How to Avoid and Manage Puncture Site Complications?.

Introduction: Recently percutaneous transluminal angioplasty (PTA) using catheter-based interventions has
become the first-line option in the treatment of lower limb ischemia as it improves all patients’ symptoms with a
relatively lower complication rate.
Aim of work: Evaluation of puncture site complications, their incidence, management & how to avoid it.
Results: This study was conducted on 163 patients with PAD, 99 (60.7%) males. Patients age ranged between
44 to 87 years with a median of 63 years, 8 (4.9%) patients were complaining of severe claudication, 31 (19%)
presented with ischemic rest pain, patients with minor & major tissue loss were 79 (48.4%) & 45 (27.6%)
respectively. Sixteen patients had puncture site complications; hematoma 11 (6.14%), pseudoaneurysm (PSA) 3
(1.6%), dissection 1 (0.56%) & 1 (0.56%) case with arteriovenous fistula. Patients ˃ 60 years & female gender
had a higher number of complications. Regarding puncture site complications management: 11 (68.75%) patients
were managed conservatively, 2 (12.5%) with U/S guided compression, 2 (12.5%) by open surgical repair and 1
(6.25%) patient with low-pressure balloon inflation for 5 minutes.
Conclusion: Puncture site complications could be avoided or reduced by risk assessment, meticulous puncture
technique, usage of Doppler ultrasound and proper compression. It could be managed by minimally invasive
procedures with good results, but surgery remains a role in difficult, resistant and complicated cases.