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Li L, Xiu J, Yuan L, Zhang X, Li Y. Single ultrasound-guided local high-dose thrombin injection in the treatment of giant brachial artery pseudoaneurysm: A case report. Medicine (Baltimore) 2022; 101:e30103. [PMID: 35984187 PMCID: PMC9387992 DOI: 10.1097/md.0000000000030103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pseudoaneurysm (PSA) is a common complication related to vascular intervention, and surgical therapy is the primary method. However, a giant brachial artery PSA over 2 weeks is rarely observed. Due to the adhesion of surrounding tissue, thrombus organization, the extensive injury, and the high expense of transluminal stent-graft placement, a single ultrasound-guided local high-dose thrombin injection can be a therapy option. Such cases are rarely reported. PATIENT CONCERNS A 71-year-old man with a history of left elbow fossa interventional puncture presented to our hospital with a pulsatile mass in the left elbow fossa. He had a history of cerebral infarction 32 years prior without sequelae, emphysema for more than 2 years, hyperlipidemia for 3 months, and prostatic hyperplasia for 8 months. After conservative therapy, the lumbar compression fracture produced by trauma 24 years ago healed, and the intracranial hematoma induced by trauma ten years ago was absorbed. DIAGNOSIS Ultrasound examination showed giant mixed echoes on the posterior medial side of the left brachial artery. INTERVENTIONS The patient underwent a single ultrasound-guided local high-dose thrombin injection to treat giant brachial artery PSA. OUTCOMES Following therapy, the ultrasonography revealed that extensive thrombosis immediately formed in the cavity, and the internal blood flow signals had completely vanished. A week later, a physical examination showed that the PSA had shrunk with no apparent tenderness and that the texture had hardened. Pulsation and vascular murmurs disappeared. Ultrasound showed that the PSA was reduced, and no blood flow signals were found. LESSONS A single ultrasound-guided local high-dose thrombin injection had a considerable effect in curing large iatrogenic PSA. However, when deciding on the best therapy, specificity must be taken into account.
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Affiliation(s)
- Liang Li
- Department of Ultrasound, Guang’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Junqing Xiu
- Oncology Department, South area of Guang’anmen Hospital, Academy of Traditional Chinese Medicine, China
| | - Lian Yuan
- Surgery Department, Guang’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Xing Zhang
- Oncology Department, South area of Guang’anmen Hospital, Academy of Traditional Chinese Medicine, China
| | - Yue Li
- Oncology Department, South area of Guang’anmen Hospital, Academy of Traditional Chinese Medicine, China
- *Correspondence: Yue Li, Guang’anmen Hospital, China Academy of Traditional Chinese Medicine, No.5, Beixian Pavilion, Xicheng District, Beijing, China (e-mail: )
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Yen Min Madeline C, Pei Shi L, Lim D. Isolated Mycotic Internal Iliac Artery Aneurysm Treated With a Combined Endovascular Stenting and Percutaneous Drainage Approach: A Case Report and Review of Current Literature. Vasc Endovascular Surg 2022; 56:609-615. [DOI: 10.1177/15385744221095675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Isolated mycotic internal iliac artery aneurysms are rare and management of these patients can be complex. Case summary We present a rare case of isolated mycotic right internal iliac artery aneurysm caused by Salmonella enteritides. This was managed in stages – with intravenous antibiotics, followed by endovascular stenting and embolization, and subsequent percutaneous drainage of the remnant collection. The patient had no perioperative complications, and has remained well at more than 18 months post-operatively with no evidence of stent infection. Conclusion A minimally-invasive approach combining endovascular aneurysm repair and percutaneous drainage is a viable option in the management of a mycotic internal iliac artery aneurysm.
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Affiliation(s)
| | - Lew Pei Shi
- Department of Surgery, Changi General Hospital, Singapore, Singapore
| | - Darryl Lim
- Department of Surgery, Changi General Hospital, Singapore, Singapore
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Rodney SR, Anand V, Vishnu M, Raj S, Chaudhari H, S Sravan CP, Lende V, Davra D, Jain P, Vishal H, Krishna KS, Nishan B. Emergency endovascular management of ruptured mycotic aneurysm of the iliac artery using “bare stent-graft technique”. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_92_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Domanin M, Romagnoni G, Romagnoli S, Rolli A, Gabrielli L. Emergency Hybrid Approach to Ruptured Femoral Pseudoaneurysm in HIV-positive Intravenous Drug Abusers. Ann Vasc Surg 2016; 40:297.e5-297.e12. [PMID: 27908808 DOI: 10.1016/j.avsg.2016.07.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/06/2016] [Accepted: 07/30/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic traumatism of the common femoral artery due to intravenous injection in drug abusers, in association with local infections and arterial wall weakening caused by human immunodeficiency virus (HIV), can lead to the development of pseudoaneurysms (PSAs). Rupture of PSA is a dramatic event in such patients, and its correction is difficult and controversial. Most of the cases reported describe open surgical elective options, which consist in ligation, repair, or substitution of the damaged arterial segment, using when possible biological grafts. In literature, few cases describe an endovascular repair with covered stent deployment. METHODS We present 2 cases of HIV-positive intravenous injection in drug abusers who needed emergency treatment for active bleeding in ruptured PSA of the right common femoral artery. In both cases, under general anesthesia needed for lack of patient's compliance and unstable hemodynamics, a short dissection to the distal superficial femoral artery was required. RESULTS Then, maintaining a manual compression on the bleeding site to stop hemorrhage, we deployed a covered stent graft in the site of the arterial breakdown through a retrograde approach. CONCLUSIONS The favorable results and progressive healing of wound and local infections persuaded us not to perform any further surgical correction. The absence of recurrences and late complications, after 3 years in the first case and 1 year in the second one, lead us to consider this hybrid endovascular approach as a valuable alternative to open surgery in HIV intravenous injection in drug abuser patients, in particularly when emergency conditions occur.
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Affiliation(s)
- Maurizio Domanin
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy.
| | - Giovanni Romagnoni
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Silvia Romagnoli
- Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Antonio Rolli
- Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Livio Gabrielli
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
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Shahi N, Kwon JJ, Arosemena M, Salvatore DM, DiMuzio PJ, Abai B. Endovascular Repair of Ruptured Infected Arteries as a Temporizing Measure Versus Destination Therapy. Vasc Endovascular Surg 2016; 50:373-9. [DOI: 10.1177/1538574416655894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Mycotic rupture of the arteries is a rare but deadly disorder. Current management typically involves open surgical repair. However, endovascular repair is a potential treatment that can be used to delay open repair, especially in acutely unstable patients. A case report and review of the literature was conducted to determine whether endovascular therapy could be a destination therapy for patients with arterial rupture secondary to infection. Methods: We present the case of a 72-year-old man with a left common iliac artery aneurysm rupture secondary to Salmonella infection treated with endovascular therapy upon initial presentation. A literature review of PubMed yielded 29 patients with ruptured aortic and iliac infected aneurysms that were initially treated with endovascular repair. Results: Majority of the patients (76.7%, 23 of 30) were successfully treated with the endovascular treatment and did not require open revision. These patients were often placed on long-term antibiotics. Conclusion: The literature review supports endovascular repair with a stent graft as a temporizing measure for infected ruptured arteries in an emergent setting and, in select cases, as a destination therapy.
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Affiliation(s)
- Niti Shahi
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Jeontaik J. Kwon
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Mariano Arosemena
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Dawn M. Salvatore
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Paul J. DiMuzio
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Babak Abai
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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Karkos CD, Kalogirou TE, Giagtzidis IT, Papazoglou KO. Ruptured mycotic common femoral artery pseudoaneurysm: fatal pulmonary embolism after emergency stent-grafting in a drug abuser. Tex Heart Inst J 2014; 41:634-7. [PMID: 25593530 DOI: 10.14503/thij-13-3882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The rupture of a mycotic femoral artery pseudoaneurysm in an intravenous drug abuser is a limb- and life-threatening condition that necessitates emergency intervention. Emergency stent-grafting appears to be a viable, minimally invasive alternative, or a bridge, to subsequent open surgery. Caution is required in cases of suspected concomitant deep vein thrombosis in order to minimize the possibility of massive pulmonary embolism during stent-grafting, perhaps by omitting stent-graft postdilation or by inserting an inferior vena cava filter first. We describe the emergency endovascular management, in a 60-year-old male intravenous drug abuser, of a ruptured mycotic femoral artery pseudoaneurysm, which was complicated by a fatal pulmonary embolism.
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MESH Headings
- Aneurysm, False/diagnosis
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/microbiology
- Aneurysm, Ruptured/surgery
- Blood Vessel Prosthesis Implantation/adverse effects
- Drug Users
- Emergencies
- Endovascular Procedures/adverse effects
- Fatal Outcome
- Femoral Artery/diagnostic imaging
- Femoral Artery/microbiology
- Femoral Artery/surgery
- Humans
- Male
- Middle Aged
- Pulmonary Embolism/diagnosis
- Pulmonary Embolism/etiology
- Radiography, Interventional
- Substance Abuse, Intravenous/complications
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Stent-graft placement with early debridement and antibiotic treatment for femoral pseudoaneurysms in intravenous drug addicts. Cardiovasc Intervent Radiol 2014; 38:565-72. [PMID: 25288174 DOI: 10.1007/s00270-014-0994-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Explore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts. MATERIALS AND METHODS We evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013. RESULTS 15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication. CONCLUSIONS SG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.
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Uberoi R, Tsetis D, Shrivastava V, Morgan R, Belli AM. Standard of Practice for the Interventional Management of Isolated Iliac Artery Aneurysms. Cardiovasc Intervent Radiol 2010; 34:3-13. [PMID: 21161661 DOI: 10.1007/s00270-010-0055-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/15/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Raman Uberoi
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Emergency endovascular treatment of early spontaneous nonaneurysmal popliteal artery rupture in a patient with Salmonella bacteremia. J Vasc Surg 2010; 52:751-7. [DOI: 10.1016/j.jvs.2010.04.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 04/14/2010] [Accepted: 04/14/2010] [Indexed: 11/24/2022]
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Kan CD, Lee HL, Luo CY, Yang YJ. The Efficacy of Aortic Stent Grafts in the Management of Mycotic Abdominal Aortic Aneurysm—Institute Case Management with Systemic Literature Comparison. Ann Vasc Surg 2010; 24:433-40. [DOI: 10.1016/j.avsg.2009.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 07/06/2009] [Accepted: 08/23/2009] [Indexed: 02/07/2023]
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:66-73. [PMID: 19225308 DOI: 10.1097/moo.0b013e32832406ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lupattelli T, Garaci FG, Basile A, Minnella DP, Casini A, Clerissi J. Emergency stent grafting after unsuccessful surgical repair of a mycotic common femoral artery pseudoaneurysm in a drug abuser. Cardiovasc Intervent Radiol 2008; 32:347-51. [PMID: 18931876 DOI: 10.1007/s00270-008-9401-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 05/16/2008] [Accepted: 05/27/2008] [Indexed: 01/28/2023]
Abstract
Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.
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Affiliation(s)
- Tommaso Lupattelli
- Department of Interventional Radiology, Multimedica IRCCS, Sesto San Giovanni, Milan, Italy.
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Stent-Graft Treatment of Mycotic Aneurysms: A Review of the Current Literature. J Vasc Interv Radiol 2008; 19:S51-6. [DOI: 10.1016/j.jvir.2008.02.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 02/17/2008] [Accepted: 02/17/2008] [Indexed: 11/22/2022] Open
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