Local Venous Thrombosis After Cardiac Catheterization

Abstract

Pulmonary embolism is a rare but life-threatening complication of cardiac catheterization. Underlying deep venous thrombosis (DVT) is often not detectable clinically. To determine the true incidence of DVT the authors prospectively studied 450 consecutive patients (29% women, 71% men, mean age: fifty-eight years) undergoing a diagnostic cardiac catheterization. Patients were examined clinically and by duplex sonography with a high-resolution (5 or 7.5 MHz) transducer before and twenty-four hours after catheterization before mobilization. Duplex sonography excluded complete proximal DVT in all patients. Only partial occluding thrombi (pDVT) were detected in 11 (2.4%) patients. The thrombi were always localized at the puncture site. In 2 patients a difference was found in the circumferences of the legs, but no other clinical signs of DVT were seen. With use of continuous wave (cw) Doppler sonography, only 3 of these 11 patients (27%) showed a spontaneous (s) sound. Phlebography was performed in 4/11 patients (36%). In 2 patients the diagnosis was confirmed; in 1 patient extravenous compression was assumed, and the other demonstrated a normal-appearing phlebography at the time of investigation. Logistic regression analysis yielded a 3.5 times higher risk for developing a pDVT if a venous puncture was performed in addition to arterial puncture. Furthermore a 9.8 times higher risk was found if more than one venous puncture was necessary. During the follow-up no patient developed clinical signs of pulmonary embolism. The results of this study demonstrate that DVT is a rare complication of cardiac catheterization (0/450 patients), but pDVT occurred in 2.4%. Risk factors for pDVT are the venous puncture itself and multiple puncture attempts. Clinical relevance of pDVT remains to be determined.

Pulmonary Thromboembolism Caused by Prolonged Compression at the Femoral Access Site and a Venous Aneurysm of the Ipsilateral Popliteal Vein

“…Moreover, in case with both venous and arterial puncture, the risk of developing proximal DVT is reported 3.5 times higher than arterial puncture alone. 9) Although venous thromboembolism (VTE) was incidentally recognized in this case, it is clear that keeping a high level of suspicion after the cardiac catheterization may be vital. Even if the patient has no clinical evidence of DVT after catheterization, life-threatening pulmonary embolism still can occur as in the present case.…”

Deep Vein Thrombosis Due to Hematoma as a Rare Complication after Femoral Arterial Catheterization

“…The incidence of DVT as a complication of femoral arterial catheterization has been reported as occurring in 0.05% to 2.4% of patients. 6,7 Filis et al reported five cases of DVT in 10,450 patients who underwent femoral arterial puncture for cardiac catheterization. 7 In all five of these patients, DVT was detected after the discharge during the antiplatelet treatment and was successfully resolved using conservative management.…”

“…[1][2][3][4][5] Most of the reported complications are bleeding, hematoma, and pseudoaneurysm. Deep-vein thrombosis (DVT) as a complication of femoral arterial catheterization has also been reported with an infrequent incidence of 0.05% to 2.4%, 6,7 and most of the reported cases were considered to have been caused by prolonged manual compression after the removal of sheath.…”

Deep vein thrombosis after transfemoral endomyocardial biopsy in cardiac transplant recipients

“…For our patients, femoral vein catheterization was of short duration, and most of our patients initiated de-ambulation within 4 hours; under these conditions, deep vein thrombosis rarely occurs soon after diagnostic cardiac catheterization. 2 In our experience, the femoral vein is a safe access route for endomyocardial biopsy. Its main inconvenience is the requirement for a short period of bedrest after the procedure.…”

“…Nor have these complications been observed in other series. 2 In some reports, 3 but not others, 4 deep vein thrombosis has been associated with femoral vein catheterization in critically ill patients. For our patients, femoral vein catheterization was of short duration, and most of our patients initiated de-ambulation within 4 hours; under these conditions, deep vein thrombosis rarely occurs soon after diagnostic cardiac catheterization.…”