Distal Vessel Injury and Hematoma Formation in ADR Strategies: An Angiographic Observational Study

Abstract

Abstract

Objective: To evaluate the impact of distal vessel injury and hematoma formation on the procedural success of Antegrade Dissection and Re-Entry (ADR) strategies in chronic total occlusion (CTO) interventions, with a focus on advanced angiographic imaging techniques.

Methodology: A retrospective observational study was conducted at the Department of Cardiology, Hayatabad Medical Complex, Peshawar, from June 2024 to December 2024. A total of 150 patients were included, with a sample size determined using the WHO sample size calculation. Data was collected on distal vessel injury, hematoma formation, and procedural success, along with patient demographics and risk factors. Statistical analysis was performed using descriptive statistics, Chi-square tests, T-tests, and logistic regression with p-values set at <0.05.

Results: Among 150 patients, 120 (80%) had successful procedural outcomes, with 30 (20%) experiencing complications. The success rate for patients with distal vessel injury was 70% (p = 0.002), while those with hematoma formation had a success rate of 72.5% (p = 0.03). Angiographic assessments showed 45% had subintimal hematomas, and a significant association was found between distal vessel injury and hematoma formation (p = 0.01). Follow-up revealed a 6% recurrence rate for patients without complications and an 18% recurrence rate for those with complications (p = 0.04).

Conclusion: Distal vessel injury and hematoma formation significantly impact ADR procedural success. Advanced angiographic imaging plays a crucial role in minimizing complications and improving outcomes. Future studies should explore better management strategies for these complications.