LOCAL VENOUS THROMBOSIS AFTER CARDIAC-CATHETERIZATION

Pulmonary embolism is a rare but life-threatening complication of card iac catheterization. Underlying deep venous thrombosis (DVT) is often not detectable clinically. To determine the true incidence of DVT the authors prospectively studied 450 consecutive patients (29% women, 71% men, mean age: fifty-eight years) undergoing a diagnostic cardiac cat heterization. Patients were examined clinically and by duplex sonograp hy with a high-resolution (5 or 7.5 MHz) transducer before and twenty- four hours after catheterization before mobilization. Duplex sonograph y excluded complete proximal DVT in all patients. Only partial occludi ng thrombi (pDVT) were detected in 11 (2.4%) patients. The thrombi wer e always localized at the puncture site. In 2 patients a difference wa s found in the circumferences of the legs, but no other clinical signs of DVT were seen. With use of continuous wave (cw) Doppler sonography , only 3 of these 11 patients (27%) showed a spontaneous (s) sound. Ph lebography was performed in 4/11 patients (36%). In 2 patients the dia gnosis was confirmed; in 1 patient extravenous compression was assumed , and the other demonstrated a normal-appearing phlebography at the ti me of investigation. Logistic regression analysis yielded a 3.5 times higher risk for developing a pDVT if a venous puncture was performed i n addition to arterial puncture. Furthermore a 9.8 times higher risk w as found if more than one venous puncture was necessary. During the fo llow-up no patient developed clinical signs of pulmonary embolism. The results of this study demonstrate that DVT is a rare complication of cardiac catheterization (0/450 patients), but pDVT occurred in 2.4%. R isk factors for pDVT are the venous puncture itself and multiple punct ure attempts. Clinical relevance of pDVT remains to be determined.