ABSTRACT
Visualization of cardiac chambers, great vessels and coronary arteries requires invasion of the cardiovascular system through an access site (arterial and/or venous), advancement of catheters inside major vessels up to left or right cardiac chambers/great vessels, selective cannulation of coronary ostia, and administration of contrast media for appropriate visualization on X-ray examination. Complications1-3 (Table 4.1) may occur at any level of the process, and include access site complications (excessive bleeding, pseudoaneurysms, fistulae, and dissections), complications anywhere in the vascular system (dissections, embolism, thrombosis, and occlusion of any vessel, including femoral, iliac, renal, mesenteric, subclavian, carotid, and coronary arteries), and general complications, including contrast media side-effects. The clinical consequences of these complications are excessive local
Complication Diagnostic procedures (%) PTCA (%) Valvuloplasty (%) Death 0.1-0.5 0.5-2 0.1-1
Myocardial infarctiona 0.1-0.2 2-5 0.05-0.1
Cardiac surgeryb 0.01 0.5-1 0.5-2
Neurological events:
Transient 0.3-0.5 0.3-0.5 0.2-1
Permanent 0.1-0.2 0.1-0.3 0.1-0.5
Cardiac perforationc 0.01-0.1 0.5-2 0.5-2
Arrhythmia:
Defibrillation 0.1-0.2 0.1-1 0.01-0.2
PM insertion 0.05-0.1 0.1-1 0.05-0.1
Access site complications:
Without surgery 1-5 1-10 1-10
With surgery 0.1-1 0.5-2 0.5-2
Vasovagal reactiond 1-4 1-4 1-4
Severe allergy 0.01-0.05 0.01-0.05 0.01-0.05 a Myocardial infarction defined as increase in CK, CK-MB, or troponin level. b Cardiac surgery indicated for ischemia or perforation. c Cardiac tamponade requiring pericardiocentesis. d Vasovagal reaction requiring atropine and fluid administration.
