Iatrogene Verletzungen an den Zugangsgefäßen für intravaskuläre Prozeduren: Ursachen, Therapie und Prävention

Background: Vascular access is used for many diagnostic and therapeutic procedures. During and after the interventions, considerable complications may occur. Objectives: In this paper, typical complications after percutaneous access are described. The causes, therapeutic options, and ways to prevent such courses are depicted. Materials and methods: Cases from our own clinical practice are used to summarize the typical pitfalls of vascular access and are discussed based on the current literature. Results: The vessel used by most disciplines to gain arterial access is the common femoral artery. Cardiologists also use the ulnar and radial artery. Besides the correct technique to puncture the vessel, management after deployment of the sheath is of crucial importance. Implantation of catheters (central venous catheter, dialysis catheter, invasive blood pressure monitoring) may also result in vessel injury. As complications, mainly bleedings, false aneurysms, AV fistulas, and vessel occlusions can occur. The latter three are seen more frequently after low puncture of the femoral artery. A high puncture results in an increased risk for retroperitoneal bleeding. The risk of a complication increases considerably in percutaneous procedures with large diameters (aortic stent grafts, TAVI). Vascular closure devices do not reduce the probability of a vascular complication compared to manual compression. For diagnosis, color-coded duplex Doppler ultrasound and CT angiography are of most importance. The therapeutic options comprise the whole spectrum of vascular intervention and surgical techniques. Conclusions: Complications in vascular puncture are to some extent avoidable. An exact preinterventional strategy and correct puncture technique help to reduce vascular lesions. Open surgical revision in case of bleedings may result in long procedures, so minimally invasive options should be preferred.