This case involves a 45-year-old male with no significant past medical history who presented to the hospital complaining of rectal bleeding for the first time. The patient was prepped and sent for a colonoscopy, which revealed colitis in the rectum and sigmoid colon with internal hemorrhoids. The patient complained of chest pain following the procedure and was found to have an ST-elevated MI. He was given sublingual nitroglycerin in the recovery room and was then emergently taken to the cardiac catheterization lab. The catheterization lab flow sheet indicated he was alert and responsive at 12:18, but went into V-Fib arrest at 12:25. In the lab, the patient was found to have a 100% stenosis of the left main artery with a large filling defect consistent with thrombus formation. During the procedure, the patient went into cardiogenic shock and required vasopressor support. A percutaneous external heart assist device was unsuccessfully advanced through the left femoral artery, into the left ventricle. Shortly after the procedure, it was recognized that the patient’s left femoral artery had been perforated. The patient was rushed back in for an emergent repair procedure that was tolerated well. Over the next week he was noted to be responsive and follow commands but he became profoundly septic and died within one month of admission.
Question(s) For Expert Witness
1. Is this a known complication of the procedure?
Expert Witness Response E-005014
These are obviously extreme complications in what seems like a desperately sick patient who was probably in acute and chronic cardiogenic shock for some time. Many if not all of the attempted arterial punctures and subsequent vessel tears are known complications but are exceedingly rare. This does not preclude the fact that in spite of these issues, a well trained interventional cardiologist might have been able to avoid some or all of these complications.
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