0930_Gujja.pdf

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1、Complications TIMEDont Panic!Management of Complications:Retroperitoneal Bleeds,Perforations and Vessel ClosureKarthik Gujja,MD,MPH,RPVIDirector for Endovascular Services,Mount Sinai South Nassau Medical CenterDirector of Cardiac and Endovascular ServicesOutpatient Interventional SuitesLong Island H

2、eart and Vascular SpecialistEmpire City Heart and Vascular SpecialistsCase 1:Retroperitoneal Bleeding6 Fr IMACoilsRetroperitoneal Hematoma Incidence 3.0%.Avoid“high”CFA arterial puncture.Front-wall puncture desirable.Suspect when:Blood loss,hypovolemia,hypotension.Supra-inguinal fullness,tenderness.

3、Flank pain.Retroperitoneal Hematoma If suspicion is high,and blood loss significant,treat before a definitive diagnosis is made.Discontinue/reverse anticoagulation.Ballon Tamponade and CoilingCT ScanSurgical RepairContralateral AccessBalloon TamponadeHYPOTENSION POST-CATHDifferential DiagnosisCase 2

4、:Resident on Call SHEATH EMBOLISMPOPLITEALFINALIschemia/Thrombosis/Emboli Incidence 1.0%.Risk factors:Large access catheter/small artery.Presence of peripheral arterial disease.Iatrogenic dissection.Thrombus within sheath.Ischemia/Thrombosis/Emboli Signs and symptoms:Pain Pallor Paresthesia Pulseles

5、s Polar(cold).Ischemia/Thrombosis/Emboli Contralateral access and angiography.Selective lysis below access site.Mechanical thrombectomy.Suction thrombectomy.Long day of work Load and this shows up 65yo with RLE progressive claudicationCTA showed Right common and external occlusion with reconstitutio

6、n just above common femoral artery.During the caseVery smooth case so far(first concern)CTO crossing was successfulPre-balloon the tractI placed a Bare Metal StentThen Patient became very uncomfortablePain increasingPressure slowly droppingTachycardia increasingFor me and the patient Learning lesson