Percutaneous management of access site complications

Samal, Aditya K.; White, Christopher J.

doi:10.1002/ccd.10179

Cited by 73 publications

(58 citation statements)

References 61 publications

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“…31 The TransAtlantic Inter-Society Consensus (TASC) document described characteristic lesion morphology for ideal (type A) and unfavorable (type D) iliac lesions ( Figure 5) for endovascular therapy. 1 Surgical and percutaneous treatments of TASC type B and C lesions have been compared in a nonrandomized observational study.…”

Section: Patient Selection and Outcomes Aortoiliac Diseasementioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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Abstract-Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. (Figure 1). 1,2 It is important to remember the significant association of coincident coronary artery disease and cerebrovascular disease in these patients, because it represents the major cause of major morbidity and mortality in the PAD population. 3 Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. Catheter-based revascularization of the lower extremities was first performed by Charles Dotter 4 and advanced by Andreas Gruentzig, who employed then newly developed inflatable balloon catheters that could dilate vascular stenoses. 5 The availability of stents, more than any other advance, has fueled the growth of catheterbased procedures by improving the safety, durability, and predictability of percutaneous revascularization.Endovascular therapy offers several distinct advantages over open surgical revascularization for selected lesions. 6,7 It is performed with local anesthesia, which enables the treatment of patients who are at high risk for general anesthesia. The morbidity and mortality from catheter-based therapy is extremely low, especially compared with open surgical revascularization. After successful percutaneous revascularization, patients are ambulatory on the day of treatment, and unlike after vascular surgery, they can often return to normal activity within 24 to 48 hours of an uncomplicated procedure. Endovascular therapies generally do not preclude or alter subsequent surgery and may be repeated if necessary.Multiple specialties, including interventional cardiology, have contributed to the advancement of the field of peripheral vascular intervention over the past several decades. 8 The recognition of an unmet need for a trained cadre of clinicians to care for patients with PAD prompted the development of a core curriculum document (COCATS-11) 9 and a multispecialty societal competency statement. 10 The American Heart Association and American College of Cardiology have published guidelines and recommendations for the diagnosis and treatment of PAD. 2 Improved patient and physician awareness of PAD and the availability of high-quality noninvasive diagnostic imaging have increased the number of patients seeking treatment for PAD. Diagnostic Evaluation Noninvasive AssessmentThe initial assessment should include a physical examination, with the patient's shoes and socks removed, to look for signs of acute or chronic peripheral ischemia and distal embolization and to determine the status of the peripheral pulses. The abdomen is examined for evidence of an aortic aneurysm, and blood pressure should be meas...

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Section: Patient Selection and Outcomes Aortoiliac Diseasementioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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“…Факторы риска развития острой КИН [9] Контраст-индуцированная нефропатия/ Contrast-Induced Nephropathy 3,3-16,5% [13] Холестериновые эмболии/Cholesterol embolism < 2% 25%-30% (по данным аутопсии)/ (according to autopsy data) [14] Повреждение сосудов/Damage to blood vessels 0,7% -11,7% [15,16,17] Брадиаритмии/Bradyarrhythmias 3,5% [18] Летальность/Mortality 3% (диссекция левой коронарной артерии)/ (left coronary artery dissection) [19] Инфаркт миокарда/Myocardial infarction 0,05%-0,07% [20,21] Цереброваскулярные осложнения/ Cerebrovascular complications Диссекция коронарных артерий/ Dissection of the coronary arteries 0,3-0,6% [22] Ятрогенные события при эндоскопических проце-дурах могут проявляться не только осложнениями со стороны исследуемого органа (пищевод, желудок, ки-шечник), но и зависят также от состояния больного, его подготовки к проведению процедуры, техникой эндоскопии [25,26].…”

Section: осложнения при эндоскопических исследованияхunclassified

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Дворецкий¹

2018

Arhivʺ vnutr. med.

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РезюмеОсобую группу ятрогений составляют осложнения, связанные с различными диагностическими манипуляциями -от физикального об-следования больного до ангиографических исследований, диагностической лапароскопии или торакоскопии. В статье приводятся данные о частоте и характере диагностических ятрогений в клинической практике. Диапазон диагностических ятрогений по своим проявлениям, тяжести и прогнозу достаточно широк -от раздражения кожи гелем при проведении УЗИ до диссекции коронарной артерии во время коро-нароангиографии. В статье представлены примеры ятрогений диагностических процедур, начиная с процесса клинического обследования (сбор жалоб и анамнеза, физикальное исследование), и заканчивая сложными инвазивными обследованиями. Подробно рассмотрены ятро-гении, возникающие при применении препаратов, содержащих контраст (в частности йодсодержащих препаратов), которые достаточно ши-роко используются в клинической практике (КТ с контрастированием, ангиографии и др.) с диагностической целью. В статье рассказывается о факторах риска, знание которых и осведомленность об их наличии у пациента обязательны перед введением препаратов, содержащих контраст. Проведен обзор осложнений, возникающих при эндоскопических исследованиях. Автор напоминает, что ятрогенные события при эндоскопических процедурах могут проявляться не только осложнениями со стороны исследуемого органа (пищевод, желудок, кишечник), но зависят также и от состояния больного, его подготовки к проведению процедуры, владения специалистом техникой эндоскопии. В за-ключение автор приводит клиническое наблюдение, в котором фактором риска ятрогенного события было наличие у больной аномалии протоковых систем печени и поджелудочной железы. Автор статьи призывает коллег более внимательно относиться к процессу принятия решения о проведении диагностического исследования, всегда оценивать соотношение польза/риск с точки зрения реальной пользы диа-гностического исследования для больного и риска развития осложнения. Ключевые слова: ятрогения, контраст-индуцированная нефропатия, коронароангиография, эндоскопия, эзофагогастродуоденоско-пия, колоноскопия AbstractA special group of iatrogenic complications are associated with various diagnostic manipulations -from a physical examination of the patient to angiographic studies, diagnostic laparoscopy or thoracoscopy. The article presents data on the frequency and nature of diagnostic iatrogenic in clinical practice. The range of diagnostic iatrogenesis in terms of its manifestations, severity and prognosis is wide enough -from skin irritation with gel during ultrasound to dissection of the coronary artery during coronary angiography. The article presents examples of iatrogenic diagnostic procedures, starting with the clinical examination process (collection of complaints and anamnesis, physical examination), and ending with complex invasive examinations. Yatrogenia, which occur with the use of preparations containing contrast (in particular iodine-containing drugs), which are widely used in clinical practice (CT with contras...

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“…Vascular closure devices are used in many diagnostic catheterization laboratories and in approximately 40% of patients undergoing PCI in the National Cardiovascular Data Registry (NCDR) data registry. Occasionally, the complication with VCD is more severe than with manual compression [23]. One of the most significant of these is infection of the suture or collagen anchor leading to arteritis [24].…”

Section: F Sheath Removal and Vascular Closure Devicesmentioning

confidence: 99%

Infection control guidelines for the cardiac catheterization laboratory: Society guidelines revisited

Chambers

Eisenhauer²,

McNicol³

et al. 2005

Cathet Cardio Intervent

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In the early years of diagnostic cardiac catheterization, strict sterile precautions were required for cutdown procedures. Thirteen years ago, when the original guidelines were written, the brachial arteriotomy was still frequently utilized, femoral closure devices were uncommon, “implantables,” such as intracoronary stents and PFO/ASD closure devices, were in their infancy, and percutaneous valve replacement was not a consideration. In 2005, the cardiac catheterization laboratory is a complex interventional suite with percutaneous access routine and device implantation standard. Despite frequent device implantation, strict sterile precautions are often not observed. Reasons for this include a decline in brachial artery cutdown, limited postprocedure follow‐up with few reported infections, limited use of hats and masks in televised cases, and lack of current guidelines. Proper sterile technique has the potential to decrease the patient infection rate. Hand washing remains the most important procedure for preventing infections. Caps, masks, gowns, and gloves help to protect the patient by maintaining a sterile field. Protection of personnel may be accomplished by proper gowning, gloving, and eye wear, disposal of contaminated equipment, and prevention and care of puncture wounds and lacerations. With the potential for acquired disease from blood‐borne pathogens, the need for protective measures is as essential in the cardiac catheterization laboratory as is the standard Universal Precautions, which are applied throughout the hospital. All personnel should strongly consider vaccination for hepatitis B. Maintenance of the cardiac catheterization laboratory environment includes appropriate cleaning, limitation of traffic, and adequate ventilation. In an SCAI survey, members recommended an update on guidelines for infection control in the cardiac catheterization laboratory. The following revision of the original 1992 guidelines is written specifically to address the increased utilization of the catheterization laboratory as an interventional suite with device implantation. In this update, infection protection is divided into sections on the patient, the laboratory personnel, and the laboratory environment. Additionally, specific CDC recommendation sections highlight recommendations from other published guidelines. © 2005 Wiley‐Liss, Inc.

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Percutaneous management of access site complications

Cited by 73 publications

References 61 publications

Endovascular Therapies for Peripheral Arterial Disease

Endovascular Therapies for Peripheral Arterial Disease

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Infection control guidelines for the cardiac catheterization laboratory: Society guidelines revisited

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