Butman Complications of Percutaneous Coronary Interventions

1. Auflage 2010
ISBN: 978-0-387-29301-1
Verlag: Springer US
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 170 Seiten, Web PDF

Reihe: Medicine

This book is designed to complement available texts that detail percutaneous interventional procedures in cardiology. By covering the range of complications that arise, from medication related to difficulties with closure devices, this text helps physicians improve care by anticipating or recognizing problems earlier. Cardiac arrest, legal matters, and adverse event reporting are also addressed. Chapters include cases, and essential information is easily accessible in useful tables. Cardiologists, as well as interventional radiologists who perform these procedures, will appreciate the logically organized and nicely illustrated format.

Zielgruppe

Research

Autoren/Hrsg.

Butman, Samuel M.

Inhaltsverzeichnis

Complications of the Medications.- Groin Complications.- Complications of Plain Old Balloon Angioplasty.- Coronary Guidewire Complications.- Complications Related to Coronary Stenting.- Complications of Atherectomy Devices.- The No-Reflow Phenomenon.- Early versus Late Complications.- Complications of Radiation Exposure and Therapy.- Complications of Closure Devices.- Legal Complications of Percutaneous Coronary Procedures.- Cardiac Arrest and Resuscitation During Percutaneous Coronary Interventions.- Adverse Event Reporting: Physicians, Manufacturers, and the Food and Drug Administration.

Leseproben

"9 Early versus Late Complications (p. 92-93)

Albert W. Chan and Christopher White

One stitch in time saves nine

1. Case

A 70-year-old woman had acute onset of groin pain and hypotension about 3 hours after removal of an arterial sheath. The patient was brought to the catheterization laboratory and ante grade contrast injection via the contralateral access identified the location of the bleeding (Figure 9-1A, arrow). After the advancement of the stiffangled guidewire and the insertion of a crossover sheath, balloon inflation was performed across the extravasation site (Figure 9-1B).

A total of 3000U of diluted 1: 10,000 thrombin was injected percutaneously while the balloon was inflated within the artery (Figure 9-1C, blocked arrow). Repeat angiography revealed minimal residual leak (Figure 9-1D, arrow), but an intra-arterial thrombus was identified in the common femoral artery and part of it migrated distally to the superficial femoral artery (Figure 9-1E, arrowhead) and to the tibioperoneal trunk (Figure 9-1F, arrowhead).

Angiojet, Percusurge Guardwire, and Filterwire were used sequentially in both the anterior and posterior tibial artery to reduce the thrombus burden (Figures 9-1G,H). Tissue plasminogen activator and papaverine were given through a Transit catheter. Because of residual thrombotic occlusion in the infrapopliteal arteries (Figure 9-1I), intra-arterial thrombolysis was administered overnight. To avoid bleeding in the common femoral artery, a Wallgraft was placed to seal the original extravasation site in the common femoral artery. The patient was discharged on the next day after an uneventful recovery.

2. Introduction

Patients who have undergone a successful percutaneous coronary intervention (PCI) are conventionally observed in the hospital overnight. However, procedure-related complications do happen beyond the hospitalization period (Table 9-1). Appropriate selections of arterial access, antithrombotic regimen, guide catheters, guidewires, and balloon and stent catheters, combined with meticulous techniques, contribute to the lowering of the periprocedural risk and late complications.

Indeed, with a routine stent strategy and improved antiplatelet and anticoagulation regimens, complications associated with PCI are much less common in recent years; and when combined with the use of vascular closure devices, same-day discharge has become possible, and even advocated by some for low-risk patients.1-7 The objective of this chapter is to discuss and contrast several major early and late complications of PCI, and include possible preventive measures as well as management strategies for their resolution.

3. Complications with Arterial Access

Arterial access-site complications are the most common complications of PCI, occurring in -3%-5% of all cases," Dissection, hematoma, pseudoaneurysm, and retroperitoneal hemorrhage represent examples of the early arterial access complications, while pseudoaneurysm and infection may sometimes be noted only days after the index procedure. Arterial access complications may cause major morbidity, prolongation of hospital stay, increased cost, and even mortality. "