Angiogram complications: Difference between revisions

Revision as of 01:13, 21 March 2026

Background

Complications from diagnostic or interventional catheterization (cardiac or peripheral) via femoral, radial, or brachial access
Complication rate ~1-2% for diagnostic procedures, higher for interventional
Patients typically present to ED within hours to days after discharge from cath lab

Clinical Features

Access Site Complications

Hematoma: Most common; swelling, ecchymosis, tenderness at puncture site
Pseudoaneurysm: Pulsatile mass with bruit; risk of rupture or compression
Arteriovenous fistula: Continuous bruit (machinery murmur) over access site
Retroperitoneal hemorrhage: Abdominal pain, back/flank pain, hypotension, dropping hematocrit without visible bleeding — HIGH mortality if missed
Arterial thrombosis/occlusion: Cool, pale, pulseless limb distal to access site

Systemic Complications

Contrast-induced nephropathy: Rise in creatinine 24-72 hrs post-procedure
Cholesterol embolization (blue toe syndrome): Livedo reticularis, blue/purple toes, preserved pedal pulses
Stroke: From catheter-related thromboembolism
Stent thrombosis: Chest pain, ST changes after recent PCI (especially if antiplatelet therapy was interrupted)
Allergic/anaphylactoid reaction: To contrast dye (usually during procedure)
Cardiac tamponade: From coronary perforation (rare)

Differential Diagnosis

Hematoma (visual exam)
Arteriovenous fistula (bruit)
Retroperitoneal hemorrhage
Acute kidney injury (creatinine)
Vascular injury
Cholesterol embolization

Evaluation

Focused exam of access site: inspect, palpate, auscultate for bruit
Distal pulses and neurovascular exam of affected limb
Labs: CBC, BMP (creatinine), coagulation studies
CT abdomen/pelvis with contrast if retroperitoneal hemorrhage suspected
Duplex US of access site for suspected pseudoaneurysm or AV fistula
ECG if chest pain or concern for stent thrombosis

Management

Hematoma: Direct pressure, reverse anticoagulation if expanding
Pseudoaneurysm: US-guided thrombin injection or compression; surgery if failed
Retroperitoneal hemorrhage: Aggressive fluid resuscitation, blood products, reverse anticoagulation, emergent IR or surgery consult
Arterial occlusion: Emergent vascular surgery consult, heparin if no contraindication
Stent thrombosis: Emergent cardiology consult for repeat catheterization
Hold anticoagulation decisions in consultation with interventional cardiology

Disposition

Admit expanding hematomas, retroperitoneal hemorrhage, acute limb ischemia, stent thrombosis
Small stable hematomas may be observed and discharged with close follow-up

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+*Complications from diagnostic or interventional catheterization (cardiac or peripheral) via femoral, radial, or brachial access
+*Complication rate ~1-2% for diagnostic procedures, higher for interventional
+*Patients typically present to ED within hours to days after discharge from cath lab
 ==Clinical Features==
+===Access Site Complications===
+*'''Hematoma:''' Most common; swelling, ecchymosis, tenderness at puncture site
+*'''Pseudoaneurysm:''' Pulsatile mass with bruit; risk of rupture or compression
+*'''Arteriovenous fistula:''' Continuous bruit (''machinery murmur'') over access site
+*'''Retroperitoneal hemorrhage:''' [[Abdominal pain]], back/flank pain, [[hypotension]], dropping hematocrit without visible bleeding — HIGH mortality if missed
+*'''Arterial thrombosis/occlusion:''' Cool, pale, pulseless limb distal to access site
+===Systemic Complications===
+*'''[[Contrast-induced nephropathy]]:''' Rise in creatinine 24-72 hrs post-procedure
+*'''Cholesterol embolization (''blue toe syndrome''):''' Livedo reticularis, blue/purple toes, preserved pedal pulses
+*'''[[Stroke]]:''' From catheter-related thromboembolism
+*'''[[Acute coronary syndrome (main)|Stent thrombosis]]:''' Chest pain, ST changes after recent PCI (especially if antiplatelet therapy was interrupted)
+*'''Allergic/anaphylactoid reaction:''' To contrast dye (usually during procedure)
+*'''[[Cardiac tamponade]]:''' From coronary perforation (rare)
 ==Differential Diagnosis==
@@ Line 7: / Line 24: @@
 *Arteriovenous fistula (bruit)
 *[[Retroperitoneal hemorrhage]]
-*[[Acute Renal Failure]] (creatinine)
+*[[Acute kidney injury]] (creatinine)
 *[[Vascular injury]]
+*[[Cholesterol embolization]]
 ==Evaluation==
+*Focused exam of access site: inspect, palpate, auscultate for bruit
+*Distal pulses and neurovascular exam of affected limb
+*Labs: CBC, BMP (creatinine), coagulation studies
+*CT abdomen/pelvis with contrast if retroperitoneal hemorrhage suspected
+*Duplex US of access site for suspected pseudoaneurysm or AV fistula
+*[[ECG]] if chest pain or concern for stent thrombosis
 ==Management==
+*'''Hematoma:''' Direct pressure, reverse anticoagulation if expanding
+*'''Pseudoaneurysm:''' US-guided thrombin injection or compression; surgery if failed
+*'''Retroperitoneal hemorrhage:''' Aggressive fluid resuscitation, blood products, reverse anticoagulation, emergent IR or surgery consult
+*'''Arterial occlusion:''' Emergent vascular surgery consult, heparin if no contraindication
+*'''Stent thrombosis:''' Emergent cardiology consult for repeat catheterization
+*Hold anticoagulation decisions in consultation with interventional cardiology
+==Disposition==
+*Admit expanding hematomas, retroperitoneal hemorrhage, acute limb ischemia, stent thrombosis
+*Small stable hematomas may be observed and discharged with close follow-up
 ==See Also==
-*[[Acute Arterial Occlusion]]
+*[[Acute arterial occlusion]]
 *[[Vascular injury]]
+*[[Retroperitoneal hemorrhage]]
+*[[Contrast-induced nephropathy]]
+==References==
+<references/>
 [[Category:Cardiology]]
-[[Category:Vascular]]
+[[Category:Procedures]]