Presentazione di PowerPoint

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SIMPLE AND EFFECTIVE TREATMENT OF ULNAR ARTERY
RUPTURE DURING PCI
Dr. Christian PristipinoCoronary Intervention
UnitSan Filippo Neri HospitalRome, Italy
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CLINICAL FEATURES

• 61 years old man
• Family history of coronary artery disease
• Type IIb Dyslipidemia
• Hospitalisation for troponin negative unstable
  angina with transient ST segment downsloping in
  V4-V6, D1 aVL resolved with i.v. nitrates
• 6 days later coronary angiography

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TECHNICAL DETAILS

• Left transulnar approach with 6 Fr radial sheath
  (Cordis)
• Diagnostic angiography performed with 4 Fr.
  Terumo diagnostic catheters without complications
  which showed a critical stenosis on mid LAD and
  LCx
• While passing 6 Fr. XB 3.5 Cordis guiding
  catheter over a 0,35 diagnostic wire, patient
  complained of acute pain located at the forearm
  and progression of the guiding cather became
  impossible
• Ulnar angiography performed through the arterial
  sheath showed the arterial rupture with large
  dye extravasation. A complete resolution of the
  rupture was obtained with a single 15 min.
  compression with sphygmomanometer cuff inflated
  at a level not impairing distal pulse
• The procedure was completed by right transulnar
  PCI on LAD and LCx

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ULNAR RUPTURE
Left omeral artery
Left radial artery
Dye effusion
Wired left ulnar artery
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CUFF INFLATION
Compression area
Sphygmomanometer cuff
Reduced effusion
left ulnar artery
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CONTROL ANGIOGRAPHY
Left omeral artery
Left radial artery
Left ulnar artery
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FINAL REMARKS

• Transradial access for PCI demonstrated several
  advantages over femoral approach, however ulnar
  access may be preferred in patients eligible for
  cardiac surgery with use of radial harvesting or
  when radial artery is smaller than ulnar.
• Although severe peripheral complications such as
  rupture may occur with ulnar and radial access,
  the forearm anatomy allow their simple, fast and
  effective treatment in cath lab preventing
  peripheral compartment syndromes and avoiding
  surgery
• The easy management of potentially serious
  complications underscores the advantages of
  forearms arteries access for PCI