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

Abstract

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.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcome of Transmetatarsal Amputations in Diabetics Using Antibiotic Beads

“…Because transmetatarsal amputation (TMA) allows a weightbearing residuum 9,11 and has a lower mortality rate 7 , it is a preferable alternative to a transtibial amputation. The primary goal of a TMA is removal of nonviable tissue and preservation of limb function by preserving the ankle joint and limb length.…”

“…Many surgeons still advocate a transtibial amputation (TTA) as the primary surgical option for non-healing foot ulcerations because of the 17% to 44% failure rate (average 30%) of TMA. 4,9,11,12,17 Initial wound edge necrosis of the transmetatarsal stump followed by secondary infection and wound breakdown are leading causes of TMA's failures. Even after TMA, blood supply, oxygenation and metabolism of the remaining soft-tissues are still impaired by diabetic micro-and macroangiopathy, and appropriate antibiotic penetration of the affected soft-tissues may not be achieved with orally or intravenously administered antibiotics.…”

Iatrogenic Pseudoaneurysm: An Uncommon Cause of Deep Vein Thrombosis

“…Iatrogenic pseudoaneurysms (IPA) form when an arterial puncture site fails to seal, allowing arterial blood to jet into the surrounding tissues and form a pulsatile hematoma. Femoral artery pseudoaneurysm (FAP) occurs in 0.1% to 0.2% of diagnostic angiograms and 0.8% to 2.2% following interventional procedures [ 1 ]. Local manifestations of pseudoaneurysm result from compression of surrounding tissues that can result in neuropathy, ischemia, and venous obstruction that can result in deep vein thrombosis (DVT).…”

Review of Transmetatarsal Amputations in the Management of Peripheral Arterial Disease in an Asian Population

“…Typically, TMA healing rates were shown to improve from 62% to 83% after surgical bypass. 27 ) Preoperative and intra-operative assessments are vital in deciding if a TMA is suitable. A retrospective analysis of TMA revealed a 92% healing rate if patients had all of these 3 factors: minimum ABI of 0.45 in non-diabetics and 0.5 in diabetics, blood total lymphocyte count of >1.5×10 3 /µL and serum albumin ≥3 g/dL.…”