|Year : 2015 | Volume
| Issue : 4 | Page : 118-119
Deep Vein Thrombosis after Coronary Angiography
Vivek Singh Guleria1, Mukesh Dhillon1, Tanuja Rana2, AK Sood1
1 Medical Specialist, Department of Medicine, Military Hospital, Palampur, Himachal Pradesh, India
2 CSIR Palampur, Kangra, Himachal Pradesh, India
|Date of Web Publication||21-Dec-2015|
Vivek Singh Guleria
Medical Specialist Military Hospital Palampur, Kangra, Himachal Pradesh - 176 061
Source of Support: None, Conflict of Interest: None
Deep vein thrombosis (DVT) is a rare but potentially serious complication of coronary angiography (CAG), incidence being just 0.05%. Only a few clinical cases of DVT after diagnostic transfemoral catheterization have been reported. Here, we describe the case of a 54-year-old woman who developed significant DVT after CAG without venous thromboembolism (VTE) and, which was treated with anticoagulants.
Keywords: Angiography, anticoagulants, DVT
|How to cite this article:|
Guleria VS, Dhillon M, Rana T, Sood A K. Deep Vein Thrombosis after Coronary Angiography. Heart India 2015;3:118-9
| Introduction|| |
Coronary interventions are associated with various complications, deep vein thrombosis (DVT) being one of them. Incidence of DVT after coronary artery bypass grafting is 17.4% and only 0.05% in femoral catheterizations for cardiac diagnostic and therapeutic interventions. In the latter group, etiology of DVT is attributed to venous compression; with an enlarging hematoma, mechanical groin compression, or prolonged procedures. We describe the case of a 54-year-old woman who developed significant DVT after CAG.
| Case Report|| |
A 54-year-old hypertensive lady had inferior wall ST elevated myocardial infarction in 2010. Coronary angiography (CAG) revealed a 95% stenosis of right coronary artery. During the same session, adrug-eluting stent was placed in right coronary artery and she was under regular medical follow-up for last 3 years. Since January 2013 she started having progressive dyspnea on exertion. Repeat transfemoral CAG was done on 13 April 2013, which did not reveal any fresh lesions. The whole procedure was uneventful. Hemostasis was achieved by manual pressure bandage which was removed after 4 h. The patient was discharged 24 h after the procedure. On 20 April 2013, patient presented with gradually increasing swelling and pain right lower limb. The swelling had progressed to right thigh within 48 h. On examination, pulse was 62/min, blood pressure 158/106 mmHg, afebrile, and there was no lymphadenopathy. Entire right lower limb was swollen (right calf circumference - 32 cm and left calfcircumference- 29.5 cm) with shiny red skin and raised local temperature [Figure 1]. Other systemic examination was normal.
Investigations revealed microcytic hypochromic anemia and raised D-dimer level [Table 1]. Computed tomography (CT) venography revealed venous thrombosis of right external iliac, common femoral, and proximal superficial femoral vein with short segment partial thrombosis in distal superficial vein [Figure 2]. Multiple superficial collaterals were seen in right leg. Patient was diagnosed as a case of iatrogenic proximal DVT and started on heparin and oral anticoagulants (OAC). Heparin was eventually stopped and presently the patient is on 5 mg of warfarin. Swelling has reduced and plan is to continue OAC for 3 months.
|Figure 2: CT venography showing filling defect in right femoral vein. CT = Computed tomography|
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| Discussion|| |
Peripheral vascular complications after femoral artery catheterization include access site hematoma, pseudoaneurysm, arteriovenous fistula, arterial dissection, retroperitoneal hematoma, and rarely DVT. A recent retrospective review of all vascular complications after femoral artery catheterization gave the incidence of DVT as 0.05% (five cases among 10,450 cardiac diagnostic or therapeutic catheterizations).  The rate of DVT is relatively high after CABG (17.4%). 
Following angiography, hemostasis is usually achieved by manual or mechanical compression of the puncture site, followed by a period of bed rest in supine and upright positions. However, this period varies widely between institutions, and can be as much as 24 h.  Superiority of manual and mechanical compression device is debatable. Gall et al.,  concluded that early mobilization at 90 min was safe for patients undergoing elective CAG performed via the right femoral artery, with mechanical compression using the 'Femostop' device (RADI Medical Systems AB Uppsala, Sweden). Eggeling et al.,  studied 500 consecutive patients undergoing diagnostic CAG for vascular complications using either a conventional or a special mechanical device for compression dressing. Eight patients developed a DVT after mechanical device pressure dressing compared to only one in the conventional dressing group. Five patients, with mechanical device dressing, suffered from clinical apparent pulmonary embolism.
In this case, we believe, leg vein thrombosis was due to excessive compression of the groin and subsequent immobilization. There is a in most cases without clinically significant symptoms.
A period of immobility following a shorter period of groin compression of indefinite pressure is always a risk for DVT. 
In recent years, the radial artery has become the preferred access site for coronary procedures, because reported complications are negligible, mobilization times are reduced, and patients prefer it.
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[Figure 1], [Figure 2]