Interactive Transcript
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So, what is the most concerning
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arterial access-related complication?
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I would say active bleeding is probably the most
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concerning arterial access complication and,
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you know, some studies actually report incidences
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ranging from a third to two-thirds of a percent.
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So, when we think about active hemorrhage, you know,
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the common femoral artery access is one that can,
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you know, if we think about active hemorrhage,
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retroperitoneal hemorrhage above the inguinal ligament
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is a concern on the order of about, obviously, 0.2 to 0.5%
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13 00:00:30,435 --> 00:00:31,905
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We look at sort of post-cardiac
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catheterization patients, and mortality
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can be as high as about 7%.
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And there are risk factors, known anticoagulation,
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of course, high blood pressure, higher pressure
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in the blood system, high femoral arterial
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puncture above the inguinal ligament, hitting
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the external iliac artery, larger sheath sizes.
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And then, of course, if we
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are actually trying to perform a venous
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procedure but we actually hit the artery instead.
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Not a good look.
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So what do these patients
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present and how do they present?
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They present with serial decrease in hemoglobin.
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They present often with dizziness or orthostatic
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hypotension or ipsilateral regional pain
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depending on where that inadvertent access is,
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where that hemorrhage is resulting from.
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And, you know, when we talk about sort of
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diagnosis, you know, again, CT is very, very
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sensitive, gives a good bird's eye view.
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It allows us to see all the spaces, retroperitoneal
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obviously being an important one for common
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femoral artery access, sees the size of
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hematoma and any other concomitant injuries.
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So in summary, thrombus formation results in focal
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cessation of blood flow; it can present with any of
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the six Ps of acute ischemia. It sort of results
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in, sort of, very clear evidence on ultrasound, marked
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by, sort of, spectral broadening with a biphasic
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pattern in the thrombus artery, with some monophasic
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low-velocity flow distal to the thrombus artery.
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Contrast-enhanced CT scan actually
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is particularly recommended to determine
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the range of the occlusion at that site.
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And then we have immediate treatment which
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I would, sort of, recommend after diagnosis.
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With IV unfractionated heparin being a good
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choice to limit propagation of thrombus.
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