Pulmonary artery rupture as a complication of Swan-Ganz catheter application. Diagnosis and endovascular treatment: a single centre’s experience

Abstract

IntroductionThe placement of a Swan-Ganz catheter into the pulmonary artery may lead to a number of complications (2–17%). In less than 0.2% of cases Swan-Ganz catheterization results in serious vascular damage – pulmonary artery rupture (PAR). This paper presents two distinct forms of iatrogenic PAR treated endovascularly using different vascular devices.AimTo evaluate the effectiveness of endovascular treatment and the application of different types of vascular devices in the management of pulmonary artery rupture caused by Swan-Ganz catheterization.Material and methodsIn this retrospective study we evaluated 2 patients in whom Swan-Ganz catheter application was used for perioperative monitoring and resulted in pulmonary artery rupture. This complication was treated endovascularly by means of interventional cardiology.ResultsWe report the cases of 2 patients with a pulmonary artery pseudoaneurysm formed in the perioperative period. In case 1, a single, 4-loop, 3 mm diameter coil was implanted. In case 2, a 5 mm Amplatzer Vascular Plug IV was applied. In both cases, the endovascular approach resulted in total occlusion of the feeding artery and reduced further extravasation of the blood.ConclusionsDespite its extremely low incidence, iatrogenic PAR is a serious, life-threatening complication of Swan-Ganz catheterization that requires urgent attention. Among available methods of treatment, percutaneous embolization is a relatively quick, safe, accurate and highly effective alternative to traumatizing surgery.

Unilateral pulmonary artery pre-operative occlusion test: technical feasibility and safety prior to pneumonectomy or pleuropneumonectomy for malignancy

“…Furthermore, PA injury induced by a PA catheter has been reported, particularly by Swan-Ganz catheters. [15][16][17] This may be caused by over-inflation of the balloon or inadvertent partial inflation of the balloon in a small branch vessel. When performing the UPAO test in patients with pulmonary hilar tumours, the possibility of tumour invasion to the right or left PA needs to be considered.…”

Use of a Non-invasive Cardiac Output Measurement in a Patient with Low-output Dilated Cardiomyopathy

“…Furthermore, another meta-analysis found that SGC-guided management did not improve the mortality rate or cost-effectiveness for adult HF patients in intensive care ( 16 ). However, we cannot ignore the complications associated with SGC ( 2 ), and the advantages of monitoring circulation by SGC are weakened by those complications. Following the publication of these SGC meta-analyses, Chatterjee reviewed the indications for the use of SGC and determined that routine SGC in high-risk cardiac and noncardiac patients is not recommended ( 17 ).…”

“…However, SGC is invasive, expensive, and labor-intensive. Major risks of an SGC procedure include bruising at the site of insertion, excessive bleeding, and vein injury, and minor risks include blood clots, low blood pressure, arrhythmias, cardiac tamponade, and pulmonary artery rupture, a rare occurrence with a 50% mortality rate ( 2 ).…”

Right heart catheterization procedures in patients with suspicion of pulmonary hypertension – experiences of a tertiary center

“…Likewise, arrhythmias are reported in previous studies in a similar percentage [ 14 ]. Frequency of adverse events, especially more serious, appear mainly in research in which a greater number of patients was taken into consideration [ 9 , 13 , 14 , 33 ]. Complications such as artery puncture with/without insertion of a vascular sheath depend on access site and operator’s experience.…”