Percutaneous femoral catheterization is complicated by intimal dissection with or without associated arterial thrombosis in 0.5 % of the cases. Fortunately, in most cases, subintimal passage of the guidewire or catheter is immediately recognized, and another arterial access is selected, or the procedure is postponed; in such an occasion, usually the vessel patency is not compromised. In a minority of cases, the dissected intima can cause severe stenosis or even acute thrombosis of the arterial lumen.
It is not unusual for arterial dissection or thrombosis to be diagnosed only after completion of the endovascular procedure. A possible mechanism explaining the latter is that the guidewire follows a subintimal route with spontaneous re-entry to the true lumen; this extensive vessel injury, in combination with excessively firm external compression applied after sheath removal, may cause a severe obstruction to flow in the iliofemoral region, resulting in acute thrombosis.
KeywordsCatheter Ischemia Heparin Fibrinogen Actilyse
- 2.Labropoulos N, Giannoukas AD, Volteas SK, Kutoubi AA. Complications of the balloon assisted percutaneous transluminal angioplasty. J Cardiovasc Surg. 1994;35:475–89.Google Scholar