BibTex RIS Cite

Kalp Kateterizasyonu Yapılan Çocuklarda Kateter Giriş Yerine Ait Vasküler Komplikasyonlar

Year 2012, Volume: 6 Issue: 1, 23 - 30, 01.12.2012

Abstract

Giriş: Kardiyak kateterizasyondan sonra kateter giriş yerinde tromboz, psödoanevrizma, diseksiyon, laserasyon, arteriyovenöz fistül, kanama, enfeksiyon ve distal embolizasyon gibi lokal komplikasyonlar görülebilir.Yöntem: Kliniğimizde Mayıs 2003 - Mayıs 2006 yılları arasında kalp kateterizasyonu yapılan 178 hastanın kayıtları ponksiyon yerinde gelişen lokal komplikasyonların özellikleri, tedavi yaklaşımları ve eşlik eden risk faktörleri yönünden retrospektif olarak incelendi.Bulgular: Hastaların, yaşları 3 gün ile 17 yaş arasında değişmekte (ortalama 5.3 ± 4.9 yaş) olup, 101’i kız, 77’si erkek idi. Hastaların 125 (% 70.2)’ine tanısal, 53 (% 29.7)’üne girişimsel işlem amacıyla kalp kateterizasyonu yapıldı. Kateterizasyondan sonraki ilk 24 saat içinde komplikasyon gelişen 7 (% 3.9) hastanın yaşları 6 ay ile 6 yaş arasında değişmekteydi (ortalama 2.4 ± 0.7 yaş). İki hastada diseksiyon ve tromboz, beş hastada ise tromboz gelişti. Komplikasyon gelişen hastalardan beşine tanısal, ikisine girişimsel amaçlı kateterizasyon yapılmıştı. Bu hastalardan biri heparin ve doku plazminojen aktivatörü (t-PA) infüzyonları ile tedavi edilirken, ikisi sadece heparin infüzyonu ile, diğer 4 hasta da heparin ve streptokinaz infüzyonları ile tedavi edildi. Üç hastaya (birinde tromboz, diğer ikisinde diseksiyon ve tromboz) trombektomi yapıldı. Diseksiyonu olan hastalardan birine safen ven ile yama anjiyoplasti yapıldı. Komplikasyonların; Down sendromu olmayan 170 hastanın beşinde (%2.9), Down sendromu olan sekiz hastanın ise ikisinde (%25) geliştiği görüldü (p<0.05).Sonuç: Kalp kateterizasyonu yapılan hastaların lokal vasküler komplikasyonlar yönünden yakın takibinin ve tromboz saptanan olguların, antitrombotik ve fibrinolitik ajanlarla erken dönemde tedavi edilmesinin, gerekli hastaların ise zamanında cerrahiye verilmesinin hastaların sekelsiz olarak iyileşmesi açısından son derece önemli olduğu, ayrıca Down sendromunun bu hastalarda tromboz oluşumunu artıran bir risk faktörü olduğu düşünüldü.

References

  • Radtke WA. Vascular access and management of its complications. Pediatr Cardiol 2005;26(2):140-6.
  • Lin PH, Dodson TF, Bush RL, Weiss VJ, Conklin BS, Chen C, et al. Surgical intervention for complications caused by femo- ral artery catheterization in pediatric patients. J Vasc Surg 2001; 34(6):1071-8.
  • Liu Q, Yan CW, Zhao SH, Jiang SL, Xu ZY, Huang LJ, et al. Throm- bolytic therapy for femoral artery thrombosis after left cardiac cat- heterization in children. Chin Med J (Engl) 2009;122(8):931-4.
  • Monagle P, Chan A, Massicotte P, Chalmers E, Michelson AD. An- tithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):645S-687S.
  • Gürgey A. Çocuklarda Antitrombotik Tedavi. Türk Hematoloji Derneği-Temel Hemostaz Kursu 2007;85-9.
  • Bergersen L, Marshall A, Gauvreau K, Beekman R, Hirsch R, Fo- erster S, et al. Adverse event rates in congenital cardiac cathete- rization - a multi-center experience. Catheter Cardiovasc Interv 2010;15(3):389-400.
  • Huang YC, Chang JS, Lai YC, Li PC. Importance of prevention and early intervention of adverse events in pediatric cardiac cathe- terization: a review of three years of experience. Pediatr Neonatol 2009;50(6):280-6.
  • Mehta R, Lee K, Chaturvedi R, Benson L. Complications of pedi- atric cardiac catheterization: A review in the current era. Catheter Cardiovasc Interv 2008;72(2):278–85.
  • Küçükarslan N, Öz BS, Özal E, Yıldırım V, Okutan V, Tutar H. Pediyatrik Yaş Grubunda Uygulanan Kardiyak Kateterizasyonun Vasküler Komplikasyonları ve Morbidite Üzerine Etkisi. Damar Cer Derg 2004;13(1):5-10.
  • Stambouly JJ, McLaughlin LL, Mandel FS, Boxer RA. Complica- tions of care in a pediatric intensive care unit: a prospective study. Intensive Care Med 1996;22(10):1098-104.
  • Brus F, Witsenburg M, Hofhuis WJ, Hazelzet JA, Hess J. Strepto- kinase treatment for femoral artery thrombosis after arterial cardiac catheterisation in infants and children. Br Heart J 1990;63(5):291- 4.
  • Albisetti M, Schmugge M, Haas R, Eckhardt BP, Bauersfeld U, Baenziger O, et al. Arterial thromboembolic complications in criti- cally ill children. J Crit Care 2005;20(3):296-300.
  • Alonso M, Tascon J, Hernandez F, Andreu J, Albarran A, Velaz- quez MT. Complications with Femoral Access in Cardiac Cathe- tization. Impact of Previous Sytematic Femoral Anjiography and Hemostasis with Vasoseal-Es Collagen Plug. Rev Esp Cardiol 2003;56(6):569-77.
  • Tavris DR, Dey S, Albrecht-Gallauresi B, Brindis RG, Shaw R, Weintraub W, et al. Risk of local adverse events following cardiac catheterization by hemostasis devive use-phase II. J Invasive Car- diol 2005;17(9):644-50.
  • Tavris DR, Gallauresi BA, Dey S, Brindis R, Mitchel K. Risk of local adverse events by gender following cardiac catheterization. Pharmacoepidemiol Drug Saf 2007;16(2):125-31.
  • Gwon HC, Doh JH, Choi JH, Lee SH, Hong KP, Park JE, et al. A 5Fr catheter approach reduces patient discomfort during transradial coronory intervention compared with a 6Fr approach: a prostective randomized study. J Invasive Cardiol 2006;19(2):141-7.
  • Akalın F, Ayabakan C. Kateterizasyon Komplikasyonları. Çeliker A, editör. Konjenital Kalp Hastalıklarında Girişimsel Tanı ve Teda- vi. 1. Baskı. Ankara: Hacettepe Üniversitesi Hastaneleri Basımevi. Erkem Tıbbi Yayıncılık, 2008:302-18.
  • Bulbul ZR, Galal MO, Mahmoud E, Narden B, Solymar L, Chaud- hary MA, et al. Arterial complications following cardiac cathete- rization in children less than 10 kg. Asian Cardiovasc Thorac Ann 2002;10(2):129-32.
  • Fruhwirth J, Pascher O, Hauser H, Aman W. Local vascular comp- lications after iatrogenic femoral artery pucture. Wien Klin Woc- henschr 1996;108(7):196-200.
  • Berge PG, Winter UJ, Hoffmann M, Albrecht D, Hoop HW, Hilger HH. Local vascular complications in heart catheter studies. Z Kar- diol 1993;82(7):449-56.
  • Zenz W, Muntean W, Beitzke A, Zobel G, Riccabona M, Gamills- cheg A. Tissue plasminogen activator (alteplase) treatment for fe- moral artery thrombosis after cardiac catheterisation in infants and children. Br Heart J 1993;70(4):382-5.
  • Aspalter M, Domenig CM, Haumer M, Kitzmüller E, Kretschmer G, Hölzenbein TJ. Management of iatrogenic common femoral ar- tery injuries in pediatric patients using primary vein patch angiop- lasty. J Pediatr Surg 2007;42(11):1898-902.
  • Vila-Herrero E, Padilla-Parrado F, Vega-Pérez J, García-Casares N, Heras-Pérez JA, Romero-Acebal M. Moya-moya syndrome and arterial dysplasia associated to Down syndrome. Rev Neurol 2004;39(10):943-5.
  • Celkan T, Özkan A, Apak H, Kuruoglu S, Yüksel L, Yıldız İ. Inc- reased factor VIII activity and dural sinus thrombosis. Medical and Pediatric Oncology 2002;39(1):70-2.
  • Mulder R, van Schouwenburg IM, Mahmoodi BK, Veeger NJ, Mul- der AB, Middeldorp S, et al. Associations between high factor VIII and low free protein S levels with traditional arterial thrombotic risk factors and their risk on arterial thrombosis: Results from a retros- pective family cohort study. Thromb Res 2010;126(4):249-54.

VASCULAR COMPLICATIONS BELONGING TO CATHETER INSERTION IN CHILDREN WHO UNDERWENT CARDIAC CATHETERIZATION

Year 2012, Volume: 6 Issue: 1, 23 - 30, 01.12.2012

Abstract

Introduction: Local complications such as thrombosis, pseudoaneursym, dissection, laceration, anteriovenous fistule, hemorrhage, infection, and distal embolization can be observed after cardiac catheterization (CC). The aim of the study is to evaluate these complications in our patients. Methods: The medical records of 178 patients underwent CC in our clinic between May 2003-May 2006 were retrospectively evaluated for local complications, treatment approaches, and associated risk factors. Results: The mean age of the patients was 5.3 ± 4.9 years (3 days-17 years); 101 were female and 77 were male. CC were performed in 125 (70.2%) patients for diagnostic purposes and 53 (29.7%) patients for therapeutic interventions. During 24 hours after CC, some complications developed in 7 (3.9%) cases with a mean age of 2.4±0.7 years (6 months-6 years). Thrombus was determined in 5 patients and dissection with thrombus was determined in 2 patients. These complications were observed in 5 patients underwent diagnostic CC and in 2 patients underwent therapeutic CC. Two cases were treated with only heparin infusion, whereas one patient was treated with both heparin and tissue plasminogen activator (t-PA) infusion. Additionally, 4 patients treated with heparin and streptokinase infusion. Thrombectomy was performed in 1 patient with thrombus and 2 patients with dissection and thrombus. The saphenous vein patch angioplasty has also been performed in 1 patient with dissection. These complications were determined in 5 of 170 patients (2.9%) without Down syndrome and in 2 of 8 patients (25%) with Down syndrome (p<0.05).Conclusions: Patients who underwent cardiac catheterization should be closely follow up for development of local vascular complications. If a thrombus was developed as a complication, this should be promptly treated with antithrombotic and fibrinolitic agents in early period and appropriate surgery should be performed on time. These measures are very important for the recovery of the patients without sequela. Furthermore, Down syndrome may be a risk factor for thrombus formation in these patients

References

  • Radtke WA. Vascular access and management of its complications. Pediatr Cardiol 2005;26(2):140-6.
  • Lin PH, Dodson TF, Bush RL, Weiss VJ, Conklin BS, Chen C, et al. Surgical intervention for complications caused by femo- ral artery catheterization in pediatric patients. J Vasc Surg 2001; 34(6):1071-8.
  • Liu Q, Yan CW, Zhao SH, Jiang SL, Xu ZY, Huang LJ, et al. Throm- bolytic therapy for femoral artery thrombosis after left cardiac cat- heterization in children. Chin Med J (Engl) 2009;122(8):931-4.
  • Monagle P, Chan A, Massicotte P, Chalmers E, Michelson AD. An- tithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):645S-687S.
  • Gürgey A. Çocuklarda Antitrombotik Tedavi. Türk Hematoloji Derneği-Temel Hemostaz Kursu 2007;85-9.
  • Bergersen L, Marshall A, Gauvreau K, Beekman R, Hirsch R, Fo- erster S, et al. Adverse event rates in congenital cardiac cathete- rization - a multi-center experience. Catheter Cardiovasc Interv 2010;15(3):389-400.
  • Huang YC, Chang JS, Lai YC, Li PC. Importance of prevention and early intervention of adverse events in pediatric cardiac cathe- terization: a review of three years of experience. Pediatr Neonatol 2009;50(6):280-6.
  • Mehta R, Lee K, Chaturvedi R, Benson L. Complications of pedi- atric cardiac catheterization: A review in the current era. Catheter Cardiovasc Interv 2008;72(2):278–85.
  • Küçükarslan N, Öz BS, Özal E, Yıldırım V, Okutan V, Tutar H. Pediyatrik Yaş Grubunda Uygulanan Kardiyak Kateterizasyonun Vasküler Komplikasyonları ve Morbidite Üzerine Etkisi. Damar Cer Derg 2004;13(1):5-10.
  • Stambouly JJ, McLaughlin LL, Mandel FS, Boxer RA. Complica- tions of care in a pediatric intensive care unit: a prospective study. Intensive Care Med 1996;22(10):1098-104.
  • Brus F, Witsenburg M, Hofhuis WJ, Hazelzet JA, Hess J. Strepto- kinase treatment for femoral artery thrombosis after arterial cardiac catheterisation in infants and children. Br Heart J 1990;63(5):291- 4.
  • Albisetti M, Schmugge M, Haas R, Eckhardt BP, Bauersfeld U, Baenziger O, et al. Arterial thromboembolic complications in criti- cally ill children. J Crit Care 2005;20(3):296-300.
  • Alonso M, Tascon J, Hernandez F, Andreu J, Albarran A, Velaz- quez MT. Complications with Femoral Access in Cardiac Cathe- tization. Impact of Previous Sytematic Femoral Anjiography and Hemostasis with Vasoseal-Es Collagen Plug. Rev Esp Cardiol 2003;56(6):569-77.
  • Tavris DR, Dey S, Albrecht-Gallauresi B, Brindis RG, Shaw R, Weintraub W, et al. Risk of local adverse events following cardiac catheterization by hemostasis devive use-phase II. J Invasive Car- diol 2005;17(9):644-50.
  • Tavris DR, Gallauresi BA, Dey S, Brindis R, Mitchel K. Risk of local adverse events by gender following cardiac catheterization. Pharmacoepidemiol Drug Saf 2007;16(2):125-31.
  • Gwon HC, Doh JH, Choi JH, Lee SH, Hong KP, Park JE, et al. A 5Fr catheter approach reduces patient discomfort during transradial coronory intervention compared with a 6Fr approach: a prostective randomized study. J Invasive Cardiol 2006;19(2):141-7.
  • Akalın F, Ayabakan C. Kateterizasyon Komplikasyonları. Çeliker A, editör. Konjenital Kalp Hastalıklarında Girişimsel Tanı ve Teda- vi. 1. Baskı. Ankara: Hacettepe Üniversitesi Hastaneleri Basımevi. Erkem Tıbbi Yayıncılık, 2008:302-18.
  • Bulbul ZR, Galal MO, Mahmoud E, Narden B, Solymar L, Chaud- hary MA, et al. Arterial complications following cardiac cathete- rization in children less than 10 kg. Asian Cardiovasc Thorac Ann 2002;10(2):129-32.
  • Fruhwirth J, Pascher O, Hauser H, Aman W. Local vascular comp- lications after iatrogenic femoral artery pucture. Wien Klin Woc- henschr 1996;108(7):196-200.
  • Berge PG, Winter UJ, Hoffmann M, Albrecht D, Hoop HW, Hilger HH. Local vascular complications in heart catheter studies. Z Kar- diol 1993;82(7):449-56.
  • Zenz W, Muntean W, Beitzke A, Zobel G, Riccabona M, Gamills- cheg A. Tissue plasminogen activator (alteplase) treatment for fe- moral artery thrombosis after cardiac catheterisation in infants and children. Br Heart J 1993;70(4):382-5.
  • Aspalter M, Domenig CM, Haumer M, Kitzmüller E, Kretschmer G, Hölzenbein TJ. Management of iatrogenic common femoral ar- tery injuries in pediatric patients using primary vein patch angiop- lasty. J Pediatr Surg 2007;42(11):1898-902.
  • Vila-Herrero E, Padilla-Parrado F, Vega-Pérez J, García-Casares N, Heras-Pérez JA, Romero-Acebal M. Moya-moya syndrome and arterial dysplasia associated to Down syndrome. Rev Neurol 2004;39(10):943-5.
  • Celkan T, Özkan A, Apak H, Kuruoglu S, Yüksel L, Yıldız İ. Inc- reased factor VIII activity and dural sinus thrombosis. Medical and Pediatric Oncology 2002;39(1):70-2.
  • Mulder R, van Schouwenburg IM, Mahmoodi BK, Veeger NJ, Mul- der AB, Middeldorp S, et al. Associations between high factor VIII and low free protein S levels with traditional arterial thrombotic risk factors and their risk on arterial thrombosis: Results from a retros- pective family cohort study. Thromb Res 2010;126(4):249-54.
There are 25 citations in total.

Details

Other ID JA99FC76BS
Journal Section Research Article
Authors

Birsen Uçar This is me

Zübeyir Kılıç This is me

Zehra Karataş This is me

Publication Date December 1, 2012
Submission Date December 1, 2012
Published in Issue Year 2012 Volume: 6 Issue: 1

Cite

Vancouver Uçar B, Kılıç Z, Karataş Z. VASCULAR COMPLICATIONS BELONGING TO CATHETER INSERTION IN CHILDREN WHO UNDERWENT CARDIAC CATHETERIZATION. Türkiye Çocuk Hast Derg. 2012;6(1):23-30.


The publication language of Turkish Journal of Pediatric Disease is English.


Manuscripts submitted to the Turkish Journal of Pediatric Disease will go through a double-blind peer-review process. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in the field, in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent editor to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions. Articles accepted for publication in the Turkish Journal of Pediatrics are put in the order of publication, with at least 10 original articles in each issue, taking into account the acceptance dates. If the articles sent to the reviewers for evaluation are assessed as a senior for publication by the reviewers, the section editor and the editor considering all aspects (originality, high scientific quality and citation potential), it receives publication priority in addition to the articles assigned for the next issue.


The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. It also publishes editorial opinions, letters to the editor, reviews, case reports, book reviews, comments on previously published articles, meeting and conference proceedings, announcements, and biography. In addition to the field of child health and diseases, the journal also includes articles prepared in fields such as surgery, dentistry, public health, nutrition and dietetics, social services, human genetics, basic sciences, psychology, psychiatry, educational sciences, sociology and nursing, provided that they are related to this field. can be published.