0:01

So, what is the most concerning

0:02

arterial access-related complication?

0:04

I would say active bleeding is probably the most

0:06

concerning arterial access complication and,

0:08

you know, some studies actually report incidences

0:10

ranging from a third to two-thirds of a percent.

0:15

So, when we think about active hemorrhage, you know,

0:17

the common femoral artery access is one that can,

0:20

you know, if we think about active hemorrhage,

0:23

retroperitoneal hemorrhage above the inguinal ligament

0:26

is a concern on the order of about, obviously, 0.2 to 0.5%

0:29

13 00:00:30,435 --> 00:00:31,905

0:32

We look at sort of post-cardiac

0:33

catheterization patients, and mortality

0:35

can be as high as about 7%.

0:37

And there are risk factors, known anticoagulation,

0:39

of course, high blood pressure, higher pressure

0:43

in the blood system, high femoral arterial

0:46

puncture above the inguinal ligament, hitting

0:48

the external iliac artery, larger sheath sizes.

0:51

And then, of course, if we

0:52

are actually trying to perform a venous

0:54

procedure but we actually hit the artery instead.

0:57

Not a good look.

0:58

So what do these patients

0:59

present and how do they present?

1:01

They present with serial decrease in hemoglobin.

1:03

They present often with dizziness or orthostatic

1:05

hypotension or ipsilateral regional pain

1:08

depending on where that inadvertent access is,

1:11

where that hemorrhage is resulting from.

1:13

And, you know, when we talk about sort of

1:15

diagnosis, you know, again, CT is very, very

1:18

sensitive, gives a good bird's eye view.

1:21

It allows us to see all the spaces, retroperitoneal

1:24

obviously being an important one for common

1:26

femoral artery access, sees the size of

1:28

hematoma and any other concomitant injuries.

1:31

So in summary, thrombus formation results in focal

1:33

cessation of blood flow; it can present with any of

1:35

the six Ps of acute ischemia. It sort of results

1:39

in, sort of, very clear evidence on ultrasound, marked

1:44

by, sort of, spectral broadening with a biphasic

1:46

pattern in the thrombus artery, with some monophasic

1:49

low-velocity flow distal to the thrombus artery.

1:53

Contrast-enhanced CT scan actually

1:54

is particularly recommended to determine

1:56

the range of the occlusion at that site.

1:59

And then we have immediate treatment which

2:01

I would, sort of, recommend after diagnosis.

2:04

With IV unfractionated heparin being a good

2:07

choice to limit propagation of thrombus.