Catheterizations

[Lourdes__0]

  I posted a question about catheterizations and the risks of developing artery blockages later (from the catheter irritating the lining of the aorta where the catheter goes into the heart) The doctor that answered my post said he wasn't sure what I meant by "bruising" of the artery during a cath. To clarify...the Yale University School of Medicine Heartbook lists as one of the risks or complications of cardiac catheterization as "bruising or damage to the artery in which the catheter is inserted" and my concern was the risk of developing a blockage to my artery because of this. I did not have angioplasty and I know that sometimes people develop blockages from having angioplasty. Could you explain to me the risks of developing a blockage after just a catheterization versus the risks after angioplasty? Am I at risk for a blockage if my artery was "bruised" or irritated by the catheter? I'm concerned because during the procedure I felt pain just before my cardiologist removed the catheter and I'm afraid that was the "bruising" How can I tell if this has happened to me?

[CCF CARDIO MD APS]

_
Dear Lourdes,
Firstly, let me clarify that during a catheterization one accesses the aorta via one of its
main branches, usually the femoral artery in the leg or the brachial artery in the arm.  In
other words this is the artery that the needle goes in to in order to introduce the access
catheter that stays in the artery until the case is completed (the needle comes out almost
immediately, it only sits inside the artery for a few seconds.  Now the point you are making
and the concerns you have all relate to the potential damage related to the access catheter,
the one that stays in for the entire procedure.  Just for further clarification, the much
smaller and longer catheters that are used to inject contrast in the arteries are introduced
via the access catheter in to the aorta and up to the heart, in contrast the access catheter
does not reach the aorta.  
Now I will talk of the potential side effects of having that access catheter in your femoral
artery.  The size (bore or what doctors call french size) of the access catheter is important
as the larger the size, the greater the risk to the artery ( angioplasty requires much larger
bore access catheters than just an angioplasty, thus the greater risk in those undergoing
angioplasty.)  Technique and the amount of scar tissue effect the difficulty in placing an
access catheter, for instance it is often more difficult to stick the femoral artery in just
the right place in those with multiple prior caths that usually produces a lot of scar.  This
could mean that the artery is actually punctured but the access catheter will not go in and
unfortunately that means the cardiologist has to start all over, and repunture the artery in another spot.
Although difficult access it usually not a problem, it will cause more temporary damage to
the artery than not.  The hole that is created by the access catheter is sealed off by your
own wound healing mechanisms but since the artery has a pressure head behind it, the nurses,
technicians, and doctors must in some way aid the  artery in its healing so that the pressure
does not continually dislodge your body's own clot and thereby cause continual bleeding.  As
the artery is healing (usually there is a device and or manual pressure held during this time)
there is an unavoidable leakage of some blood from the artery and this can cause bruising to appear
on the leg and groin area. Because the artery has nerves in its wall, and the femoral artery
runs just alongside the femoral artery, it is not surprising that you felt some pain at the
end of the case as this catheter came out(usually the numbing medicine has worn off by this
time.)  Signs that there has been actual damage (unlikely) to the artery where the catheter
was placed would be persistent pain in the groin and or leg, peristent bulge or hematoma/mass
palpated in the groin, and pain in the same leg with walking that goes away with rest.  
It is very unlikely that the catheter would cause any type of blockage of the artery, however
if the patient has some atherosclerotic plaque in that femoral artery the catheter can
exacerbate the prior existing blockage cause by that plaque.  It is in your best interest to
speak with a vascular medicine physician and or your cardiologist if you have experienced any
of the above mentioned problems and or you have persistent problems with the leg since the
catheterization.  As for the next time you get a catheterization (should you ever need one)
inquire as to all the risks including those to the artery that is accessed and make sure you
understand them before undergoing the procedure even though it is widely known that the risks
to the femoral artery are small (unlikely).  As for the bruising of the aorta itself
by the smaller catheters that travel through the aorta on their way to the heart
there is no clinical evidence of their bruising the aortic wall, usually they are
guided up the aorta via a floppy type wire that is literally ahead of the catheter
until they reach the coronary arteries.  Good Luck.
Information provided in the heart forum is intended for general informational purposes only,
actual diagnosis and treatment can only be made by your physician(s).

[theblind1]

A related discussion, Life After Angioplasty was started.