Abstract
BackgroundThe 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.ResultsNinety-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%.ConclusionsThe 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.
Highlights
The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular complications at the access site
Inclusion criteria are: I) major vascular access site complications: pseudoaneurysms (PSA), arteriovenous fistulas (AVF), retrograde dissections (RD) and retroperitoneal bleedings (RB); II) evaluation by a multidisciplinary team of vascular surgeons, interventional radiologists and anaesthetists; III) refusal of surgical approach by patients or being considered unfit for surgery when surgery has been considered the better choice among treatment options by the multidisciplinary team
In the remaining 8 cases, PSAs were located in the upper limbs, 3/8 in the axillary artery (AA), treated by placement of Nitinol PTFE-covered stent-graft, and 5/8 in the brachial artery (BA), treated by ultrasound-guided injection of bovine thrombin
Summary
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%. The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular complications at the access site. The incidence of these events is between 0.2–1% (Tsetis 2010). 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 (Cianci et al 2013)
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