LOCAL VASCULAR COMPLICATIONS AFTER CARDIA C-CATHETERIZATION

After diagnostic and interventional cardiac catheterization, local vas cular complications at the arterial entry site must be expected. With respect to the method applied for catheterization and the puncture sit e, the type of complications may vary. With transfemoral approach a la rge variety of vascular complications have to be feared, mostly in the form of bleeding complications and hematomas, arterial dissections or occlusions, pseudoaneurysms and AV-fistulas. Each of these complicati ons may have the potential for serious morbidity. When cardiac cathete rization is performed via the arteries of the arm (either in the class ical Sones technique by arterial cutdown to the brachial artery or by direct puncture of the brachial or radial artery) vascular occlusions will mostly occur as local vascular complications. These occlusions ca n often be managed conservatively or by a surgical procedure. The inci dence of a vascular complication is mainly dependent on patient-relate d (sex, age, height, weight, arterial hypertension, diabetes, presence of peripheral vascular disease and compliance of the patient after wi thdrawal of the sheath) and procedure-related (arterial access site, d iagnostic or interventional study, sheath size, periprocedural anticoa gulation, duration of intra-arterial sheath placement, faulty puncture technique, operator skill) factors. In addition, the definition of a complication, the publication year of a certain study and the techniqu e used for identification of complications seem to play a role for the reported incidence of peripheral vascular complications after cardiac catheterization. Currently, incidences of 0.1 to 2% for significant l ocal vascular complications after diagnostic transfemoral catheterizat ion are reported, after interventional transfemoral treatment 0.5 to 5 % and after complex procedures using large sheath sizes with periproce dural anticoagulation (directional atherectomy, IABP, left-heart assis t, valvuloplasty) up to 14%. Following transbrachial and transradial c atheterization, local vascular complications at the entry site amount to 1 to 3% after diagnostic and 1 to 5% after interventional procedure s. Local vascular complications map be diminished by a cautious and se nsitive puncture technique with additional care in patients at higher risk for vascular complications (females, prediagnosed peripheral vasc ular disease, mandatory anticoagulation, necessity for large sheaths). By using smaller sized catheters and an adequate, defensive anticoagu lation regimen, the rate of arterial access site complications may be reduced. Proper methods for achievement of hemostasis as well as a clo se and careful observation after sheath withdrawal are required.