Vascular complications of percutaneous femoral cardiac interventions. Incidence and operative repair

J. J. Skillman, D. Kim and D. S. Baim
Charles A. Dana Research Institute, Department of Surgery, Harvard Medical School, Boston, MA.

Of 7333 patients undergoing percutaneous left-heart catheterization procedures during a seven-year seven-month period, 73 patients (1%) underwent 75 operative repairs of catheterization-related vascular complications. The overall incidence of operative repair varied according to the type of percutaneous femoral artery procedure performed: 0.6% for diagnostic heart catheterization, 0.9% for percutaneous transluminal angioplasty, 5.2% for transfemoral balloon valvuloplasty, and 11.5% for intra-aortic balloon pump placement. This suggests that (1) femoral and iliac artery occlusions can and should be repaired promptly while the patient is under local anesthesia; (2) false aneurysms in this clinical setting can be approached directly through the aneurysm cavity; (3) the diagnosis of false aneurysm or arteriovenous fistula can usually be made on clinical grounds alone, without resorting to angiography; (4) venous or arterial patch angioplasty is the preferred technique for small or severely traumatized femoral arteries; and (5) the necessity for operative repair of these lesions will continue to increase in frequency as percutaneous cardiologic diagnostic and therapeutic interventions are used more widely.

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