Patient-Related Complications

3.1 General Complications Related to Endovascular Procedures

3.2 Management of Vascular Complications

Major periprocedural complications are uncommon in interventions, but they may manifest suddenly and require swift and orderly response. Although the experience of the surgeon, nursing, and technical staff is important, the relative rarity of serious events makes the use of a checklist a valuable practice, helping to ensure organized implementation of a preplanned response.

“Planning for failure” is a strategy used by effective teams that perform procedures with significant risks. Patel et al (2012) report improved endovascular outcomes with a preprocedural “mental rehearsal” in hybrid aortic cases.6 In 2013, Chen developed a checklist for response to a cerebral artery aneurysm perforation and a separate checklist for thrombosis in neurosurgical interventions.⁷ These listed expected responses from the surgeon, anesthesiologist, nursing and technologist staff, each with specific roles and responsibilities.

In the case of thrombosis, the interventionist should record the activated clotting time (ACT) and request an empiric bolus of heparin based on the patient’s weight and predetermined dose. If vasospasm is detected at the site of the sheath, intra-arterial nitroglycerin should be given. Nursing staffshould administer fluids, and the technologist should prepare aspiration or thrombolysis devices.

For bleeding complications, the interventionist should clearly communicate details of the complication to the staffand his or her plans for correction. Serious bleeding from a superficial femoral artery (SFA) intervention is rare, but a high femoral artery puncture or concomitant iliac artery intervention can lead to rapid blood loss into the pelvis. A retroperitoneal hemorrhage can quickly result in shock. Clearly and succinctly articulating the problem and the anticipated next steps is critical, and it is important to verbally confirm that team members have heard and understood what was said.

Arterial access should be maintained. Required equipment, such as a covered stent, tourniquet, or occlusion balloon should be requested. The nurse should maintain fluids and blood products as necessary and request an anesthesiologist to assist if the patient is in extremis. The technologist should alert the operating room staff of the potential need for open conversion, and the operating room should be prepared if endovascular solutions are limited or if there is hemodynamic instability.