Management of early and late detected vascular complications following femoral arterial puncture for cardiac catheterization.

Introduction: latrogenic vascular trauma is more frequent today as a result of the increase in diagnostic and therapeutic femoral catheterizations. Management of related complications is elective or urgent and sometimes needs complex vascular reconstruction. The present study evaluated when and whether conservative, urgent surgical, or elective surgical treatment is appropriate.

Methods: A retrospective analysis was made of 45 consecutive iatrogenic vascular trauma patients, among 10,450 cardiac diagnostic or therapeutic catheterizations. Patients' demographics, type of catheterization, time from catheterization to initial diagnosis, the type of complication (thrombosis, infection, bleeding, pseudoaneurysm, etc.), time from presentation of the complication to definite treatment, diagnostic imaging and decision making, the surgical or conservative management, the length of stay and the clinical outcome were determined and analyzed.

Results: We identified and treated 30 early and 15 late (after patient's discharge) arterial complications: 18 pseudoaneurysms, 6 bleedings, 9 hematomas, 5 deep vein thromboses, 3 arteriovenous fistulas, 2 arterial embolisms and 2 arterial thromboses. Eight patients underwent emergency surgical repair, three elective surgical repair and 31 were managed conservatively. Decision making was based only on clinical evaluation in 12 patients, whereas vascular ultrasound was the most frequent diagnostic imaging modality in the remainder. A total of 10 (22.2%) minor secondary complications were identified after the initial management with no limb loss and zero mortality.

Conclusions: Close clinical observation and conservative management of vascular trauma complications resulted in a low incidence of the necessity for surgical repair (25% of cases). Bleeding and acute leg ischemia were the most frequent indication for emergency surgical treatment, whereas the majority of pseudoaneurysms, fistulas and vein thrombosis were successfully treated conservatively. Late vascular complications do occur and add an important morbidity factor to early catheterization complications.