[Perforations in recanalization of arterial occlusions of the femoropopliteal area].
Interventional recanalizations may induce wall perforations. The aim of this study was to evaluate the incidence and the management of this complication in chronic femoropoliteal occlusions. 512 cases undergoing interventional recanalization (PTA or Excimer laser-assisted angioplasty) of femoropopliteal occlusions between 5 and 32 cm in length (mean: 13.8 cm) were included. Perforations were immediately examined by angiography or colour-coded ultrasonography (7.5 MHz). Perforations were observed in 22/512 cases (4.3%). The event was coincident with guide-wire manipulations in 16/512 cases (3.1%), laser catheter advancement without wire guidance in 3/58 cases (5.2%), and balloon dilatation in 3/431 cases (0.7%), while lasering via wire guidance (n = 408) did not induce perforation. Combining treatment with prolonged balloon dilatation (success: 6/8, recurrent bleeding: 4/6), ultrasound-guided compression (UGC; success: 20/20) and regulation of anticoagulation, all active bleedings could be terminated. Due to perforation, 12/512 cases (2.3%) required repeated interventions for successful recanalization. Except hematomas of 15-320 ml volume (ultrasound measurement) and prolonged hospital stays for 24-72 h, no further clinical sequelae resulted. In conclusion, perforations occurring during recanalization of long and chronic femoropopliteal occlusions have to be considered as primary interventional failure. However, with immediate treatment including UGC, the risk of serious clinical sequelae is low.
Ragg
J C
JC
Klinische und Interventionelle Angiologie, Humboldt-Universität zu Berlin.
Biamino
G
G
D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D016342:Angioplasty, Laser / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000293:injuries*; D019233:Retreatment; D018615:Ultrasonography, Doppler, Color