scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Arterial Thrombus Formation During Clinical Percutaneous Catheterization

01 May 1970-Circulation (Lippincott Williams & Wilkins)-Vol. 41, Iss: 5, pp 833-839
TL;DR: Deposition of thrombotic material on catheters was observed following more than 50% of 93 diagnostic catheterizations and a definite time relationship between the thrombus formation and the duration of the catheterization procedure was noted.
Abstract: Deposition of thrombotic material on catheters was observed following more than 50% of 93 diagnostic catheterizations. The incidence of deposition of thrombotic material on catheters remaining in the body for more than 1 day was 100%. Polyethylene and siliconized polyurethane catheters were less thrombogenic than Teflon end-occluded catheters. A definite time relationship between the thrombus formation and the duration of the catheterization procedure was noted. The growth of thrombi on the outside of catheters does not appear to be linear since catheters can remain in place for 10 days or more. Postcatheterization thrombosis is believed to be due to thrombi stripped from the catheter by the arterial wall. The thrombus which originally encases the catheter will pile up at the puncture site as the catheter is withdrawn. The thrombus may remain attached at the puncture site or embolize peripherally.
Citations
More filters
Journal ArticleDOI
TL;DR: Findings are an undesirable potential hazard and concern of thromboembolism is certainly warranted, and methods to eliminate fibrin sleeves seem justified.
Abstract: Fifty-five subclavian veins with previous indwelling catheters were dissected at autopsy. Two groups of subclavian catheters injected with contrast material during removal were studied by cinefluoroscopy. Group 1 consisted of 25 patients with indwelling Teflon and polyethylene catheters. Group 2 comprised six patients with indwelling graphite-benzakonium chloride-heparin sodium (GBH) bonded polyethylene catheters. The vein dissections and the cinefluoroscopic studies in group 1 revealed that totally circumferential fibrin sleeves consistently and extensively formed on indwelling subclavian catheters. They developed on polyethylene, Teflon, nylon, and siliconized rubber catheters. These fibrin sleeves were noted at dissection on catheters within 24 hours after insertion. Two associated thrombi were discovered. Cinefluoroscopy detected one additional thrombus. These findings are an undesirable potential hazard and concern of thromboembolism is certainly warranted. Methods to eliminate fibrin sleeves seem justified. Evidence suggests that GBH-bonded catheters significantly inhibit fibrin sleeve formation.

358 citations

Journal ArticleDOI
TL;DR: The incidence of major complications-including death, myocardial infarction, and cerebral embolism-was higher in examinations using the femoral approach than the brachial approach, and the incidence of arterial thrombosis and contrast agent reactions was higher for the brACHial approach.
Abstract: A nationwide survey was undertaken to determine the rate of complications due to coronary arteriography during 1970-71. The responses from 173 hospitals-including a total of 46,904 coronary arteriograms-were analyzed in relationship to the technique employed and to the number of examinations performed at each hospital during the two-year period. The overall mortality rate was 0.45% (brachial 0.13%, femoral 0.78%). The mortality rate in institutions performing fewer than 200 examinations per two years was eight times higher than in institutions performing more than 800 examinations per two years. Similarly, the incidence of myocardial infarction and cerebral embolism was significantly higher when a smaller number of examinations was performed. The incidence of major complications-including death, myocardial infarction, and cerebral embolism-was higher in examinations using the femoral approach than the brachial approach. The incidence of arterial thrombosis and contrast agent reactions was higher for the b...

312 citations

Journal ArticleDOI
TL;DR: It is concluded from this experience that the incidence and location of major variations in coronary arterial origin are relatively predictable and useful in expeding coronary arteriography procedures and thus improving patient care.
Abstract: In 51 (1.2%) of 4,250 patients studied by selective coronary arteriography, one or more major elements of the coronary arterial system originated from the sinuses of Valsalva in an ectopic manner. The majority of variations involved the left coronary artery. The majority of ectopic ostia were located in the right sinus of Valsalva. Failure to recognize variations in coronary arterial origin can prolong arteriography procedures and lead to errors in interpretation of coronary artery anatomy and pathology. It is concluded from this experience that the incidence and location of major variations in coronary arterial origin are relatively predictable. The data are useful in expeding coronary arteriography procedures and thus improving patient care.

261 citations

Journal ArticleDOI
TL;DR: The use of more aggressive supportive measures in these high-risk cases appears essential to reduce the total complication rate from coronary arteriography significantly.
Abstract: Distressing rates of embolic complications from coronary arteriography performed by the percutaneous femoral approach have been reported since 1972. From 1970-1974, 5250 patients underwent coronary arteriography in our laboratory by the same percutaneous femoral technique with preformed polyethylene catheters and no systemic heparinization. Data were recorded during and for 24 hours postcatheterization. The annual mortality rate averaged 0.23% and remained relatively stable. Our incidence of embolic complications was very low. In patients with normal coronary arteries, no fatal or serious nonfatal complications occurred. Left main coronary artery disease was present in all cases of mortality and greater than or equal to 60% stenosis was shown in nine of 12 instances. Thus major risk was proportional to the severity of disease in the left coronary system. The use of more aggressive supportive measures in these high-risk cases appears essential to reduce the total complication rate from coronary arteriography significantly.

226 citations

Journal ArticleDOI
TL;DR: Computer analysis of complications of 5,000 catheter cerebral arteriograms performed at four hospitals revealed a total of 68 complications, eight of which were major: five patients required thrombectomy or embolectomy, two had permanent neurologic deficits, and one patient died.
Abstract: Computer analysis of complications of 5,000 catheter cerebral arteriograms performed at four hospitals (two training and two nontraining) revealed a total of 68 complications (1.4%). Eight (0.16%) of these complications were major: five patients required thrombectomy or embolectomy, two had permanent neurologic deficits, and one patient died. The complication rate for the training hospitals (3.9%) was significantly higher than that for the nontraining hospitals (0.9%), but the rates of permanent complications were identical in both groups (0.1%). Reporting criteria and complication types are described.

213 citations

References
More filters
Journal ArticleDOI
TL;DR: This study was devised to assess the role of several factors in the production of local arterial thrombosis, including type of catheter, duration of procedure, and oscillometric index of the limb employed.
Abstract: Thrombosis of the punctured vessel has been, in our experience, the most significant complication of catheter angiography. In a preliminary investigation it was noted that a filling defect develops at the puncture site during the course of an arteriographic procedure. This study was devised to assess the role of several factors in the production of local arterial thrombosis. The parameters evaluated were: type of catheter, duration of procedure, and oscillometric index of the limb employed. Methods A Collens Sphygmo-oscillometer was used in the evaluation of each patient prior to angiography. The oscillometric index, which is the greatest excursion of the indicator needle, was recorded at the biceps for axillary studies and at the calf for femoral studies. Oscillometric readings were obtained a second time on the morning following the procedure. Angiography was performed using the Seldinger method of catheterization of the femoral or axillary artery.

69 citations

Journal ArticleDOI
TL;DR: The purpose of this work was to investigate the rate of clotting on the surface of various catheters and to find possible means of prevention.
Abstract: Thrombotic and embolic accidents are serious complications of vascular catheterizations Some of these complications are caused by the stripping of clot from the surface of the catheters as these catheters are withdrawn through the holes in the vascular walls (Fig 1) The purpose of this work was to investigate the rate of clotting on the surface of various catheters and to find possible means of prevention The catheters studied were those commonly employed in clinical catheterization, namely nonradiopaque polyethylene, nonradiopaque Teflon, radiopaque polyethylene of Swedish manufacture, radiopaque polyethylene of American manufacture, radiopaque Teflon, woven Rodriguez Alvarez coated with a “special compound,” woven directable Cordis catheters (probably covered with polyurethane), and Silastic medical grade tubing All catheters were No 7 French Technic Under general anesthesia, the carotids and the jugular veins of large dogs were isolated as far as possible toward the head and toward the chest On

64 citations

Journal ArticleDOI

60 citations


"Arterial Thrombus Formation During ..." refers background in this paper

  • ...bogenicity of various plastic materials used for cardiac catheters; (4) the fate of thrombi remaining in the arterial system following withdrawal of the catheters; and (5) whether formation of the thrombus starts on the catheter surface or at the puncture site....

    [...]

Journal ArticleDOI
TL;DR: It was thought worthwhile to investigate if platelets adhere to the surface of a catheter and aggregate, as there is evidence that the risk varies with the area of the outer surface of the intravascular part of the catheter.
Abstract: Vascular catheterisation is now widely used in diagnostic techniques (angiography, blood analysis, blood pressure recording) and in therapeutics (artificial cardiac pace-makers, intravenous and intraarterial drip). The most common serious complication of vascular catheterisation is thromboembolism. Though the causal mechanism is not properly understood, there is evidence that the risk varies with the area of the outer surface of the intravascular part of the catheter. This suggests thrombus formation to be stimulated by some reaction of the blood to the surface of the catheter (JACOBSSON & SCHLOSSMAN 1969a). I t has been demonstrated in vitro that platelets adhere to the surface of a catheter and aggregate (JACOBSSON 1969a). The initial phase of thrombus formation is characterised by a similar reaction of platelets to the vessel wall (HuGUES 1962, ZUCKER & BORRELLI 1962, HOVIG 1963, OWREN 1964, MUSTARD et colI. 1967). It was therefore thought worthwhile to investigate if platelets

46 citations

Journal ArticleDOI
TL;DR: VASCULAR catheterization is widely employed in diagnostic technics (angiography' sampling of blood, and recording of blood pressure) and therapeutic methods (implants of artificial pacemakers and intravenous and intra–arterial drip infusions).
Abstract: VASCULAR catheterization is widely employed in diagnostic technics (angiography' sampling of blood, and recording of blood pressure) and therapeutic methods (implants of artificial pacemakers and intravenous and intra–arterial drip infusions) . In diagnosis the catheter is seldom left in the vessel for more than a few hours, but in therapy it may remain in the vessel for up to several days. The most common serious complication of brief as well as of prolonged vascular catheterization is thromboembolism. Its frequency varies widely from series to series, e.g., frequencies of 1 per cent (11) and of 73 per cent (4) have been reported for prolonged catheterization of the inferior caval vein and 0 per cent (9) and 13 per cent (14) for the superior vena cava. Freyschuss (2) gives a figure of 1.9 per cent for arterial catheterization of four to six days duration. It has recently been shown (8) that the risk of thromboembolism varies with the area of the outer surface of the intravascular part of the catheter. Th...

42 citations


"Arterial Thrombus Formation During ..." refers background or methods in this paper

  • ...The most popular opinions were: (1) localized trauma to the arterial wall and thrombus formnation at the puncture site; (2) hypercoagubility state; (3) large catheter in relation to the internal diameter of the catheterized vessel; and (4) prolonged intravascular position of the catheter....

    [...]

  • ...(2) Large catheters tend to decrease or eliminate flow through the catheterized vessel, stimulating thrombus formation induced by stasis....

    [...]

  • ...It is the purpose of this study to determine (1) the incidence of thrombus formation on catheters in clinical practice; (2) the relation of thrombus formation to the duration of the catheterization procedure; (3) the throm-...

    [...]