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Management Of Percutaneous Access Complications
Benjamin Lind, MD1, Chad Jacobs, MD1, Ferral Hector, MD1, Peter Hunt, MD2, Walter McCarthy, MD1.
1Rush University Medical Center, Chicago, IL, USA, 2Cardiovascular Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.

Objective: We review our experience with percutaneous intervention complications, management and outcomes.
Methods: 33 consecutive referrals over an 18-month period for arterial complications following percutaneous vascular interventions in an urban tertiary care center were reviewed.
Results: 33 patients (12 male, 21 female) were identified, with a mean age of 63.5 (range 27-89). Six of the initial attempted procedures were venous and 27 were arterial. Ultrasound guidance was not used for any procedure; the total number of procedures performed was unavailable. The most common initial attempted procedures were neurologic angiography (n=12) and cardiac angiography (n=8). The most common complication was pseudoaneurysm (n=16). Ten of sixteen pseudoaneurysms were treated by thrombin injection. Two required operative repair due to expansile nature. The remaining were followed with serial ultrasounds. One patient with significant preexisting peripheral vascular disease sustained an iliac dissection during angiography, which ultimately resulted in limb loss. There were no complications secondary to closure device use. There was no mortality in this series.
Conclusions: Most percutaneous intervention complications are not life- or limb-threatening, but must be addressed and managed expeditiously. Reasons for operative intervention include ongoing hemorrhage, critical limb ischemia, arteriovenous fistula resulting in high-output cardiac failure or steal syndrome, and significant compression of adjacent structures such as skin or nerves. Pseudoaneurysms were the most common complication seen in this series and can often be managed by thrombin injection.
Although the use of ultrasound has been advocated for many years to facilitate central line placement, its role in arterial punctures is understudied. Further study of ultrasound guidance for arterial punctures is warranted to address is potential role in reducing arterial injury after percutaneous intervention.


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