Download PDF
CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(02): 097-107
DOI: 10.1055/s-0042-1760246
Review Article

Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review

Ajay Pawan Kumar
1   Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
,
Jineesh Valakkada 
1   Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
,
Anoop Ayappan 
1   Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
,
Santhosh Kannath
1   Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Endovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.

Keywords

pseudoaneurysm - complications - femoral artery access


Publication History

Article published online:
27 December 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Chandrasekar B, Doucet S, Bilodeau L. et al. Complications of cardiac catheterization in the current era: a single-center experience. Catheter Cardiovasc Interv 2001; 52 (03) 289-295
    CrossrefPubMedGoogle Scholar
  • 2 Brenna CTA, Ku JC, Pasarikovski CR. et al. Access-site complications in ultrasound-guided endovascular thrombectomy: a single-institution retrospective cohort study. Neurosurg Focus 2021; 51 (01) E3
    CrossrefPubMedGoogle Scholar
  • 3 Sherev DA, Shaw RE, Brent BN. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc Interv 2005; 65 (02) 196-202
    CrossrefPubMedGoogle Scholar
  • 4 Bhatty S, Cooke R, Shetty R, Jovin IS. Femoral vascular access-site complications in the cardiac catheterization laboratory: diagnosis and management. Interv Cardiol 2011; 3 (04) 503-514
    CrossrefPubMedGoogle Scholar
  • 5 Sajnani N, Bogart DB. Retroperitoneal hemorrhage as a complication of percutaneous intervention: report of 2 cases and review of the literature. Open Cardiovasc Med J 2013; 7: 16-22
    CrossrefPubMedGoogle Scholar
  • 6 Piper WD, Malenka DJ, Ryan Jr TJ. et al; Northern New England Cardiovascular Disease Study Group. Predicting vascular complications in percutaneous coronary interventions. Am Heart J 2003; 145 (06) 1022-1029
    CrossrefPubMedGoogle Scholar
  • 7 Sui YG, Teng SY, Qian J. et al. Cross-sectional study of retroperitoneal hematoma after invasive intervention in a Chinese population: prevalence, characteristics, management and outcomes. Exp Ther Med 2020; 20 (04) 2975-2984
    PubMedGoogle Scholar
  • 8 Kent KC, Moscucci M, Mansour KA. et al. Retroperitoneal hematoma after cardiac catheterization: prevalence, risk factors, and optimal management. J Vasc Surg 1994; 20 (06) 905-910 , discussion 910–913
    CrossrefPubMedGoogle Scholar
  • 9 Spahn DR, Bouillon B, Cerny V. et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 2019; 23 (01) 98
    CrossrefPubMedGoogle Scholar
  • 10 Chee YE, Liu SE, Irwin MG. Management of bleeding in vascular surgery. Br J Anaesth 2016; 117 (Suppl. 02) ii85-ii94
    CrossrefPubMedGoogle Scholar
  • 11 Samal AK, White CJ. Percutaneous management of access site complications. Catheter Cardiovasc Interv 2002; 57 (01) 12-23
    CrossrefPubMedGoogle Scholar
  • 12 Tsetis D. Endovascular treatment of complications of femoral arterial access. Cardiovasc Intervent Radiol 2010; 33 (03) 457-468
    CrossrefPubMedGoogle Scholar
  • 13 Ohlow MA, Secknus MA, von Korn H. et al. Incidence and outcome of femoral vascular complications among 18,165 patients undergoing cardiac catheterisation. Int J Cardiol 2009; 135 (01) 66-71
    CrossrefPubMedGoogle Scholar
  • 14 Lee MS, Applegate B, Rao SV, Kirtane AJ, Seto A, Stone GW. Minimizing femoral artery access complications during percutaneous coronary intervention: a comprehensive review. Catheter Cardiovasc Interv 2014; 84 (01) 62-69
    CrossrefPubMedGoogle Scholar
  • 15 Altin RS, Flicker S, Naidech HJ. Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures. AJR Am J Roentgenol 1989; 152 (03) 629-631
    CrossrefPubMedGoogle Scholar
  • 16 Gabriel M, Pawlaczyk K, Waliszewski K, Krasiński Z, Majewski W. Location of femoral artery puncture site and the risk of postcatheterization pseudoaneurysm formation. Int J Cardiol 2007; 120 (02) 167-171
    CrossrefPubMedGoogle Scholar
  • 17 Miller-Thomas MM, West OC, Cohen AM. Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics 2005; 25 (Suppl. 01) S133-S142
    CrossrefPubMedGoogle Scholar
  • 18 Madia C. Management trends for postcatheterization femoral artery pseudoaneurysms. JAAPA 2019; 32 (06) 15-18
    CrossrefPubMedGoogle Scholar
  • 19 Stolt M, Braun-Dullaeus R, Herold J. Do not underestimate the femoral pseudoaneurysm. Vasa 2018; 47 (03) 177-185
    CrossrefPubMedGoogle Scholar
  • 20 Kurzawski J, Sadowski M, Janion-Sadowska A. Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm. J Clin Ultrasound 2016; 44 (03) 188-195
    CrossrefPubMedGoogle Scholar
  • 21 Aytekin C, Firat A, Yildirim E, Kirbas I, Boyvat F. Ultrasound-guided glue injection as alternative treatment of femoral pseudoaneurysms. Cardiovasc Intervent Radiol 2004; 27 (06) 612-615
    CrossrefPubMedGoogle Scholar
  • 22 San Norberto García EM, González-Fajardo JA, Gutiérrez V, Carrera S, Vaquero C. Femoral pseudoaneurysms post-cardiac catheterization surgically treated: evolution and prognosis. Interact Cardiovasc Thorac Surg 2009; 8 (03) 353-357
    CrossrefPubMedGoogle Scholar
  • 23 Glaser RL, McKellar D, Scher KS. Arteriovenous fistulas after cardiac catheterization. Arch Surg 1989; 124 (11) 1313-1315
    CrossrefPubMedGoogle Scholar
  • 24 Kelm M, Perings SM, Jax T. et al. Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment. J Am Coll Cardiol 2002; 40 (02) 291-297
    CrossrefPubMedGoogle Scholar
  • 25 Thalhammer C, Kirchherr AS, Uhlich F, Waigand J, Gross CM. Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents. Radiology 2000; 214 (01) 127-131
    CrossrefPubMedGoogle Scholar
  • 26 Thavarajan D, Bakran A. Iatrogenic arteriovenous fistula in the groin presenting as cardiac failure. NDT Plus 2009; 2 (01) 46-48
    PubMedGoogle Scholar
  • 27 Ruebben A, Tettoni S, Muratore P, Rossato D, Savio D, Rabbia C. Arteriovenous fistulas induced by femoral arterial catheterization: percutaneous treatment. Radiology 1998; 209 (03) 729-734
    CrossrefPubMedGoogle Scholar
  • 28 Lemaire JM, Dondelinger RF. Percutaneous coil embolization of iatrogenic femoral arteriovenous fistula or pseudo-aneurysm. Eur J Radiol 1994; 18 (02) 96-100
    CrossrefPubMedGoogle Scholar
  • 29 Perings SM, Kelm M, Lauer T, Strauer BE. [Duplex ultrasound determination of shunt volume in iatrogenic arteriovenous fistulas after heart catheterization]. Z Kardiol 2002; 91 (06) 481-486
    PubMedGoogle Scholar
  • 30 Vaninbroukx I, Vandekerkhof J. Endovascular stent graft treatment for iatrogenic arteriovenous fistulas after femoral catheterisation. Acta Chir Belg 2004; 104 (05) 584-587
    CrossrefPubMedGoogle Scholar
  • 31 Onal B, Kosar S, Gumus T, Ilgit ET, Akpek S. Postcatheterization femoral arteriovenous fistulas: endovascular treatment with stent-grafts. Cardiovasc Intervent Radiol 2004; 27 (05) 453-458
    CrossrefPubMedGoogle Scholar
  • 32 Gardiner Jr GA, Meyerovitz MF, Stokes KR, Clouse ME, Harrington DP, Bettmann MA. Complications of transluminal angioplasty. Radiology 1986; 159 (01) 201-208
    CrossrefPubMedGoogle Scholar
  • 33 Rizk T, Patel D, Dimitri NG, Mansour K, Ramakrishnan V. Iatrogenic arterial perforation during endovascular interventions. Cureus 2020; 12 (08) e10018
    PubMedGoogle Scholar
  • 34 Atta I, Zekilah S, El Abd A, Fouda H, Sawaby A. Arterial perforation during lower limb percutaneous transluminal angioplasty for treating critical lower limb ischemia. Egypt J Surg 2021; 40 (02) 522-527
    PubMedGoogle Scholar
  • 35 Danek BA, Karatasakis A, Brilakis ES. Consequences and treatment of guidewire entrapment and fracture during percutaneous coronary intervention. Cardiovasc Revasc Med 2016; 17 (02) 129-133
    CrossrefPubMedGoogle Scholar
  • 36 Al-Moghairi AM, Al-Amri HS. Management of retained intervention guide-wire: a literature review. Curr Cardiol Rev 2013; 9 (03) 260-266
    CrossrefPubMedGoogle Scholar
  • 37 Silberstein M, Tress BM, Hennessy O. Selecting the right technique to reform a reverse curve catheter (Simmons style): critical review. Cardiovasc Intervent Radiol 1992; 15 (03) 171-176
    CrossrefPubMedGoogle Scholar
  • 38 Zeller T, Frank U, Müller C. et al. Technological advances in the design of catheters and devices used in renal artery interventions: impact on complications. J Endovasc Ther 2003; 10 (05) 1006-1014
    CrossrefPubMedGoogle Scholar
  • 39 Watts MM. Pharmacology of peripheral arterial disease in the angio suite: what every interventionalist should know. Semin Intervent Radiol 2018; 35 (05) 393-398
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Balloon Rupture During Coronary Angioplasty - Conrad C. Simpfendorfer. . Alexios P. Dimas, Adnan Zaidi, Jay Hollman, Irving Franco, Valerie Knezinek, Robert E. Hobbs, 1986 [Internet]. 2022 [cited 2022 Sep 6]. Accessed December 14, 2022, at: https://journals.sagepub.com/doi/abs/10.1177/000331978603701106
    PubMed
  • 41 Rhodes A, Evans LE, Alhazzani W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43 (03) 304-377
    CrossrefPubMedGoogle Scholar
  • 42 Basile A, Rebonato A, Failla G. et al. Early post-procedural patients compliance and VAS after UAE through transradial versus transfemoral approach: preliminary results. Radiol Med (Torino) 2018; 123 (11) 885-889
    CrossrefPubMedGoogle Scholar
  • 43 Andreou A. Balloon rupture during stent postdilation: lesson from a movie. Curr Res Cardiol. 2016; 3: 25-26
    CrossrefPubMedGoogle Scholar
  • 44 Murata R, Kamiizumi Y, Haneda T. et al. Retrieval strategy for ruptured balloon with circumferential tear during angioplasty for arteriovenous fistula in hemodialysis patients. J Vasc Access 2020; 21 (02) 246-250
    CrossrefPubMedGoogle Scholar
  • 45 Tegtmeyer CJ, Bezirdjian DR. Removing the stuck, ruptured angioplasty balloon catheter. Radiology 1981; 139 (01) 231-232
    CrossrefPubMedGoogle Scholar
  • 46 Davies MG, Bismuth J, Saad WE. et al. Implications of in situ thrombosis and distal embolization during superficial femoral artery endoluminal intervention. Ann Vasc Surg 2010; 24 (01) 14-22
    CrossrefPubMedGoogle Scholar
  • 47 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
    CrossrefPubMedGoogle Scholar
  • 48 Kaufman C, Kinney T, Quencer K. Practice trends of fibrinogen monitoring in thrombolysis. J Clin Med 2018; 7 (05) 111
    CrossrefPubMedGoogle Scholar
  • 49 Razavi MK. Detection and treatment of acute thromboembolic events in the lower extremities. Tech Vasc Interv Radiol 2011; 14 (02) 80-85
    CrossrefPubMedGoogle Scholar
  • 50 Kwok CHR, Fleming S, Chan KKC. et al. Aspiration thrombectomy versus conventional catheter-directed thrombolysis as first-line treatment for noniatrogenic acute lower limb ischemia. J Vasc Interv Radiol 2018; 29 (05) 607-613
    CrossrefPubMedGoogle Scholar
  • 51 de Donato G, Pasqui E, Sponza M. et al; INDIAN trial collaborators. Safety and efficacy of vacuum assisted thrombo-aspiration in patients with acute lower limb ischaemia: the INDIAN trial. Eur J Vasc Endovasc Surg 2021; 61 (05) 820-828
    CrossrefPubMedGoogle Scholar
  • 52 Kim C, Jeon W, Shin T. et al. Stent-assisted recanalisation of acute occlusive arteries in patients with acute limb ischaemia. Eur J Vasc Endovasc Surg 2010; 39 (01) 89-96
    CrossrefPubMedGoogle Scholar
  • 53 Stangl PA, Lewis S. Review of currently available GP IIb/IIIa inhibitors and their role in peripheral vascular interventions. Semin Intervent Radiol 2010; 27 (04) 412-421
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Altenburg A, Haage P. Antiplatelet and anticoagulant drugs in interventional radiology. Cardiovasc Intervent Radiol 2012; 35 (01) 30-42
    CrossrefPubMedGoogle Scholar
  • 55 Lam RC, Shah S, Faries PL, McKinsey JF, Kent KC, Morrissey NJ. Incidence and clinical significance of distal embolization during percutaneous interventions involving the superficial femoral artery. J Vasc Surg 2007; 46 (06) 1155-1159
    CrossrefPubMedGoogle Scholar
  • 56 Allaire E, Melliere D, Poussier B, Kobeiter H, Desgranges P, Becquemin JP. Iliac artery rupture during balloon dilatation: what treatment?. Ann Vasc Surg 2003; 17 (03) 306-314
    CrossrefPubMedGoogle Scholar
  • 57 Darcy M. Complications of iliac angioplasty and stenting. Tech Vasc Interv Radiol 2000; 3 (04) 226-239
    CrossrefPubMedGoogle Scholar
  • 58 Tanemoto M, Abe T, Chaki T, Satoh F, Ishibashi T, Ito S. Cutting balloon angioplasty of resistant renal artery stenosis caused by fibromuscular dysplasia. J Vasc Surg 2005; 41 (05) 898-901
    CrossrefPubMedGoogle Scholar
  • 59 Ge BH, Copelan A, Scola D, Watts MM. Iatrogenic percutaneous vascular injuries: clinical presentation, imaging, and management. Semin Intervent Radiol 2015; 32 (02) 108-122
    Article in Thieme ConnectPubMedGoogle Scholar
  • 60 Arce-Gonzalez JM, Schwartz L, Ganassin L, Henderson M, Aldridge H. Complications associated with the guide wire in percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1987; 10 (01) 218-221
    CrossrefPubMedGoogle Scholar
  • 61 Joseph N, Levy E, Lipman S. Angioplasty-related iliac artery rupture: treatment by temporary balloon occlusion. Cardiovasc Intervent Radiol 1987; 10 (05) 276-279
    CrossrefPubMedGoogle Scholar
  • 62 Brountzos EN, Ptohis N, Triantafyllidi H. et al. Renal artery rupture following cutting balloon angioplasty for fibromuscular dysplasia: a case report. Cases J 2009; 2: 8881
    CrossrefPubMedGoogle Scholar
  • 63 Ashenburg RJ, Blair RJ, Rivera FJ, Weigele JB. Renal arterial rupture complicating transluminal angioplasty: successful conservative management. Radiology 1990; 174 (3 Pt 2): 983-985
    CrossrefPubMedGoogle Scholar
  • 64 Cooper SG, Sofocleous CT. Percutaneous management of angioplasty-related iliac artery rupture with preservation of luminal patency by prolonged balloon tamponade. J Vasc Interv Radiol 1998; 9 (1 Pt 1): 81-83
    CrossrefPubMedGoogle Scholar
  • 65 Marin ML, Veith FJ, Panetta TF. et al. Transluminally placed endovascular stented graft repair for arterial trauma. J Vasc Surg 1994; 20 (03) 466-472 , discussion 472–473
    CrossrefPubMedGoogle Scholar
  • 66 Murphy TP, Dorfman GS, Segall M, Carney Jr WI. Iatrogenic arterial dissection: treatment by percutaneous transluminal angioplasty. Cardiovasc Intervent Radiol 1991; 14 (05) 302-306
    CrossrefPubMedGoogle Scholar
  • 67 Fitzgerald PJ, Ports TA, Yock PG. Contribution of localized calcium deposits to dissection after angioplasty. An observational study using intravascular ultrasound. Circulation 1992; 86 (01) 64-70
    CrossrefPubMedGoogle Scholar
  • 68 Fujihara M, Takahara M, Sasaki S. et al. Angiographic dissection patterns and patency outcomes after balloon angioplasty for superficial femoral artery disease. J Endovasc Ther 2017; 24 (03) 367-375
    CrossrefPubMedGoogle Scholar
  • 69 Shammas NW, Lam R, Mustapha J. et al. Comparison of orbital atherectomy plus balloon angioplasty vs. balloon angioplasty alone in patients with critical limb ischemia: results of the CALCIUM 360 randomized pilot trial. J Endovasc Ther 2012; 19 (04) 480-488
    CrossrefPubMedGoogle Scholar
  • 70 Huber MS, Mooney JF, Madison J, Mooney MR. Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol 1991; 68 (05) 467-471
    CrossrefPubMedGoogle Scholar
  • 71 Kobayashi N, Hirano K, Yamawaki M. et al. Simple classification and clinical outcomes of angiographic dissection after balloon angioplasty for femoropopliteal disease. J Vasc Surg 2018; 67 (04) 1151-1158
    CrossrefPubMedGoogle Scholar
  • 72 Hong SK, Jang JY, Kang MJ, Han IW, Kim SW. Comparison of clinical outcome and cost-effectiveness after various preoperative biliary drainage methods in periampullary cancer with obstructive jaundice. J Korean Med Sci 2012; 27 (04) 356-362
    CrossrefPubMedGoogle Scholar
  • 73 Banerjee S, Sarode K, Mohammad A. et al. Femoropopliteal artery stent thrombosis: report from the excellence in peripheral artery disease registry. Circ Cardiovasc Interv 2016; 9 (02) e002730
    CrossrefPubMedGoogle Scholar
  • 74 Lüscher TF, Steffel J, Eberli FR. et al. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation 2007; 115 (08) 1051-1058
    CrossrefPubMedGoogle Scholar
  • 75 Dippel EJ, Makam P, Kovach R. et al; EXCITE ISR Investigators. Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis). JACC Cardiovasc Interv 2015; 8 (1 Pt A): 92-101
    CrossrefPubMedGoogle Scholar
  • 76 Shammas NW, Radaideh Q, Shammas WJ, Daher GE, Rachwan RJ, Radaideh Y. The role of precise imaging with intravascular ultrasound in coronary and peripheral interventions. Vasc Health Risk Manag 2019; 15: 283-290
    CrossrefPubMedGoogle Scholar
  • 77 Johanning JM, Franklin DP, Elmore JR, Han DC. Femoral artery infections associated with percutaneous arterial closure devices. J Vasc Surg 2001; 34 (06) 983-985
    CrossrefPubMedGoogle Scholar
  • 78 Olivia G, Petter L, Håkan P. Acute compartment syndrome following thrombolysis for acute lower limb ischemia. Ann Vasc Surg 2022; 79: 182-190
    CrossrefPubMedGoogle Scholar