PCI complications: access site complications

Percutaneous coronary intervention Microchapters

Home

Patient Information

Overview

Risk Stratification and Benefits of PCI

Preparation of the Patient for PCI

Equipment Used During PCI

Pharmacotherapy to Support PCI

Vascular Closure Devices

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post-PCI Management

Risk Reduction After PCI

Post-PCI follow up

Hybrid coronary revascularization

PCI approaches

PCI Complications

Factors Associated with Complications

Vessel Perforation

Dissection

Distal Embolization

No-reflow

Coronary Vasospasm

Abrupt Closure

Access Site Complications

Peri-procedure Bleeding

Restenosis

Renal Failure

Thrombocytopenia

Late Acquired Stent Malapposition

Loss of Side Branch

Multiple Complications

PCI in Specific Patients

Cardiogenic Shock

Left Main Coronary Artery Disease

Refractory Ventricular Arrhythmia

Severely Depressed Ventricular Function

Sole Remaining Conduit

Unprotected Left Main Patient

Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion

The Calcified Lesion

The Ostial Lesion

The Angulated or Tortuous Lesion

The Bifurcation Lesion

The Long Lesion

The Bridge Lesion

Vasospasm

The Chronic Total Occlusion

The Left Internal Mammary Artery

Multivessel Disease

Distal Anastomotic Lesions

Left Main Intervention

The Thrombotic Lesion

PCI complications: access site complications On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of PCI complications: access site complications

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on PCI complications: access site complications

CDC on PCI complications: access site complications

PCI complications: access site complications in the news

Blogs on PCI complications: access site complications

Directions to Hospitals Treating Percutaneous coronary intervention

Risk calculators and risk factors for PCI complications: access site complications

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor: Cafer Zorkun, M.D., Ph.D. [2]

## Overview[edit | edit source]

Vascular access site complications are common during cardiac catheterization and PCI, and local bleeding (a local hematoma formation) is the most common one. A thoughtful and systematic approach to the catheterization procedure decreases problems of access.

## Access Site Complications[edit | edit source]

An old cathlab saying, Take time to evaluate and do it right the first time, should always be remembered.

Complications for vascular access can be divided into acute (during the insertion period or shortly after) or long term. Operators should have a thorough knowledge of the anatomy and of the potential complications from the procedure to identify and quickly treat any complications that may arise. Access through synthetic peripheral vascular grafts should be avoided if possible.

The femoral artery approach is the most frequent site of vascular access during invasive cardiac procedures. Possible vascular access routes are as follow:

#### Arterial[edit | edit source]

* Axillary
* Brachial
* Femoral
* Radial (rarely used for cardiac catheterization, more common for diagnostic angiographies and percutaneous interventions)
* Subclavian (not used for cardiac catheterization)
* Translumbar (not used for cardiac catheterization)

#### Venous[edit | edit source]

* Brachial
* Femoral
* Internal jugular
* Subclavian

### Patients at High Risk for Access Site Complications[edit | edit source]

* Obesity
* Patients with high blood pressure
* Elderly
* Female gender
* Patients with aortic insufficiency
* Patients who undergone prior puncture
* Patients with advanced peripheral arteriosclerosis
* Patients who suffer from coagulopathy or those taking anticoagulant or antiplatelet agents
* Patients with excessive edema

### Possible Complications[edit | edit source]

* Local tissue trauma or damage (e.g., bleeding into surrounding tissues, nerve injury)
* Vascular damage (e.g., perforation, dissection)
* AV fistula: If the femoral artery and the vein are both used, arterial sheath should be removed first and then the venous one to decrease risk of arteriovenous fistula formation.
* Infection and sepsis: After hemostasis is obtained the access area should be cleaned with antiseptic solution.
* Aberrant catheter placement

* Complication during subclavian vein cannulation. Copyleft image courtesy of C. Michael Gibson.

* Normal anatomic position of subclavian vein

* Complication during right femoral artery puncture. Copyleft image courtesy of C. Michael Gibson.

* Complication during right femoral artery puncture. Copyleft image courtesy of C. Michael Gibson.

* Complication of pulling out when there was resistance in a stent graft system. Part of right iliac and femoral arteries stripped with stent graft system from right femoral artery puncture site. Copyleft image courtesy of C. Michael Gibson.

* Higher Level puncture of femoral artery and cannula kinking. Copyleft image courtesy of C. Michael Gibson.

## References[edit | edit source]

Template:WikiDoc Sources