Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

Abstract

Background The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele. Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications. Results Ninety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%. Conclusions The percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.

Occupational and Patient Radiation Dose and Quality Implications of Femoral Access Imaging During Coronary Angiography

“…Ipsilateral imaging (ie the RAO for the right CFA) is considered to be the best orientation to display the bifurcation of the deep and superficial femoral branches, 19 but this view was used exclusively in only 26% of included cases. CFA imaging performed in the AP view (≤15°) was associated with significantly lower radiation dose to the patient, but imaging in the AP view only may lead to misdiagnosis.…”

“…These findings support those of Zurcher et al, who reported a patient dose reduction of 40% when DSA was substituted by fluoroscopic imaging during endovascular aneurysm repairs, 18 and Pearl et al who concluded that DSA of the femoral artery should be replaced with fluoro save during cerebral angiography. 15 Ipsilateral imaging (ie the RAO for the right CFA) is considered to be the best orientation to display the bifurcation of the deep and superficial femoral branches, 19 but this view was used exclusively in only 26% of included cases. CFA imaging performed in the AP view (≤15°) was associated with significantly lower radiation dose to the patient, but imaging in the AP view only may lead to misdiagnosis.…”

Incidence of and predisposing factors for pseudoaneurysm formation in a high-volume cardiovascular center

“…Patients with asymptomatic PSA underwent treatment only if the PSA did not resolve and showed an increase in size within a week or if the patient became symptomatic [7]. Patients with symptomatic PSA were treated with replacement of the pressure bandage, UGC, UGTI, or open surgical repair [1,[4][5][6][7]. In patients whose coagulation status was normal, in whom PSA was detected within a week after the procedure, the PSA sac was superficial, simplex, and small (<20 mm), and the PSA neck was long and narrow, replacement of the pressure bandage or UGC was attempted [7,16].…”

“…Pseudoaneurysm (PSA) development is the second most common complication in those undergoing procedures that require an arterial puncture [4]. Its prevalence has been reported to range from 0.05% to 6%, with a higher incidence after therapeutic interventions than after diagnostic catheterizations [1,[4][5][6][7]. The etiology of PSA is multifactorial.…”

“…The diagnosis is based on color Doppler ultrasound examination [11][12][13][14][15]. Although PSAs can spontaneously thrombose, untreated cases may lead to rupture or get infected; therefore, most patients undergo some kind of treatment, such as the replacement of the pressure bandage, ultrasound-guided compression (UGC), ultrasoundguided thrombin injection (UGTI), and/or open surgical repair [4][5][6][7][11][12][13][14][15].…”