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Complications - Percutaneous transluminal angioplasty and stenting of the right internal carotid artery in recurrent stenosis– Vascular surgery

vascular surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative complications

    Access problems

    • If inguinal puncture not possible -> switch to opposite side; if this too fails -> continue with contralateral arm

    Stent misplacement

    • Overstenting or converting to open surgery, depending on the specific situation.

    Carotid dissection

    • Extend stenting

    Carotid occlusion

    • Emergency conversion to open surgery

    Vascular spasms

    • Triggered by intraoperative manipulations or guidewire movements
    • Usually transient, but may also result in intermittent occlusion of the vessel with secondary stasis and thrombus formation

  2. Postoperative complications

    Hematoma, secondary bleeding from puncture site

    • Apply adequate external / manual compression; compression dressing; bed rest.
    • In case of a larger hematoma → compression will not suffice
    • Possibly surgical revision with hematoma evacuation, vascular suture

    Manual compression time and duration of bed rest following intervention

    Instrument

    Compression time [min]

    Bed rest [h]

    4F catheter

    5

    2-4

    4F sheath, 5F catheter

    10-15

    6-8

    5F sheath

    15-20

    6-8

    6F sheath

    >20

    >8

    Source: Wielpütz MO, Radeleff BA (2013) Punktions- und Hämostasetechnik. In: Radeleff BA (Eds.) Angiofibel, 1st Edition Springer, Heidelberg, p. 9–22

    Pseudoaneurysm

    • No skin lesion, little pain, no nerve injury → compression under ultrasonic guidance, compression dressing, thrombin injection
    • Significant pain, skin blisters/necrosis, nerve compression → hematoma relief, vascular reconstruction (usually suture).

    AV fistula

    • Small shunt volume → nonsurgicall course
    • large shunt volume, clinical symptoms → open surgery to close fistula, in critically ill patients also stent grafting

    Stent thrombosis

    • Extremely rare since the advent of platelet inhibitors and adequate antithrombotic anticoagulants

    Apoplectic stroke

    • Assessment by color flow Doppler imaging of carotid arteries, MRI of the brain parenchyma
    • In carotid artery occlusion and preserved consciousness, emergency open surgery; in somnolent patients and those with cerebral hemorrhage, nonsurgical management (BP control; calcium antagonists; heparin pause; discontinue platelet inhibitors); consult with neurologist