Sterile inflammation associated with transradial catheterization and hydrophilic sheaths

Abstract

In 1999, we noted the development of inflammation and/or abscesses at the site of radial access in a group of patients. Over a 3-year period, we noted this inflammation in 33 patients out of 2,038 (1.6%) who had catheterization via the radial approach. The radial abscesses occurred in 30 patients out of 1,063 (2.8%) in whom we could confirm the use of a hydrophilic-coated sheath, but in no patient for whom we can document that an uncoated sheath was used. No infectious agent could be implicated, and the time course for the development of the abscess, typically 2 to 3 weeks, seemed long for a bacterial infection. Later patients had biopsies, and granulomatous reactions were seen in most. Additionally, a few of the biopsies showed an amorphous extravascular substance consistent with the catheter coating. All patients had good long-term outcomes.

Enhancing Brain Lesions after Endovascular Treatment of Aneurysms

“…Local foreign body reaction at the puncture site was described (2.8%-5.0%) in the cardiology literature after radial access by using long hydrophilic coated sheaths. [25][26][27] Two of our patients presented with aseptic secretion and local inflammation at the puncture site that did not respond to the initial antibiotic treatment, and eventually resolved spontaneously over a few months. Pathologic specimen was not obtained in these cases; however, the clinical picture corresponds to a foreign body skin reaction.…”

Histopathological assessment of fatal ipsilateral intraparenchymal hemorrhages after the treatment of supraclinoid aneurysms with the Pipeline Embolization Device

“…Ceasing to use this hydrophilic-coated sheath has resulted in the disappearance of this complication. 9,13,22,23 There have been previous reports of catheter coating resulting in emboli in the cerebral and other vascular territories, 3,16 but few studies have reported on the biological effects of PVP and its derivatives on the cerebral vasculature. Polyvinylpyrrolidone is generally considered safe and has been approved by the FDA.…”

Friction behaviour of hydrophilic lubricious coatings for medical device applications

“…Further, the use of certain hydrophilic coatings (for example, those manufactured by Cook [12,13]) has been associated with the formation of sterile granulomas and abscesses [14][15][16][17][18]. Clearly, there is substantial room for improvement in the field of lubricious coatings for endovascular catheter use and, in particular, biodegradability would be a marked advantage.…”