[Local complications of arterial catheterization by the Scarpa technique. New therapeutic approaches].
Local complications of femoral artery catheterization are less frequent than those occurring after puncture of other sites. Nevertheless, their prevalence is estimated to be 0.5 to 1%. Some of them are health-threatening. Fifty-one arterial obstructions, 18 hematomas, 38 pseudoaneurysms and 11 arteriovenous fistulas have been operated on during a 25 years period. They were responsible for 4 death and 1 above-knee amputation. During the same period, several arteriovenous fistulas and pseudoaneurysms were treated conservatively. Our study and the literature show that Duplex-scan allow a management of these complications more eclectic than previously. Arterial obstructions should be operated on rapidly in case of acute ischemia with neurologic deficit. When the ischemia is less severe, heparin therapy may help the lysis of the clot. If not, simple thrombectomy is sufficient when the arteries are normal while more complete revascularizations after angiographic evaluations are necessary in case of atherosclerotic arteries. Hematomas should be avoided by local compression during a period which should be longer when the hole is large or when anticoagulation is used. An implantable bio-absorbable device has been used with good results in another study. Increasing hematomas and hematomas responsible for neurologic symptoms should be operated on. Blood restoration should be rigorous in patients with cardiac disease. Pseudoaneurysms may be easily diagnosed and controlled with Duplex-scan. Ultrasound-guided compression during 10 to 20 minutes periods should be used before deciding surgical repair.(ABSTRACT TRUNCATED AT 250 WORDS)
Mellière
D
D
Service de Chirurgie Vasculaire, CHU Henri-Mondor, Créteil.
Kuhnle
M
M
Martin-Jonathan
C
C
Becquemin
J P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology; D001164:Arteriovenous Fistula / Q000209:etiology; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002648:Child; D005263:Femoral Artery; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology
Complications locales des cathétérismes artériels au Scarpa. Nouvelles approches thérapeutiques.