Complications of diagnostic cardiac catheterization
- Joseph P Carrozza, MD
Joseph P Carrozza, MD
- Vice President
- Steward Cardiovascular Network
- Professor of Medicine
- Tufts University School of Medicine
Throughout the 1960s and 1970s, cardiac catheterization was primarily a diagnostic procedure that was used to evaluate hemodynamics, ventricular function, and coronary anatomy. However, the introduction of improved angioplasty equipment and new interventional devices in the 1980s made catheterization an important tool in the treatment of cardiovascular disease.
Although diagnostic catheterization and percutaneous coronary intervention (PCI) are done by skin puncture rather than incision, and under local rather than general anesthesia, they can cause a variety of adverse events, ranging from minor problems without long-term sequelae to major complications requiring immediate corrective action. Furthermore, newer interventional procedures may be associated with different and, in some cases, more frequent complications.
The most common complications associated with diagnostic cardiac catheterization will be reviewed here. The complications associated with cardiac catheterization involving PCI are discussed separately. (See "Periprocedural complications of percutaneous coronary intervention".)
The risk of producing a major complication (death, myocardial infarction, or major embolization) during diagnostic cardiac catheterization is generally well below 1 percent. As a result, the risk-to-benefit ratio still favors performing this procedure as a part of the evaluation of potentially fatal or lifestyle-limiting cardiac disease.
For the individual patient, the risk of an adverse event is dependent upon demographics, cardiovascular anatomy, clinical circumstances including comorbidities, the experience of the operator, and the type of procedure being performed (table 1A-C) . Severe peripheral artery disease is a risk factor for all of the major complications.
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- MAJOR COMPLICATIONS
- Myocardial infarction
- LOCAL VASCULAR COMPLICATIONS
- Hemostasis at the access site
- - Mechanical clamp
- - Closure devices
- - Chronic warfarin anticoagulation
- Hematoma formation
- - Retroperitoneal extension
- Arteriovenous fistula
- Arterial thrombosis
- Radial artery access
- - Is the palmar arch intact?
- Ventricular tachycardia or fibrillation
- Atrial arrhythmias
- Conduction disturbances
- PERFORATION OF THE HEART OR GREAT VESSELS
- ALLERGIC REACTIONS
- Local anesthetic
- Iodinated contrast agents
- ACUTE RENAL FAILURE
- Contrast nephropathy
- Renal atheroemboli
- RADIATION EXPOSURE
- ENDOMYOCARDIAL BIOPSY
- INFORMATION FOR PATIENTS