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femoral artery may also occur. The
artery may occlude completely in
approximately 1 per cent of cases5. Over
the past decade, significant advances in
anticoagulant and antiplatelet therapies
have assisted in decreasing the
incidence of major cardiovascular events
but are associated with an increased risk
of bleeding1 thus potentially reversing
the trend of lower complication rates.
Heparin Induced Thrombocytopenia
(HIT) is a serious immune-mediated
complication of heparin administration
from flushing catheters with heparinised
saline. Although the risk will not be
manifest during the procedure, the
clinical symptoms that develop in the
days after the procedure can have
potentially devastating thromboembolic
complications in patients with prior
exposure to heparin1. Roughly 1-3
per cent of patients who receive
unfractionated heparin will develop
a serious form of immune mediated
thrombocytopenia with associated
venous and arterial thrombosis1.
Vascular closure devices (VCD) are now
in common use. The evidence regarding
their effectiveness is not consistent.
Applegate et al6 reported in a significant
decrease in vascular complications: for
diagnostic angiograms post-procedure
bleeds decreased from 1.7 to 0.2 per
cent, and after PCI from 3.1 to 1.0 per
cent, respectively6. Schwartz found that
manual compression remains the ‘gold
standard’ for achieving haemostasis
at the puncture site7. In the absence
of specific puncture site-related risk
factors, the use of VCDs does not seem
to affect complication rates. Of concern,
Schwartz’ study found that VCD use
increased the risk of leg ischemia, groin
infection, and complications requiring
surgical repair, which are rare with
manual compression6. The safety of VCD
use remains unclear 7.
Angiography is a relatively safe
procedure with few complications.
Although advances in medical
management and equipment design
are associated with a significant
reduction in the already low incidence
of complications, operator awareness
and appropriateness of response
remain the most important predictors
of adverse outcomes1. With each
angiogram the potential benefit of the
procedure should be weighed against
the established risks given the well-
defined morbidity and mortality of the
procedure1. The guiding principle of
health care, ‘first do no harm’ (primum
non nocere), should apply to catheter-
guided treatment and investigations.
Anita Deakin, Australian Patient Safety
Foundation
Dr Catherine Mandel, Swinburne
University of Technology
References
1. Tavakol M, Ashraf, S., Brener, SJ. Risks and
Complications of Coronary Angiography: A
Comprehensive Review. Global Journal of
Health Science. 2012;4(1):65-93.
2. Dauerman HL, Rao, S.V., Resnic, F.S.,
Applegate, R.J. Bleeding Avoidance Strategies:
Consensus and Controversy. Journal of the
American College of Cardiology. 2011;58(1).
3. Yu JC, J. Anigiography - Consumer
Information 2013. Available from: http://www.
id=80&ref_info
4. Babu SC, Piccorelli, G. O., Shah, P. M., et al.
Incidence and results of arterial complications
among 16,350 patients undergoing cardiac
catheterization. Journal of Vascular Surgery.
1989;10(2):113-6.
5. Clark W, Lyon, S., Revell, A. & Russell, G.
Angioplasty and Stent Insertion - Consumer
Information 2015. Available from: http://www.
id=84
6. Applegate RJ, Sacrinty, M.T., Kutcher,
M.A., Kahl, F.R., Gandhi, S.K., Santos, R.M.,
Little, W.C. Trends in Vascular Complications
After Diagnostic Cardiac Catheterization
and Percutaneous Coronary Intervention
Via the Femoral Artery, 1998 to 2007. JACC
Cardiovascular Interventions. 2008;1(3):317-26.
7. Schwartz BG, Steven Burstein, S., Economides,
C., Kloner, R.A., Shavelle, D.M., Mayeda, G.S.
Review of Vascular Closure Devices 2011 [cited
19 7]. Available from:
com/articles/Review-Vascular-Closure-Devices.
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