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Arterial morbidity following interventional balloon dilation procedures

Published online by Cambridge University Press:  19 August 2008

Amanda Barlow ,
Samuel Menahem  and
James L. Wilkinson
Amanda Barlow
Affiliation:
From the Department of Cardiology, Royal Children's Hospital, Melbourne
Samuel Menahem
Affiliation:
From the Department of Cardiology, Royal Children's Hospital, Melbourne
James L. Wilkinson*
Affiliation:
From the Department of Cardiology, Royal Children's Hospital, Melbourne
*
Dr James L. Wilkinson, Department of Cardiology, Royal Children's Hospital, Parkville, Victoria 3052, Australia. Tel. 61-3-9345-5716; Fax. 61-3-9345-6001.
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Summary

Interventional catheterization procedures performed via the arterial route are well recognized therapies which are being employed with increasing frequency. This review summarizes our experience with local arterial complications of such procedures performed on 44 patients in our institution since 1985. A total of 51 balloon dilations were performed. All patients were heparinized during the procedure. Twenty-one procedures (41%) were followed by clinical evidence of reduced arterial circulation to the affected leg more than four hours after the procedure. Continuing infusion of heparin was used in 17 patients, with return of the pulse concerned in six, while two further patients developed evidence of arterial obstruction after an interval (having initially been found to have ‘satisfactory’ pulses at the end of the procedure). The final infant, whose femoral artery had been torn and could not be repaired, was observed without continuing heparinization. Streptokinase and/or tissue plasminogen activator was employed in eight patients, with resultant success in four. The remaining three, and three who failed thrombolytic therapy, underwent embolectomy. The incidence of arterial damage was related to the size of the catheter (assessed by the size of sheath required to introduce the collapsed balloon, indexed to body surface area) and to low weight or young age at the time of the procedure. No relationship could be established with other variables, including operator, type of catheter, or year or duration of procedure. At long-term follow-up, 11 (22%) patients still have absent or reduced pulses in the leg concerned. Arterial damage following interventional catheterization procedures remains a frequent occurrence despite increasing experience and technical improvements.

Keywords

Balloon angioplastycoarctationcomplicationsarterial damageinterventional procedure
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 1 , January 1996 , pp. 54 - 58
Copyright
Copyright © Cambridge University Press 1996

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References

1. Kirkpatrick, SE, Takahashi, M, Petry, EL, Stanton, RE, Lurie, PR. Percutaneous heart catheterization in infants and children. Prospective study of results and complications on 127 consecutive cases. Circulation 1970; 42: 1049–1056.CrossRefGoogle ScholarPubMed
2. Fellows, KE, Radtke, W, Keane, JF, Lock, JE. Acute complications of catheter therapy for congenital heart disease. Am J Cardiol 1987: 60:679–683.Google Scholar
3. Stanger, P, Heymann, MA, Tarnoff, H, Hoffman, JIE, Rudolph, A. Complications of cardiac catheterization of neonates, infants and children. Circulation 1974; 50: 595–608.CrossRefGoogle ScholarPubMed
4. Hurwitz, RA, Franken, EA, Girod, DA, Smith, JA, Smith, WL. Angiographic determination of arterial patency after percutaneous catheterization in infants and small children. Circulation 1977; 56: 102–105.CrossRefGoogle ScholarPubMed
5. Cassidy, SC, Schmidt, KGT, Van Hare, GF, Stanger, P, Teitel, DF. Complications of pediatric cardiac catheterization: a 3 year study. J Am Coll Cardiol 1992; 19: 1285–1293.Google Scholar
6. Franken, EA, Girod, D, Sequeira, FW, Smith, WL, Hurwitz, R, Smith, JA. Femoral artery spasm in children: catheter size is the principle cause. Am J Roent 1982; 138: 295–298.CrossRefGoogle Scholar
7. Hawker, RE, Palmer, J, Bury, RG, Bowdler, LD, Celermajer, JM. Late results of percutaneous retrograde femoral arterial catheterization in children. Br Heart J 1973; 35: 447–39.Google Scholar
8. Vermilion, RP, Snider, AR, Bengur, AR, Beekman, RH. Doppler evaluation of femoral arteries in children after aortic balloon valvuloplasty or coarctation balloon angioplasty. Pediatr Cardiol 1993; 14: 13–18.Google Scholar
9. Burrows, PE, Benson, LN, Williams, WG, Trusler, GA, Coles, J, Smallhorn, JF, Freedom, RM. Iliofemoral arterial compli-cations of balloon angioplasty for systemic obstructions in infants and children. Circulation 1990; 82: 1697–1704.Google Scholar
10. Saul, JP, Keane, JK, Fellows, KE, Lock, JE. Balloon dilation angioplasty of postoperative aortic obstructions. Am J Cardiol 1987; 59: 943–948.CrossRefGoogle ScholarPubMed
11. Tynan, M, Finley, JP, Fontes, V, Hess, J, Kan, J. Balloon angioplasty for the treatment of native coarctation: results of valvuloplasty and angioplasty of congenital anomalies registry. Am J Cardiol 1990; 65: 790–792.Google Scholar
12. Hellenbrand, WE, Allen, HD, Golinko, RJ, Hagler, DJ, Lutin, W, Kan, J. Balloon angioplasty for aortic recoarctation: results of valvuloplasty and angioplasty of congenital anomalies registry. Am J Cardiol 1990; 65: 793–797.CrossRefGoogle ScholarPubMed
13. Mullins, CE, Latson, LA, Neches, WH, Colvin, EV, Kan, J. Balloon dilation of miscellaneous lesions: results of Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol 1990; 65: 802–803.Google Scholar
14. Rocchini, AP, Beekman, RH, Shachar, GB, Benson, L, Schwartz, D, Kan, JS. Balloon aortic valvuloplasty: results of the Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol 1990; 65: 784–789.CrossRefGoogle ScholarPubMed
15. Kan, JS, White, RI, Mitchell, SE, Farmlett, EJ, Donahoo, JS, Gardner, TJ. Treatment of restenosis of coarctation by percutaneous transluminal angioplasty. Circulation 1983; 68:1087–1094.CrossRefGoogle ScholarPubMed
16. Freed, MD, Keane, JF, Rosenthal, A. The use of heparinization to prevent arterial thrombosis after percutaneous cardiac catheterization in children. Circulation 1974; 50: 565–569.CrossRefGoogle ScholarPubMed
17. Wessel, DL, Keane, LFV, Fellows, KE, Robichaud, H, Lock, JE. Fibrinolytic therapy for femoral artery thrombosis after cardiac catheterization in infants and children. Am J Cardiol 1986; 58: 347–351.CrossRefGoogle ScholarPubMed
18. Beckman, RH, Rocchini, AP, Andes, A. Balloon valvuloplasty for critical aortic stenosis in the newborn: influence of new catheter technology. J Am Coll Cardiol 1987; 17: 1172–1176.CrossRefGoogle Scholar