Repozitorij Medicinskog fakulteta Sveučilišta u Zagrebu

Access site complications following cardiac catheterization assessed by duplex ultrasonography

Banfić, Ljiljana and Vrkić Kirhmajer, Majda and Vojković, Marina and Strozzi, Maja and Šmalcelj, Anton and Lasić, Zoran (2008) Access site complications following cardiac catheterization assessed by duplex ultrasonography. Collegium antropologicum, 32 (2). pp. 385-390. ISSN 0350-6134 (Print)

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    Croatian abstract

    Najčešći uzroci periproceduralnog morbiditeta nakon kateterizacije srca su lokalne vaskularne komplikacije na mjestu arterijske punkcije. Incidencija komplikacija prema podacima iz literature je varijabilna obzirom na načine i metode kojima su komplikacije definirane i dijagnosticirane. Cilj ove prospektivne studije je utvrditi incidenciju lokalnih komplikacija punkcijskog mjesta pomoću duplex ultrazvučne pretrage pristupne arterije. U studiju je uključeno ukupno 319 kateteriziranih bolesnika kojima je u periodu od 24 do 48 sati nakon kateterizacije i manualne kompresije učinjen duplex arterije na mjestu punkcije. Dijagnostičku koronarografiju imalo je ukupno 232 (71,8%) bolesnika, dok je 87 (28,2%) imalo perkutanu koronarnu intervenciju. Uredan nalaz kolor Dopplera punkcijog mjesta imalo je 247 (77,4%) bolesnika. Hematom je dijagnosticiran u 48 (15,1%), pseudoaneurizma u 17 (5,3%) AV fistula u 2 (0,6 %) a disekcija femoralne arterije u 5 (1,6%) bolesnika. Demografske osobitosti skupina bolesnika sa i bez femoralnih komplikacija nisu se bitno razlikovale. Komplikacije kao što su pseudoaneurizme i AV fistule češće su se pojavljivale u bolesnika u kojih je učinjena perkutana koronarna intervencija (9,2% vs. 4.7% p<0,001), u bolesnika kod kojih je bila primjenjivana antikoagulantna i antiagregacijska terapija (p=0,003) te kod bolesnika koji su za vrijeme manualne kompresije imali hemodinamske poremećaje kao što su hipotenzija i bradikardija (11% vs. 4,5%, p=0,047). Primjena duplexa arterija kod kliničke sumnje na postojanje lokalnih vaskularnih komplikacija nakon kateterizacije srca bi trebala biti pristupačnija i češće primjenjiva metoda. Posebnu pozornost zaslužuju bolesnici nakon perkutane koronarne intervencije, kod kojih je primjenjeno antitrombocitno i antikoagulantno liječenje ili su imali hemodinamske poremećaje tijekom hemostaze postignute manualnom kompresijom.

    English abstract

    Access site complications are major source of morbidity following cardiac catheterization. Their incidence varies in the literature because of multiple definitions and methods of determining the presence of particular complication. The aim of this prospective study was to determine the incidence of access site complications following cardiac catheterization using arterial duplex ultrasonography. A total of 319 consecutive patients, who had cardiac catheterization underwent femoral artery duplex study 24 to 48 hours following manual hemostasis. Diagnostic angiogram had 232 (71.8%) while 87 (28.2%) had percutaneous coronary intervention (PCI). Femoral artery duplex ultrasound was normal in 247 (77.4%). Haematoma was found in 48 (15.1%), pseudoaneurysm in 17 (5.3%), AV fistula in 2 (0.6%) and dissection of the femoral artery in 5 (1.6%) patients. Baseline demografic characteristics were similar in group with normal duplex study and group with detected complication. Pseudoaneurysm and AV fistula were more commonly observed in patients following PCI than diagnostic angiogram (9.2% vs. 4.7%, p<0.001). Patients with documented complications more frequently had concomitant administration of antiplatelet and anticoagulant medication compared to the patients without complications (p=0.003). Hemodynamic disturbances (hypotension and bradycardia) during manual compression were more frequent in patients with complication (11% vs. 4.5%, p=0.047). Low threshold for use of duplex ultrasound should be exercised in patients following cardiac catheterization to establish the presence of access site complications. Special attention is needed in the setting of aggressive antiplatelet and anticoagulant therapy, interventional procedures and hemodynamic disturbances during manual hemostas.

    Item Type: Article
    MeSH: Ultrasonography, Doppler, Duplex ; Femoral Artery - ultrasonography ; Heart Catheterization - adverse effects ; Aneurysm, False - etiology ; Arteriovenous Fistula - etiology - ultrasonography ; Female ; Hematoma - etiology - ultrasonography ; Humans ; Male ; Middle Aged
    Divisions: Katedra za internu medicinu
    Depositing User: Boris Čičovački
    Status: Published
    Creators:
    CreatorsEmail
    Banfić, Ljiljana
    Vrkić Kirhmajer, Majda
    Vojković, Marina
    Strozzi, Maja
    Šmalcelj, Anton
    Lasić, Zoran
    Date: June 2008
    Date Deposited: 03 Nov 2008
    Last Modified: 23 Sep 2011 18:10
    Subjects: /
    Related URLs:
      URI: http://medlib.mef.hr/id/eprint/512

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