the interval. Each patient underwent vascular laboratory segmental pressure and waveform examination and arterial duplex scanning, as well as lower extremity bone length radiographs, which were considered positive if the catheterized leg was greater than or equal to 1.5 cm shorter than the opposite leg. Thirteen children who had only venous catheterization served as controls. No arterial abnormalities were present in the control patients (mean ankle/brachial index, 1.01). Arterial occlusion was present in both limbs of five patients who had bilateral diagnostic femoral artery catheterization and in 14 limbs of 51 patients who had unilateral diagnostic femoral artery catheterization. Thus arterial occlusion was present in 33% of patients (19 of 58) and in 37% of limbs (24 of 65). The mean ankle/brachial index in the catheterized limbs was 0.79. Leg growth retardation was present in four limbs (8%) of 51 children undergoing unilateral diagnostic femoral artery catheterization and in one (8%) control patient. The inverse relationship between ankle/brachial index and leg growth retardation was significant (R = 0.47, p less than 0.0005). Only one patient had symptoms of arterial occlusion (claudication), and one patient had symptoms of leg growth retardation (gait disturbance). We conclude that arterial occlusion is common after diagnostic femoral artery catheterization in children less than 5 years of age, but that excellent collateral supply prevents leg growth retardation and/or symptomatic arterial insufficiency in most children.(ABSTRACT TRUNCATED AT 250 WORDS)     

Easy technique for retro-antegrade superficial femoral artery catheterization

The antegrade femoral approach is a routinely used technique for the percutaneous treatment of the lower extremities vascular disease. However, this approach can be challenging in case of obese patients or due to special anatomy of the femoral bifurcation. We present a simple and inexpensive alternative by means of the use of a Fogarty catheter to convert a retrograde femoral access to an antegrade catheterization.     

Incidents and complications during pediatric cardiac catheterization

BACKGROUND: Cardiac catheterization has revolutionized the management of pediatric cardiac disease. There has been little information on adverse events during these cases from an anesthesia viewpoint. The aim of this audit was to determine the incident rate during pediatric cardiac catheterization as contemporaneously reported by the anesthetist and to identify both the types of events and which procedures had the highest risk. METHODS: Since 1993, data have been collected prospectively on an audit form for every anesthetic given in our institution, and in-theatre events were recorded on this form. We have reviewed the data collected on pediatric cardiac catheterizations over a period of 9 years. RESULTS: A total of 4454 cardiac catheterizations were recorded. The overall incidence of events was 9.3%. Cardiac catheterization with occlusion of a patent ductus arteriosus (PDA) or a secundum atrial septal defect (ASD) had the lowest event rate at 4.2%. The figure for cardiac catheterization with other therapeutic interventions was 11.6 and 9.3% for solely diagnostic cardiac catheterization. The event rate in infants under the age of 1 year was 13.9% compared with 6.7% for those children over the age of 1 year. Of the 253 reports from cardiac catheterizations that could be analyzed further, there were 91 major complications including four deaths, 72 minor complications and 90 other incidents. CONCLUSIONS: Adverse events occur more commonly during cardiac catheterization than during pediatric anesthesia in general. Cases with highest risk are those in the under 1 year olds and those including a therapeutic intervention other than PDA or ASD occlusion.     

Endovascular treatment of renal artery thrombosis caused by umbilical artery catheterization

Renal arterial thrombosis, usually in association with aortic thrombosis, has been reported as a result of prolonged neonatal umbilical artery catheterization. A case of renal artery thrombosis attributable to umbilical artery catheterization, resulting in malignant renovascular hypertension, in a 15-day-old neonate, treated by catheter-directed thrombolysis through the involuting umbilical artery, was studied. Resolution of systemic hypertension and partial return of right renal function followed rapid thrombus dissolution. (J Vasc Surg 1998;28:949-53.)     

Surgical implications of early failed endovascular intervention of the superficial femoral artery

BACKGROUND: It is generally accepted that failed infrainguinal bypass with prosthetic material significantly compromises arterial run off, which may limit future revascularization. It is well known that the negative consequences of early vein graft thrombosis are limited, but the effect of failed peripheral angioplasty on the distal vasculature is poorly studied. The purpose of this study was to determine whether early failure after superficial femoral artery intervention influences subsequent revascularization options. METHODS: Between July 1, 1998, and June 30, 2006, 276 patients underwent endovascular intervention of the superficial femoral artery. A prospective analysis of angiograms done before the intervention and after early failure (相似文献   

Long-term brachial artery catheterization: ischemic complications

The brachial artery is not used for long-term catheterization and routine hemodynamic monitoring because a high incidence of ischemic complications is anticipated. However, in a review of 157 patients who had 225 percutaneous transbrachial hepatic artery catheters placed for infusion of chemotherapeutic agents, catheters remained in situ from 1 day to 14 months (median 68 days). One hundred seventy-three catheters (77%) were removed electively and 52 catheters (23%) were removed because of complications. Diminution or loss of the radial pulses occurred on insertion of 88 catheters (39.1%) and 16 of these (8%) were removed after 24 hours because ischemic symptoms developed. Subsequently, 25 other catheters (11.1%) were removed because of complications such as paresthesia, eight (3.5%); brachial artery thrombosis, four (1.7%); microembolization, three (1.3%); claudication, two (0.8%); and pseudoaneurysm, one (0.4%). Seven catheters (3.1%) were removed because of a combination of pallor, diminished pulses, and muscle weakness. Hemorrhage from the arteriotomy site necessitated the removal of 11 other catheters (4.9%). Amputation, ischemic ulceration, major neuromuscular sequelae, and peripheral embolization to the head or lower limbs did not occur. This study suggests that long-term brachial artery catheterization is associated with a low incidence of permanent ischemic complications.     

Surgical treatment of complete renal artery occlusion in pediatric patients

Two children, 8 and 11 years old, presented with severe hypertension secondary to unilateral and bilateral total occlusion of the renal arteries, respectively. The 11-year-old developed sudden anuria requiring hemodialysis. Successful surgical reconstruction allowed recovery of renal function and normal blood pressure in both patients. Routine blood pressure control in the pediatric patient population, high clinical awareness, and judicious use of arteriography, provide the best chance for early diagnosis of renovascular disease. Surgical revascularization or transluminal angioplasty are the treatment modalities of choice in appropriately selected cases of renal artery stenosis. When total occlusion occurs, retrieval or preservation of renal function can be successfully achieved by direct surgical intervention.     

Serious complications after umbilical artery catheterization for neonatal monitoring.

Umbilical artery catheterization in critically ill neonates caused major complications, including five deaths, in 15 of 165 infants with respiratory distress syndrome who underwent autopsy at the UCLA Hospital during the past eight years. Arterial occlusion leading to visceral infarction occurred in 12 patients, and vascular perforation caused hemoperitoneum in three patients. Repeated catheter manipulation and protracted catheter use were common factors identified in patients in whom complications developed. Restricted indications for catheter use, routine roentgenographic confirmation of catheter tip location below the kidneys, low-dosage heparin sodium infusion, use of cannulas with decreased thrombogenicity, avoidance of catheter manipulation, and vigilance to remove catheters when no longer required should reduce the incidence of this iatrogenic neonatal complication while still permitting arterial pressure and blood gas monitoring when clinically indicated.     

肠系膜上动脉栓塞的外科手术治疗

肠系膜上动脉栓塞性疾病是血管外科急症,临床上虽不如肢体动脉栓塞常见,但该症起病急骤,病情进展快,而且容易误诊为其他急腹症,因而有较高的死亡率,血管外科医生应对此病有较深入的了解和认识,努力提高诊治水平,降低其死亡率。     

肱动脉穿刺术并发症的预防与处理

目的 总结经皮肱动脉穿刺术的临床经验,探讨相关并发症发生的原因及其预防及处理对策.方法 回顾性分析2001年6月至2009年6月因行血管腔内诊疗而接受超声引导下肱动脉穿刺术87例患者的临床资料,总结发生并发症情况及其发生原因.结果 87例患者在超声引导下行肱动脉穿刺术均成功,成功率为100%,其中超声引导下一次穿刺成功有53例(61%),经多次穿刺成功有34例(39%).16例患者(19例次)发生了并发症,并发症发生率为18.4%.其中导丝进入血管周围间隙4例(4.6%),穿刺局部发生血肿11例(12.6%),其中3例合并局部神经损伤(1例为迟发型神经损伤),假性动脉瘤1例(1.2%).结论 熟悉肱动脉穿刺术部位的解剖特点,掌握相应的操作技巧并对其并发症有足够的认识和处理对策的充分准备可以减少并发症及其不良后果的发生.