Emergent treatment of an Iatrogenic arterial injury at femoral puncture site With Symbiot® self‐expanding PTFE‐covered coronary stent‐graft

Arat, Anıl; Türkbey, Barış; Be, Cil; Canyiğit, Murat; Çekirge, Saruhan

doi:10.1111/j.1440-1673.2007.01849.x

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…Mehta et al [ 24 ] successfully treated a massive bleed from a guidewire perforation of an external iliac artery with hand-made stent-graft placement. Arat and colleagues [ 25 ] reported successful treatment of a femoral bleeding site with two covered self-expanding coronary stent-grafts. Nozary and Hashemi Fard [ 26 ] reported a rare simultaneous dissection, perforation and thrombosis of the external iliac artery following angiography which did not respond to firm compression and required arteriotomy and vascular repair.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature

et al. 2017

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Retroperitoneal hemorrhage from iliac artery injury is a potentially serious complication of vascular interventional procedures leading to hemorrhagic shock and death if not diagnosed early and treated promptly. We report a 70-year-old male admitted to our facility with non-ST-elevation myocardial infarction, whose heart catheterization revealed left anterior descending artery (LAD) with 80% proximal, 95% mid and 100% distal disease. The left circumflex and right coronary arteries were 100% occluded proximally and received collaterals from the LAD. The patient declined coronary artery bypass surgery; therefore, the decision was made to perform high-risk percutaneous coronary intervention (PCI) of the LAD with Impella left ventricular assist device support. Left femoral artery angiogram revealed severely tortuous and calcified aorta, left external iliac and left common iliac arteries, and was accessed with 14-inch Impella sheath. He developed groin pain with mild hypotension thought to be due to sedation, which responded to intravenous fluids and dopamine. He underwent successful rotational atherectomy of the proximal and mid LAD with deployment of drug-eluting stents. Following PCI, he suffered acute profound hypotension necessitating intravenous fluids and vasopressor support with epinephrine. Emergency transthoracic echocardiogram did not reveal any pericardial effusion, and showed normal left ventricle and right ventricle systolic function. The Impella device was removed and selective left common iliac angiogram from the right femoral access revealed a vascular injury site with shift of the bladder to the right indicative of retroperitoneal hematoma. A digital subtraction angiogram revealed extravasation of blood at the vascular injury site. An 8.0 × 59 mm iCAST covered stent was deployed to the left external iliac artery with successful sealing of the perforation. The Impella device site was closed with two Perclose devices. The patient required 4 units of packed red blood cell transfusion. His hospital course was complicated by transient acute kidney injury, with return of his renal function to baseline at discharge 10 days later. This case underscores the importance of prompt recognition and treatment of vascular complications associated with interventional procedures, and highlights some of the risk predictors of such complications, which should be anticipated and planned for prior to intervention.

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Section: Discussionmentioning

confidence: 99%

Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature

et al. 2017

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“…Iatrogenic arterial injury at the puncture site is a potential complication of CVC placement. It can present acutely with life-threatening blood loss or can insidiously lead to a pseudoaneurysm formation 7. Femoral catheterization has a higher incidence of mechanical complications than the subclavian or internal jugular access,8 with femoral or retroperitoneal hematoma the most frequent major complication, occurring in up to 1.3% of cases 1.…”

Section: Discussionmentioning

confidence: 99%

Stent-grafts in the management of life-threatening hemorrhage following inadvertent femoral catheterization in high-risk patients: report of two cases and review of the literature

Wahbi¹

2010

VHRM

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Bleeding related to inadvertent femoral catheter insertion is an infrequent but morbid complication. We report two cases of acute life-threatening bleeding after attempts at femoral vein catheterization. Both patients were morbidly obese, had multiple comorbidities, and were at high risk for surgical intervention. Aggressive resuscitation failed to stabilize the patients. Emergency digital subtraction angiography diagnosed the site of the femoral artery bleeding. In one patient, the site of injury was the right profunda femoris artery. Both bleeding sites were controlled successfully with endovascular covered stent placement, without complication. Although prior publications have reported the concept of endovascular repair in femoral artery injuries, to the best of the author’s knowledge, covering the profunda femoris artery with no complications has not been described previously. In critically ill patients with life-threatening hemorrhage following inadvertent femoral catheterization, management with endovascular covered stents is safe and effective.

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“…In major haemorrhage, haemodynamic stabilisation with blood transfusions is required. Endovascular therapies effectively use covered stents to seal active CFA bleeding, but may be limited by the considerable risk of bend-induced stent deformation at the level of the groin [ 3 , 24 ].…”

Section: Complications Of Femoral Arterial Accessmentioning

confidence: 99%

Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin

Tonolini

Ierardi

Carrafiello³

et al. 2018

Insights Imaging

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The number and complexity of endovascular procedures performed via either arterial or venous access are steadily increasing. Albeit associated with higher morbidity compared to the radial approach, the traditional common femoral artery remains the preferred access site in a variety of cardiac, aortic, oncologic and peripheral vascular procedures. Both transarterial and venous cannulation (for electrophysiology, intravenous laser ablation and central catheterisation) at the groin may result in potentially severe vascular access site complications (VASC). Furthermore, vascular and soft-tissue groin infections may develop after untreated VASC or secondarily to non-sterile injections for recreational drug use. VASC and groin infections require rapid diagnosis and appropriate treatment to avoid further, potentially devastating harm. Whereas in the past colour Doppler ultrasound was generally used, in recent years cardiologists, vascular surgeons and interventional radiologists increasingly rely on pelvic and femoral CT angiography. Despite drawbacks of ionising radiation and the need for intravenous contrast, multidetector CT rapidly and consistently provides a panoramic, comprehensive visualisation, which is crucial for correct choice between conservative, endovascular and surgical management. This paper aims to provide radiologists with an increased familiarity with iatrogenic and self-inflicted VASC and infections at the groin by presenting examples of haematomas, active bleeding, pseudoaneurysms, arterial occlusion, arterio-venous fistula, endovenous heat-induced thrombosis, septic thrombophlebitis, soft-tissue infections at the groin, and late sequelae of venous injuries.Teaching Points• Complications may develop after femoral arterial or venous access for interventional procedures.• Arterial injuries include bleeding, pseudoaneurysm, occlusion, arteriovenous fistula, dissection.• Endovenous heat-induced thrombosis is a specific form of iatrogenic venous complication.• Iatrogenic infections include groin cellulitis, abscesses and septic thrombophlebitis.• CT angiography reliably triages vascular access site complications and groin infections.

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Emergent treatment of an Iatrogenic arterial injury at femoral puncture site With Symbiot® self‐expanding PTFE‐covered coronary stent‐graft

Cited by 7 publications

References 22 publications

Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature

Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature

Stent-grafts in the management of life-threatening hemorrhage following inadvertent femoral catheterization in high-risk patients: report of two cases and review of the literature

Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin

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