Abstract

Introduction: Local complications such as thrombosis, pseudoaneursym, dissection, laceration, anteriovenous fistule, hemorrhage, infection, and distal embolization can be observed after cardiac catheterization (CC). The aim of the study is to evaluate these complications in our patients.

Methods: The medical records of 178 patients underwent CC in our clinic between May 2003-May 2006 were retrospectively evaluated for local complications, treatment approaches, and associated risk factors.

Results: The mean age of the patients was 5.3 ± 4.9 years (3 days-17 years); 101 were female and 77 were male. CC were performed in 125 (70.2%) patients for diagnostic purposes and 53 (29.7%) patients for therapeutic interventions. During 24 hours after CC, some complications developed in 7 (3.9%) cases with a mean age of 2.4±0.7 years (6 months-6 years). Thrombus was determined in 5 patients and dissection with thrombus was determined in 2 patients. These complications were observed in 5 patients underwent diagnostic CC and in 2 patients underwent therapeutic CC. Two cases were treated with only heparin infusion, whereas one patient was treated with both heparin and tissue plasminogen activator (t-PA) infusion. Additionally, 4 patients treated with heparin and streptokinase infusion. Thrombectomy was performed in 1 patient with thrombus and 2 patients with dissection and thrombus. The saphenous vein patch angioplasty has also been performed in 1 patient with dissection. These complications were determined in 5 of 170 patients (2.9%) without Down syndrome and in 2 of 8 patients (25%) with Down syndrome (p<0.05).

Conclusions: Patients who underwent cardiac catheterization should be closely follow up for development of local vascular complications. If a thrombus was developed as a complication, this should be promptly treated with antithrombotic and fibrinolitic agents in early period and appropriate surgery should be performed on time. These measures are very important for the recovery of the patients without sequela. Furthermore, Down syndrome may be a risk factor for thrombus formation in these patients

Keywords: Cardiac catheterization, local vascular complication, child

References

  1. Radtke WA. Vascular access and management of its complications. Pediatr Cardiol 2005;26(2):140-6.
  2. Lin PH, Dodson TF, Bush RL, Weiss VJ, Conklin BS, Chen C, et al. Surgical intervention for complications caused by femo- ral artery catheterization in pediatric patients. J Vasc Surg 2001; 34(6):1071-8.
  3. Liu Q, Yan CW, Zhao SH, Jiang SL, Xu ZY, Huang LJ, et al. Throm- bolytic therapy for femoral artery thrombosis after left cardiac cat- heterization in children. Chin Med J (Engl) 2009;122(8):931-4.
  4. Monagle P, Chan A, Massicotte P, Chalmers E, Michelson AD. An- tithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):645S-687S.
  5. Gürgey A. Çocuklarda Antitrombotik Tedavi. Türk Hematoloji Derneği-Temel Hemostaz Kursu 2007;85-9.
  6. Bergersen L, Marshall A, Gauvreau K, Beekman R, Hirsch R, Fo- erster S, et al. Adverse event rates in congenital cardiac cathete- rization - a multi-center experience. Catheter Cardiovasc Interv 2010;15(3):389-400.
  7. Huang YC, Chang JS, Lai YC, Li PC. Importance of prevention and early intervention of adverse events in pediatric cardiac cathe- terization: a review of three years of experience. Pediatr Neonatol 2009;50(6):280-6.
  8. Mehta R, Lee K, Chaturvedi R, Benson L. Complications of pedi- atric cardiac catheterization: A review in the current era. Catheter Cardiovasc Interv 2008;72(2):278–85.
  9. Küçükarslan N, Öz BS, Özal E, Yıldırım V, Okutan V, Tutar H. Pediyatrik Yaş Grubunda Uygulanan Kardiyak Kateterizasyonun Vasküler Komplikasyonları ve Morbidite Üzerine Etkisi. Damar Cer Derg 2004;13(1):5-10.
  10. Stambouly JJ, McLaughlin LL, Mandel FS, Boxer RA. Complica- tions of care in a pediatric intensive care unit: a prospective study. Intensive Care Med 1996;22(10):1098-104.
  11. Brus F, Witsenburg M, Hofhuis WJ, Hazelzet JA, Hess J. Strepto- kinase treatment for femoral artery thrombosis after arterial cardiac catheterisation in infants and children. Br Heart J 1990;63(5):291- 4.
  12. Albisetti M, Schmugge M, Haas R, Eckhardt BP, Bauersfeld U, Baenziger O, et al. Arterial thromboembolic complications in criti- cally ill children. J Crit Care 2005;20(3):296-300.
  13. Alonso M, Tascon J, Hernandez F, Andreu J, Albarran A, Velaz- quez MT. Complications with Femoral Access in Cardiac Cathe- tization. Impact of Previous Sytematic Femoral Anjiography and Hemostasis with Vasoseal-Es Collagen Plug. Rev Esp Cardiol 2003;56(6):569-77.
  14. Tavris DR, Dey S, Albrecht-Gallauresi B, Brindis RG, Shaw R, Weintraub W, et al. Risk of local adverse events following cardiac catheterization by hemostasis devive use-phase II. J Invasive Car- diol 2005;17(9):644-50.
  15. Tavris DR, Gallauresi BA, Dey S, Brindis R, Mitchel K. Risk of local adverse events by gender following cardiac catheterization. Pharmacoepidemiol Drug Saf 2007;16(2):125-31.
  16. Gwon HC, Doh JH, Choi JH, Lee SH, Hong KP, Park JE, et al. A 5Fr catheter approach reduces patient discomfort during transradial coronory intervention compared with a 6Fr approach: a prostective randomized study. J Invasive Cardiol 2006;19(2):141-7.
  17. Akalın F, Ayabakan C. Kateterizasyon Komplikasyonları. Çeliker A, editör. Konjenital Kalp Hastalıklarında Girişimsel Tanı ve Teda- vi. 1. Baskı. Ankara: Hacettepe Üniversitesi Hastaneleri Basımevi. Erkem Tıbbi Yayıncılık, 2008:302-18.
  18. Bulbul ZR, Galal MO, Mahmoud E, Narden B, Solymar L, Chaud- hary MA, et al. Arterial complications following cardiac cathete- rization in children less than 10 kg. Asian Cardiovasc Thorac Ann 2002;10(2):129-32.
  19. Fruhwirth J, Pascher O, Hauser H, Aman W. Local vascular comp- lications after iatrogenic femoral artery pucture. Wien Klin Woc- henschr 1996;108(7):196-200.
  20. Berge PG, Winter UJ, Hoffmann M, Albrecht D, Hoop HW, Hilger HH. Local vascular complications in heart catheter studies. Z Kar- diol 1993;82(7):449-56.
  21. Zenz W, Muntean W, Beitzke A, Zobel G, Riccabona M, Gamills- cheg A. Tissue plasminogen activator (alteplase) treatment for fe- moral artery thrombosis after cardiac catheterisation in infants and children. Br Heart J 1993;70(4):382-5.
  22. Aspalter M, Domenig CM, Haumer M, Kitzmüller E, Kretschmer G, Hölzenbein TJ. Management of iatrogenic common femoral ar- tery injuries in pediatric patients using primary vein patch angiop- lasty. J Pediatr Surg 2007;42(11):1898-902.
  23. Vila-Herrero E, Padilla-Parrado F, Vega-Pérez J, García-Casares N, Heras-Pérez JA, Romero-Acebal M. Moya-moya syndrome and arterial dysplasia associated to Down syndrome. Rev Neurol 2004;39(10):943-5.
  24. Celkan T, Özkan A, Apak H, Kuruoglu S, Yüksel L, Yıldız İ. Inc- reased factor VIII activity and dural sinus thrombosis. Medical and Pediatric Oncology 2002;39(1):70-2.
  25. Mulder R, van Schouwenburg IM, Mahmoodi BK, Veeger NJ, Mul- der AB, Middeldorp S, et al. Associations between high factor VIII and low free protein S levels with traditional arterial thrombotic risk factors and their risk on arterial thrombosis: Results from a retros- pective family cohort study. Thromb Res 2010;126(4):249-54.

Copyright and license

How to cite

1.
Uçar B, Kılıç Z, Karataş Z. VASCULAR COMPLICATIONS BELONGING TO CATHETER INSERTION IN CHILDREN WHO UNDERWENT CARDIAC CATHETERIZATION. Turk J Pediatr Dis [Internet]. 2012 Dec. 1 [cited 2025 May 25];6(1):23-30. Available from: https://turkjpediatrdis.org/article/view/168