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Transcatheter “thrombin‐blood patch” injection: A novel and effective approach to treat catheterization‐related arterial perforation
Author(s) -
Maluenda Gabriel,
Mitulescu Lavinia,
BenDor Itsik,
Sardi Gabriel,
Romaguera Rafael,
Satler Lowell F.,
Pichard Augusto D.,
Waksman Ron,
Bernardo Nelson L.
Publication year - 2012
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24389
Subject(s) - medicine , percutaneous coronary intervention , perforation , surgery , percutaneous , myocardial infarction , hemostasis , revascularization , stent , cardiac catheterization , population , cardiology , punching , materials science , environmental health , metallurgy
Objective This study aimed to describe the safety and feasibility of transcatheter “thrombin‐blood patch” (TBP) injection to treat catheterization‐related arterial vascular access perforation. Background Vascular access complications are infrequent but potentially life threatening conditions related to percutaneous procedures. Surgical vascular repair are associated with high rates of morbidity and mortality due to advanced cardiovascular disease. Methods From October 2007 to July 2010 we studied 23 patients who presented active access arterial bleeding after percutaneous procedures and underwent transcatheter angiographic guided TBP injection across the entry site of the arterial perforation as a primary approach. Results The mean age of the population was 67 years, predominantly female (78.3%) with high rate of comorbidities including diabetes (30.4%), prior coronary revascularization (50.0%), chronic renal failure (43.5%), and heart failure (56.5%). Thirteen patients (56.5%) developed severe hypotension after the index procedure. The repair procedure had a mean duration of 82 ± 57 minutes. TBP was injected in all patients. One case additionally required covered‐stent to obtain hemostasis. Angiographic success was achieved in the 23 patients; however, one case required a second intervention due to recurrent bleeding, which was effectively treated using covered‐stent. All patients were discharged alive and no major cardiovascular events, including myocardial infarction/stroke, were observed. Conclusions Transcatheter “thrombin‐blood patch” injection is a safe, novel technique that allows prompt percutaneous approach to treat catheterization‐related arterial perforation. This strategy appears particularly attractive to treat patients who cannot tolerate “open” vascular reconstruction and repair. © 2012 Wiley Periodicals, Inc.