Angiography catheter based bleeding complication at the access site related to Neurofibromatosis I

Neurofibromatosis Type I (NF-I) is one of the most common inherited human diseases with an incidence of 1/3000. Besides the cardinal features, all organs or body structures as well as several arterial regions can occasionly be affected. We present an unusual case of an access-site hematoma following percutaneous transluminal coronary angioplasty in a patient suffering from NF-1. After exposure of the vessels, excessive bleeding from surrounding proliferations of supposedly neurofibromatous or ganglioneuromatous tissue was identified as the sole source of the hematoma. Patients with neurofibromatosis are at considerable risk of obtaining catheter interventions over the years. In this group, we strongly recommend an ultrasound examination of the arterial segment where the arterial access is planned. In case of suspicious findings an alternative approach should be preferred to avoid bleeding complications.

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Intracoronary Stents for Management of Coronary Dissection after Balloon Angioplasty

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239500300206 ◽

1995 ◽

Vol 3 (2) ◽

pp. 53-57

Author(s):

Cho Seung Yun ◽

Shim Won Heum ◽

Ha Jong Won ◽

Park Si Hoon ◽

Kim Han Soo ◽

...

Keyword(s):

Artery Bypass ◽

Bypass Graft ◽

Percutaneous Transluminal Coronary Angioplasty ◽

Term Outcome ◽

Long Term Outcome ◽

Acute Thrombosis ◽

Arterial Access ◽

Vessel Closure ◽

Flexible Coil ◽

Transluminal Coronary Angioplasty

Dissection after percutaneous transluminal coronary angioplasty (PTCA) is a risk factor for acute or subacute vessel closure. Intracoronary stenting was developed to avoid these complications by pressing the intimal and medial flaps against the vessel wall, thus reducing the risk of acute thrombosis. From March 1993 through December 1993, PTCA was performed in 252 patients and implantation into the coronary arteries of a total of 33 stents was attempted in 32 patients with dissection after PTCA. Indications for stent implantation were acute closure in 6 (18.2%), threatened closure in 6 (18.2%), and suboptimal result in 21 (63.6%). Thirty-one stents were successfully deployed in 30 patients (94%), and stenting resulted in an immediate angiographic improvement in diameter stenosis from 87% before stenting to 18% after stenting by caliper estimation. Emergency coronary artery bypass graft surgery was required in 1 patient (3%). A non-Q wave myocardial infarction occurred in 1 patient (3%). Other complications included hematoma of the arterial access site requiring blood transfusion in 4 patients (12.5%) and hemopericardium in 1 patient (3%). Our initial experience with the flexible coil stent indicates it is efficacious for dissections that are threatening or causing coronary closure after angioplasty; however, the long-term outcome in all groups of patients who received coronary stents is unknown.

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A randomized clinical trial of the effect of bed position after PTCA

American Journal of Critical Care ◽

10.4037/ajcc1995.4.3.221 ◽

1995 ◽

Vol 4 (3) ◽

pp. 221-226 ◽

Cited By ~ 14

Author(s):

LM Sulzbach ◽

BH Munro ◽

Hirshfeld JWJr

Keyword(s):

Clinical Trial ◽

Back Pain ◽

Randomized Clinical Trial ◽

Coronary Angioplasty ◽

Percutaneous Transluminal Coronary Angioplasty ◽

Bleeding Complications ◽

Control Group ◽

Bed Position ◽

Transluminal Coronary Angioplasty ◽

Percutaneous Transluminal

BACKGROUND: After percutaneous transluminal coronary angioplasty, prolonged supine bedrest with the bed flat frequently causes back pain. This study was conducted to examine whether percutaneous transluminal coronary angioplasty patients could adjust their bed position to make themselves comfortable without increasing the frequency or severity of bleeding complications. OBJECTIVES: To determine whether the risk of bleeding increased in patients who were allowed to use their bed controls to make themselves comfortable, and if the difference in comfort was significant between patients who controlled and elevated their bed position and patients who remained flat in bed. METHOD: A randomized clinical trial was conducted; 54 patients undergoing percutaneous transluminal coronary angioplasty were randomly assigned to either the control group, in which patients remained flat in bed, or the experimental group, in which they controlled their bed position. Outcome measures included amount of bleeding at the catheter sites and patient comfort. RESULTS: No difference in the amount of bleeding at catheter insertion sites was found between the two groups. Few subjects reported pain at any time. Back pain at dinner and bedtime was higher in the control group, but only the bedtime difference was statistically significant. CONCLUSION: We conclude that patients may be allowed to adjust their bed position to 30 degrees for comfort without incurring increased risk of catheter entry site bleeding and that requiring patients to remain flat in bed has no scientific basis.

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