Zahn R, Fromm E, Thoma S, Lotter R, Zander M, Wagner S, Seidl K, Senges J
Department of Cardiology, Herzzentrum Ludwigshafen, Germany.
Angiology. 1997 Jan;48(1):1-7. doi: 10.1177/000331979704800101.
Pulmonary embolism is a rare but life-threatening complication of cardiac catheterization. Underlying deep venous thrombosis (DVT) is often not detectable clinically. To determine the true incidence of DVT the authors prospectively studied 450 consecutive patients (29% women, 71% men, mean age: fifty-eight years) undergoing a diagnostic cardiac catheterization. Patients were examined clinically and by duplex sonography with a high-resolution (5 or 7.5 MHz) transducer before and twenty-four hours after catheterization before mobilization. Duplex sonography excluded complete proximal DVT in all patients. Only partial occluding thrombi (pDVT) were detected in 11 (2.4%) patients. The thrombi were always localized at the puncture site. In 2 patients a difference was found in the circumferences of the legs, but no other clinical signs of DVT were seen. With use of continuous wave (cw) Doppler sonography, only 3 of these 11 patients (27%) showed a spontaneous (s) sound. Phlebography was performed in 4/11 patients (36%). In 2 patients the diagnosis was confirmed; in 1 patient extravenous compression was assumed, and the other demonstrated a normal-appearing phlebography at the time of investigation. Logistic regression analysis yielded a 3.5 times higher risk for developing a pDVT if a venous puncture was performed in addition to arterial puncture. Furthermore a 9.8 times higher risk was found if more than one venous puncture was necessary. During the follow-up no patient developed clinical signs of pulmonary embolism. The results of this study demonstrate that DVT is a rare complication of cardiac catheterization (0/450 patients), but pDVT occurred in 2.4%. Risk factors for pDVT are the venous puncture itself and multiple puncture attempts. Clinical relevance of pDVT remains to be determined.
肺栓塞是心导管检查中一种罕见但危及生命的并发症。潜在的深静脉血栓形成（DVT）在临床上通常无法检测到。为了确定DVT的真实发生率，作者对450例连续接受诊断性心导管检查的患者（29%为女性，71%为男性，平均年龄：58岁）进行了前瞻性研究。在导管插入术前和术后24小时且患者活动前，对患者进行临床检查并使用高分辨率（5或7.5兆赫）探头进行双功超声检查。双功超声检查排除了所有患者的近端完全性DVT。仅在11例（2.4%）患者中检测到部分阻塞性血栓（pDVT）。血栓总是位于穿刺部位。2例患者双下肢周长存在差异，但未发现其他DVT的临床体征。使用连续波（cw）多普勒超声检查时，这11例患者中只有3例（27%）出现自发性（s）声音。11例患者中有4例（36%）进行了静脉造影。2例患者确诊；1例患者考虑为静脉外压迫，另1例在检查时静脉造影显示正常。逻辑回归分析显示，如果除了动脉穿刺外还进行静脉穿刺，发生pDVT的风险高3.5倍。此外，如果需要进行不止一次静脉穿刺，风险则高9.8倍。在随访期间，没有患者出现肺栓塞的临床体征。本研究结果表明，DVT是心导管检查的一种罕见并发症（450例患者中0例），但pDVT的发生率为2.4%。pDVT的危险因素是静脉穿刺本身和多次穿刺尝试。pDVT的临床相关性仍有待确定。
