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Ma W, Fan Y, Li Y, Li Y, Jiang C. Treatment of Iatrogenic Femoral Arteriovenous Fistula by Balloon Tamponade Closure. J Vasc Interv Radiol 2024; 35:1086-1088. [PMID: 38508447 DOI: 10.1016/j.jvir.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Wei Ma
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China; Neurointerventional Medical Center of Inner Mongolia Medical University, Inner Mongolia, China; Neurological Diseases Clinical Medicine Research Center, Inner Mongolia, China
| | - Yu Fan
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China; Neurointerventional Medical Center of Inner Mongolia Medical University, Inner Mongolia, China; Neurological Diseases Clinical Medicine Research Center, Inner Mongolia, China
| | - Yuechun Li
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China; Neurointerventional Medical Center of Inner Mongolia Medical University, Inner Mongolia, China; Neurological Diseases Clinical Medicine Research Center, Inner Mongolia, China
| | - Yang Li
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China; Neurointerventional Medical Center of Inner Mongolia Medical University, Inner Mongolia, China; Neurological Diseases Clinical Medicine Research Center, Inner Mongolia, China
| | - Changchun Jiang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China; Neurointerventional Medical Center of Inner Mongolia Medical University, Inner Mongolia, China; Neurological Diseases Clinical Medicine Research Center, Inner Mongolia, China.
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Ok T, Seo KD, Lee IH. Fatal Femoral Pseudoaneurysm Rupture after Endovascular Intervention: A Case Report and Literature Review. Neurointervention 2024; 19:52-56. [PMID: 38303611 PMCID: PMC10910178 DOI: 10.5469/neuroint.2024.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
A rupture of a femoral pseudoaneurysm is an extremely rare complication of endovascular procedures, but its outcome can be life-threatening. In this report, we present a case of a femoral pseudoaneursym rupture in a patient in their early 90s following intra-arterial mechanical thrombectomy for acute ischemic stroke. Despite receiving medical and surgical interventions, the patient subsequently developed multiple organ failure, ultimately resulting in death. This case emphasizes the critical role of appropriate selection of vascular closure technique and careful post-procedural monitoring, particularly in high-risk patients.
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Affiliation(s)
- Taedong Ok
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwon-Duk Seo
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Il Hyung Lee
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Giurazza F, Ierardi A, Marra P, Lucatelli P, Corvino F, Pane F, Sironi S, Carrafiello G, Loffroy R, Niola R. Pseudoaneurysms embolization with glue via percutaneous direct puncture: a multicenter experience on 54 patients. CVIR Endovasc 2024; 7:11. [PMID: 38221592 PMCID: PMC10788324 DOI: 10.1186/s42155-024-00426-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND This retrospective multicentric study aims to report on technical safety and effectiveness of pseudoaneurysms embolization with glue (N-butyl cyanoacrylate) adopting a percutaneous direct puncture approach. RESULTS Fifty-four patients data were collected from five centers. All patients at the time of treatment presented with unruptured PAs and were hemodynamically stable. True aneurysms and lesions treated with embolics other than glue were excluded. Pseudoaneurysms diagnosis was based on CT and anamnestic data; initial investigation with digital-subtracted arteriography was acquired in all cases; then, percutaneous embolizations were performed in the angio-suite (ultrasound, fluoroscopy, ConeBeam CT guidance) or in CT. Technical success was considered as complete pseudoaneurysm embolization at final imaging with sole percutaneous strategy, without need for additional endovascular embolization. Clinical success was intended as pseudoaneurysm resolution within one week follow-up with stabilization or restored clinical conditions. Pseudoaneurysms origins were traumatic (57.4%), inflammatory (24.1%) or spontaneous (18.5%); 39 patients (72.2%) were symptomatic, presenting with pain and/or pulsatile mass. Mean lesions diameter was 19.3 mm (range: 7-30); pseudoaneurysms were located in abdomen (48.1%), limbs (42.6%) and thorax (9.3%). Coagulation function was impaired in 16.6% and 48.1% was under antiplatelets/anticoagulation therapy. In 16.6% the percutaneous approach followed previous treatments failure. The image-guidance modality for percutaneous puncture was most often ultrasound combined with fluoroscopy (38%). Clinical success was obtained in all patients while technical success occurred in 94.4% because 3 patients required an additional endovascular embolization. Complications were registered in 14.8%, all of low grade without clinical sequelae neither prolonged recovery (7 non target embolizations, 1 post-embolization syndrome). CONCLUSIONS In this study, pseudoaneurysms embolization with glue via percutaneous direct puncture was safe and effective with a low rate of minor complications.
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Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy.
| | - Annamaria Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, 20122, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano Bicocca, Piazza OMS 1, Bergamo, 24127, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Roma, 00161, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Francesco Pane
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano Bicocca, Piazza OMS 1, Bergamo, 24127, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, 20122, Italy
- Department of Health Sciences, Università degli Studi di Milano, Via F. Sforza 35, Milan, 20122, Italy
| | - Romaric Loffroy
- Image-Guided Therapy Center, ICMUB Laboratory, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, BP 77908, 14 Rue Paul Gaffarel, Dijon, 21079, France
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
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4
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Srivatsav A, Eilers L, Montero M, Stapleton G. Percutaneous treatment of an iatrogenic femoral arteriovenous fistula from an accessory arterial branch: a case report and review of the literature. Cardiol Young 2023; 33:2678-2680. [PMID: 37850452 DOI: 10.1017/s1047951123003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Vascular access-related complications are an important consideration in patients undergoing cardiac catheterisation. Patients with CHD are increasingly undergoing percutaneous treatment for suitable procedures as an alternative, less invasive option to surgical intervention. As such, recognition and treatment of these complications are becoming increasingly important. We present a case of a patient with repaired Tetralogy of Fallot who developed a femoral arteriovenous fistula and femoral artery pseudoaneurysm arising from an accessory arterial branch following percutaneous Harmony valve implantation, both of which were treated endovascularly with placement of a stent.
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Affiliation(s)
- Ashwin Srivatsav
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Lindsay Eilers
- Department of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Miguel Montero
- Department of Vascular Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Gary Stapleton
- Department of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
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Memarian S, Krokidis M, O'Sullivan G, Peynircioglu B, Rossi M, Kashef E. CIRSE Standards of Practice on Arterial Access for Interventions. Cardiovasc Intervent Radiol 2023; 46:302-309. [PMID: 36705706 DOI: 10.1007/s00270-022-03349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/20/2022] [Indexed: 01/28/2023]
Abstract
This CIRSE Standards of Practice document is aimed at healthcare professionals (including interventional radiologists) performing endovascular procedures to provide best practices for performing arterial access for interventions. It has been developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. This paper encompasses up-to-date clinical and technical aspects in performing safe and appropriate arterial access for interventions.
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Affiliation(s)
| | - Miltiadis Krokidis
- School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | | | - Bora Peynircioglu
- Department of Radiology, Hacettepe UTF, Sihhiye Campus, Ankara, Turkey
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Tokuda T, Yamamoto M. Vascular management during transcatheter aortic valve replacement. Cardiovasc Interv Ther 2023; 38:18-27. [PMID: 36447120 DOI: 10.1007/s12928-022-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
Transcatheter aortic valve replacement (TAVR), as an alternative to open heart surgery, has been established as the standard therapy for patients with severe aortic valve stenosis. Vascular access management, the first step in a TAVR procedure, should be managed properly. Moreover, the transfemoral and alternatives such as the transaxillary/subclavian, transcarotid, transapical, and transcaval approaches are considered access routes during TAVR. More than 90% of cases can be treated via the transfemoral approach in the current TAVR era, whereas other approaches should be considered in patients in whom the transfemoral approach is not suitable. Vascular complications regardless of access route differences are a specific issue of TAVR caused by the use of large sheaths. With the increased number of TAVR cases, we must manage vascular complications and decrease the morbidity and mortality rates associated with TAVR procedures. Thus, this study aimed to review the vascular complications during TAVR and summarize their prognosis, prevention, and adequate management.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan.
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan. .,Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan. .,Department of Cardiology, Gifu Heart Center, Gifu, Japan.
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Kumar AP, Valakkada J, Ayappan A, Kannath S. Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1760246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AbstractEndovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
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Affiliation(s)
- Ajay Pawan Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kannath
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Mach M, Okutucu S, Kerbel T, Arjomand A, Fatihoglu SG, Werner P, Simon P, Andreas M. Vascular Complications in TAVR: Incidence, Clinical Impact, and Management. J Clin Med 2021; 10:jcm10215046. [PMID: 34768565 PMCID: PMC8584339 DOI: 10.3390/jcm10215046] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
- Correspondence: ; Tel.: +43-1-40400-52620
| | - Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, 06520 Ankara, Turkey;
| | - Tillmann Kerbel
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Aref Arjomand
- Department of Cardiology, St. John of God Hospital, Geelong, VIC 3220, Australia;
| | | | - Paul Werner
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Paul Simon
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
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Schlegel RN, Clements W, Koukounaras J, Goh GS, Joseph T, Phan T, Moriarty HK. A 10-year retrospective review of management and outcomes of pseudoaneurysms at a tertiary referral centre. J Med Imaging Radiat Oncol 2021; 66:603-608. [PMID: 34490983 DOI: 10.1111/1754-9485.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pseudoaneurysms are uncommon but potentially life-threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound-guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. METHODS Retrospective single-centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010-2020). RESULTS There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm; 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound-guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was <9 h for visceral artery pseudoaneurysms and 24 h for peripheral artery pseudoaneurysms. There was no change in survival outcomes with respect to time from diagnosis and intervention. CONCLUSION In this study, pseudoaneurysms were treated with a high degree of success by observation or by using an endovascular approach, and those requiring endovascular intervention did not need to be treated immediately in an emergent setting.
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Affiliation(s)
- Richard N Schlegel
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard S Goh
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Heather K Moriarty
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
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Gooneratne T, Wijeyaratne M. Iatrogenic Deep Femoral Artery Pseudoaneurysm Causing Quadriceps Paralysis: An Indication for Open Surgery in an Endovascular Era. Vasc Specialist Int 2021; 37:25. [PMID: 34349045 PMCID: PMC8339415 DOI: 10.5758/vsi.210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/20/2022] Open
Abstract
Contemporary management of iatrogenic pseudoaneurysms is mostly performed using non-surgical techniques. Herein, we present a rare case of deep femoral artery (DFA) pseudoaneurysm with compression neuropathy, which required open repair. A 67-year-old female patient presented with increasing pain in the right groin, sensory neuropathy of the anteromedial thigh and upper leg, and quadriceps paralysis 4 days after coronary angiography via femoral puncture. Computed tomography angiography revealed a pseudoaneurysm of the DFA. The disabling compressive neuropathy warranted urgent open decompression rather than thrombin injection or endovascular therapy. Timely open evacuation of the hematoma, release of compression on the femoral nerve, and postoperative physiotherapy resulted in complete recovery of quadriceps power. The patient was pain free within 12 weeks and able to ambulate independently. This case report highlights the role of prompt open surgery for pseudoaneurysms with compression neuropathy.
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Affiliation(s)
- Thushan Gooneratne
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Mandika Wijeyaratne
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Borghese O, Ganimede MP, Briatico Vangosa A, Pisani A, Vidali S, Di Stasi C, Burdi N, Semeraro V. The Minimally Invasive Treatment of Visceral Artery Pseudoaneurysms: A Retrospective Observational Single Centre Cohort Study on Glue Embolization. Vasc Endovascular Surg 2021; 55:831-837. [PMID: 34261391 DOI: 10.1177/15385744211028730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective is to report a single centre experience in the embolization of visceral artery pseudoaneurysms with N-butyl-cyanoacrylate-methacryloxy sulfolane (NBCA-MS). METHODS A retrospective observational cohort study was conducted on data about all consecutive patients treated for visceral artery pseudoaneurysms in the Interventional Radiology Unit of SS Annunziata Hospital, in Taranto (Italy) between January 2016 and July 2020. Only patients treated with NBCA-MS embolization were included. Clinical and technical outcomes were evaluated during in-hospital stay and at 3-month follow-up by computed angiotomography (CTA). RESULTS Among 89 patients undergoing treatment for visceral artery pseudoaneurysm, a total of 58 (65.2%) patients (n = 32, 55.2% men; median age 45.8 years, range: 35-81) treated with NBCA-MS only were enrolled. Pseudoaneurysms were located in the renal artery (n = 18 cases, 31%), in the splenic artery (n = 27, 46.6%), in the intra-parenchymal hepatic artery (n = 3, 5.2%), in the common hepatic artery (n = 4, 6.9%) or in the pancreatic artery (n = 6, 10.3%). N-butyl-cyanoacrylate was diluted 1:1 with Lipiodol ultra-fluid, and mean volume injected was 0.6 ± 0.3 mL (range: 0.2-2.8 mL). Embolization was technically and clinically successful in all patients (n = 58, 100%) with an immediate total thrombosis of the pseudoaneurysm at the completion angiography. No systemic complications were noted in all cases. Five cases (8.6%) of non-target vessel embolization occurred without any clinical complication. No pseudoaneurysm recurrence was detected at the CTA control 1 day postoperatively. In one case (1.7%), a recurrence was detected 4 days after the initial treatment and successfully managed by a repeated NBCA-MS embolization. During the hospital stay, 56 patients recovered well but 2 (3.4%) died from multi-organ failure not related to the embolization. No recurrences were detected at the 3-month postoperative CTA in the remaining patients. CONCLUSIONS In properly selected patients affected with visceral artery pseudoaneurysms, NBCA-MS represents a definitive and safe embolization agent.
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Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, 55183Nord Laennec Hospital, Saint-Herblain, France.,9311University Sapienza of Rome, Rome, Italy
| | | | | | - Angelo Pisani
- Department of Cardiothoracic Surgery, 47165Pinata Grande Hospital, Castel Volturno, Italy
| | | | - Carmine Di Stasi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Nicola Burdi
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
| | - Vittorio Semeraro
- Interventional Radiology Unit, 170131SS Annunziata Hospital, Taranto, Italy
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Sohal S, Tayal R. Mechanical Circulatory Support Devices: Management and Prevention of Vascular Complications. Interv Cardiol Clin 2021; 10:269-279. [PMID: 33745675 DOI: 10.1016/j.iccl.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The use of mechanical circulatory support devices has seen a dramatic rise over the last few years owing to their increased use not only in acute circulatory collapse but also their prophylactic use in high-risk procedures. These devices continue to have their overall benefits marginalized due to the relatively high rates of complications. Vascular complications are the most common and are associated with increased risk of mortality in these patients. Preventive measures at each stage of procedure, frequent monitoring and assessment to recognize early signs of deterioration are the best ways to mitigate the effects of vascular complications.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-Barnabas Heath Newark Beth Israel Medical Center, 201 Lyon Avenue, Newark, NJ 07112, USA
| | - Rajiv Tayal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-Barnabas Heath Newark Beth Israel Medical Center, 201 Lyon Avenue, Newark, NJ 07112, USA.
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Preoperative Magnetic Resonance Imaging (MRI) for Predicting Thromboembolic Complications during Endovascular Treatment for Iliac Artery Occlusions. Ann Vasc Surg 2020; 73:211-221. [PMID: 33253808 DOI: 10.1016/j.avsg.2020.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/02/2020] [Accepted: 10/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Preoperative prediction of thromboembolic complications using magnetic resonance imaging (MRI) in coronary arteries and carotid arteries has been established. However, the technique has not been applied in peripheral arteries. This study aimed to assess the relationship between thromboembolic complications during endovascular treatment (EVT) for iliac artery occlusion and signal intensity on MRI. METHODS This single-institution study included 52 iliac artery occlusions in 51 patients (mean age, 70.4 years) who underwent successful EVT between January 2010 and March 2018. MRI using an inversion recovery-prepared, steady-state free precession technique was performed preoperatively. Thromboembolic complications were defined as distal embolization and in-stent protrusion greater than 25% of the stent cross-sectional area confirmed by angiography and intravascular ultrasonography, regardless of symptoms. The highest signal intensity of iliac artery occlusion divided by the signal intensity of adjacent iliopsoas muscle (target-to-muscle ratio, TMR) was measured on MR images. Multivariate analysis was performed to clarify the predictors of thromboembolic complications during EVT. RESULTS Thromboembolic complications observed in 11 vessels (21.2%) from 11 patients comprised distal embolization (n = 4) and in-stent protrusion (n = 7). A TMR cutoff value > 2.57 had a sensitivity of 90.9%, specificity of 78.0%, positive predictive value of 52.6%, and negative predictive value of 97.0% for detecting thromboembolic complications during EVT. In the multivariate analysis, TMR >2.57 was the only independent factor associated with thromboembolic complications (odds ratio, 30.10; 95% confidence interval, 3.26-278.00; P = 0.003). CONCLUSIONS The presence of higher signal intensity in iliac artery occlusion on MRI is useful for predicting thromboembolic complications during EVT.
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Jeong J, Shim DJ, Lee KY, Kim SK, Lee JW. Angiography-guided percutaneous thrombin injection for haemostasis of active bleeding complicated by femoral access: a case report. J Int Med Res 2020; 48:300060520947635. [PMID: 32790484 PMCID: PMC7427146 DOI: 10.1177/0300060520947635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Active bleeding from a small branch of the femoral artery can occur after catheterisation and may be difficult to treat. Stent-graft placement or embolisation after catheterisation can be a useful solution. However, stent-graft placement is often challenging for the treatment of bleeding around bifurcations, and it may be limited by available stent-graft sizes during emergencies. Embolisation can also be difficult if the vessel diameter is too small to catheterise or if the branching angle is too acute. Thrombin injection is accepted as a safe and effective treatment for iatrogenic or traumatic pseudoaneurysm. However, large haematomas can deter ultrasonographic guidance. We herein report the successful treatment of active bleeding from a small branch of the superficial femoral artery after femoral access by percutaneous direct puncture under angiographic guidance and thrombin injection at the bleeding focus.
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Affiliation(s)
- Jinho Jeong
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Jae Shim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwan Yong Lee
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Ki Kim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Whee Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Minici R, Paone S, Talarico M, Zappia L, Abdalla K, Petullà M, Laganà D. Percutaneous treatment of vascular access-site complications: a ten years' experience in two centres. CVIR Endovasc 2020; 3:29. [PMID: 32507937 PMCID: PMC7276472 DOI: 10.1186/s42155-020-00120-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele. Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications. Results Ninety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%. Conclusions The percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.
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Affiliation(s)
- Roberto Minici
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy.
| | - Sara Paone
- IRC - FSH, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Marisa Talarico
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Lorenzo Zappia
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy
| | - Karim Abdalla
- Anaesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Catanzaro, Italy
| | - Maria Petullà
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy
| | - Domenico Laganà
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy.,Radiology Division, University of Insubria, Varese, Italy
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Schahab N, Kavsur R, Mahn T, Schaefer C, Kania A, Fimmers R, Nickenig G, Zimmer S. Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions (PCI). PLoS One 2020; 15:e0230535. [PMID: 32191751 PMCID: PMC7082010 DOI: 10.1371/journal.pone.0230535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Major vascular complications (VCs) of ilio–femoral arterial access after percutaneous coronary interventions are infrequent, but are associated with increased mortality and morbidity. Routine endovascular repair of VCs is becoming the treatment of choice, especially for patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation. Here, we review the different types of vascular access site complications associated with percutaneous coronary interventions (PCIs) and assess the safety and efficacy of endovascular treatment. Methods Data were retrospectively analysed from patients who experienced VCs after transfemoral PCIs, from December 2014 to May 2018. During this period, out of 2833 patients who underwent femoral coronary interventions, 53 (1.9%) experienced major VCs. Results In total, 40/53 (75.5%) cases with major VCs led to unplanned endovascular repair and 13/53 (24.5%) cases required surgical repair. VCs included 17 (32.1%) retroperitoneal bleeding events (BARC-2, 3a,b), 20 (37.7%) intimal dissections, and 16 (30.2%) femoral pseudoaneurysms. Overall, 32 (60.4%) patients received a covered stent, two (3.8%) received a nitinol stent, five (9.4%) patients with dissections were treated with prolonged balloon angioplasty alone, and one patient with femoral pseudoaneurysm underwent thrombin injection with simultaneous balloon occlusion. The mean hospital stay for patients after endovascular treatment was 11.06 ± 5.2 days, while for patients after surgical repair it was 17 ± 8.2 days. Endovascularly treated patients were transfused with red blood cells (13/40 32.5% vs. 2/13 15.4%) significantly more often than patients treated surgically, although surgically treated patients received more red blood cell concentrates per unit than endovascularly treated patients (1 ± 0.47 vs. 2 ± 0.93). During the one-year follow-up, no intermittent claudication was reported, and no patient required secondary endovascular or surgical repair. Conclusions For patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation, endovascular management of VCs following PCIs seems to be a feasible and safe treatment option, and represents an alternative to surgical repair in life-threatening situations. Endovascular treatment was associated with significantly fewer red blood cell concentrates per patient and fewer days in hospital than surgical treatment.
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Affiliation(s)
- Nadjib Schahab
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Refik Kavsur
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Thorsten Mahn
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Alexander Kania
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
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Kehagias E, Ioannou CV, Bouloukaki I, Papadaki E, Galanakis N, Kontopodis N, Tsetis D. Feasibility of ischemic leg ulcer healing using percutaneous techniques: a real-life study. Acta Radiol 2020; 61:353-360. [PMID: 31319687 DOI: 10.1177/0284185119862955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Percutaneous transluminal angioplasty is established as the first-line vascular procedure in patients with lower extremity artery disease. Purpose We aimed to evaluate the technical and clinical effectiveness of percutaneous transluminal angioplasty in the management of ischemic foot ulcers. Material and Methods All consecutive patients presenting with a foot ulcer at the outpatient vascular surgery clinic of our hospital between June 2009 and June 2015 were evaluated using foot pulse assessment, ankle-brachial index, and duplex scanning. If non-invasive parameters suggested lower extremity artery disease, CT angiography and/or digital subtraction angiography were performed and a percutaneous transluminal angioplasty was carried out when feasible during the same session. All patients were followed until healing, amputation, death, or for at least two years. Short- and long-term clinical success was evaluated based on ulcer size and appearance. Patients with worsening ulcers after percutaneous transluminal angioplasty underwent bypass grafting or amputation. Results Percutaneous transluminal angioplasty was performed in 161 patients (100%) with stenoses > 50%, including cases lesions > 10 cm and/or multiple/calcified lesions, 144 of which completed the study. In 88 (61.2%) patients, percutaneous transluminal angioplasty was performed in the suprapopliteal axis exclusively, in 10 (6.8%) patients in the infrapopliteal axis only, and in 46 (31.9%) in both levels. Percutaneous transluminal angioplasty was technically successful in 141 (98%) patients. After 3.1 years, the rate of healing was 68%, limb salvage 88%, overall survival 69.5%, and amputation-free survival 64%. Conclusion Our data suggest that percutaneous transluminal angioplasty for ischemic foot ulceration treatment is in the majority of patients feasible, effective, and safe with high rates of healing and limb salvage.
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Affiliation(s)
- Elias Kehagias
- Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - Izolde Bouloukaki
- Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece
| | - Evangelia Papadaki
- Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece
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Minkovich LL, Kuiper GJ, Djaiani GN. The “Appropriate Use Criteria” for Treatment and Management of Peripheral Artery Disease: The Anesthesiologist Point of View. J Cardiothorac Vasc Anesth 2019; 33:2118-2122. [DOI: 10.1053/j.jvca.2019.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022]
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Chakravarty T, Jilaihawi H, Doctor N, Fontana G, Forrester JS, Cheng W, Makkar R. Complications after Transfemoral Transcatheter Aortic Valve Replacement with a Balloon-Expandable Prosthesis: The Importance of Preventative Measures and Contingency Planning. Catheter Cardiovasc Interv 2019; 91:E29-E42. [PMID: 23436313 DOI: 10.1002/ccd.24888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 01/11/2013] [Accepted: 02/17/2013] [Indexed: 12/19/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) with balloon-expandable Edwards-SAPIEN valve was superior to standard therapy in inoperable patients and noninferior to surgical aortic valve replacement in high surgical-risk, but operable patients, with severe symptomatic aortic stenosis in the randomized controlled PARTNER trial. Since the first case of TAVR with a balloon-expandable valve in 2002, several groups have reported their experience with balloon-expandable valves with high-procedural success. In the United States, the balloon-expandable Edwards-SAPIEN valve is the only transcatheter heart valve approved by the FDA for commercial use. Moreover, this is only in high-risk inoperable patients. Despite increasing experience with the TAVR procedure, it can be associated with complications, which can be technically challenging, even for an experienced operator. Complications associated with TAVR include vascular complications, valve malpositioning, regurgitation, embolization, coronary compromise, conduction abnormalities, stroke/transient ischemic attack, acute kidney injury, cardiac tamponade, and hemodynamic collapse. A thorough understanding of the procedure is essential for pre-emptive planning for procedural complications and early identification and management of complications are necessary for procedural success. We hereby review our experience of transfemoral TAVR with balloon-expandable valves, offer practical tips to maximize the likelihood of procedural success, describe pre-emptive strategies to prevent peri-procedural complications and bailout measures to manage them, should they occur. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Niraj Doctor
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | | | - Wen Cheng
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California
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20
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Long-Term Outcomes of Iliofemoral Artery Stents after Transfemoral Aortic Valve Replacement. J Vasc Interv Radiol 2018; 29:1733-1740. [PMID: 30297312 DOI: 10.1016/j.jvir.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To report long-term results of iliofemoral stent placement after transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS TAVR access-related complications treated with iliofemoral stent placement were recorded in 56 patients (mean age, 81 years; range; 53-93 years; 48% male) of 648 patients who underwent TAVR at a single center. Fifty-six patients treated with stent placement (40 patients with stent grafts and 16 patients with bare metal stents) underwent clinical and ultrasonographic follow-up after a mean of 676 days (range, 60-1840 days). RESULTS During follow-up, none of the 56 patients who had stent placement underwent a vascular reintervention of the affected limb, and none suffered from limb claudication. No decrease was observed in ankle-brachial index (ABI) values to an abnormal value, except in 1 patient (mean preprocedural and postprocedural ABI of 1.2 ± 0.14, range, 0.97-1.4 and 1.19 ± 0.24, range, 0.65-1.54, respectively). Arterial duplex assessment showed normal stent flow velocity (mean, 168.7 ± 63.2 cm/sec; range, 80-345 cm/sec) in all but 1 patient. CONCLUSION Iliofemoral stent implantation is a safe and efficacious treatment for vascular access site and access-related complications during transfemoral TAVR.
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21
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Tonolini M, Ierardi AM, Carrafiello G, Laganà D. Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin. Insights Imaging 2018; 9:631-642. [PMID: 29675625 PMCID: PMC6108968 DOI: 10.1007/s13244-018-0613-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022] Open
Abstract
Abstract The number and complexity of endovascular procedures performed via either arterial or venous access are steadily increasing. Albeit associated with higher morbidity compared to the radial approach, the traditional common femoral artery remains the preferred access site in a variety of cardiac, aortic, oncologic and peripheral vascular procedures. Both transarterial and venous cannulation (for electrophysiology, intravenous laser ablation and central catheterisation) at the groin may result in potentially severe vascular access site complications (VASC). Furthermore, vascular and soft-tissue groin infections may develop after untreated VASC or secondarily to non-sterile injections for recreational drug use. VASC and groin infections require rapid diagnosis and appropriate treatment to avoid further, potentially devastating harm. Whereas in the past colour Doppler ultrasound was generally used, in recent years cardiologists, vascular surgeons and interventional radiologists increasingly rely on pelvic and femoral CT angiography. Despite drawbacks of ionising radiation and the need for intravenous contrast, multidetector CT rapidly and consistently provides a panoramic, comprehensive visualisation, which is crucial for correct choice between conservative, endovascular and surgical management. This paper aims to provide radiologists with an increased familiarity with iatrogenic and self-inflicted VASC and infections at the groin by presenting examples of haematomas, active bleeding, pseudoaneurysms, arterial occlusion, arterio-venous fistula, endovenous heat-induced thrombosis, septic thrombophlebitis, soft-tissue infections at the groin, and late sequelae of venous injuries. Teaching Points • Complications may develop after femoral arterial or venous access for interventional procedures. • Arterial injuries include bleeding, pseudoaneurysm, occlusion, arteriovenous fistula, dissection. • Endovenous heat-induced thrombosis is a specific form of iatrogenic venous complication. • Iatrogenic infections include groin cellulitis, abscesses and septic thrombophlebitis. • CT angiography reliably triages vascular access site complications and groin infections.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Domenico Laganà
- Department of Radiology, "Magna Grecia" University, Viale Europa, 88100, Catanzaro, Italy
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Sardar MR, Goldsweig AM, Abbott JD, Sharaf BL, Gordon PC, Ehsan A, Aronow HD. Vascular complications associated with transcatheter aortic valve replacement. Vasc Med 2017; 22:234-244. [PMID: 28494713 DOI: 10.1177/1358863x17697832] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is now an accepted pathway for aortic valve replacement for patients who are at prohibitive, severe and intermediate risk for traditional aortic valve surgery. However, with this rising uptrend and adaptation of this new technology, vascular complications and their management remain an Achilles heel for percutaneous aortic valve replacement. The vascular complications are an independent predictor of mortality for patients undergoing TAVR. Early recognition of these complications and appropriate management is paramount. In this article, we review the most commonly encountered vascular complications associated with currently approved TAVR devices and their optimal percutaneous management techniques.
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Affiliation(s)
- M Rizwan Sardar
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA.,2 Aultman Hospital, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
| | - Andrew M Goldsweig
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Dawn Abbott
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Barry L Sharaf
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Paul C Gordon
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Afshin Ehsan
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Herbert D Aronow
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Segal A, Flugelman MY, Khader N, Rubinshtein R, Lavi I, Karmeli R, Jubran A, Shiran A, Jaffe R. Outcome of Stent Graft Implantation for Treatment of Access Site Bleeding After Transfemoral Transcatheter Aortic Valve Replacement. Am J Cardiol 2017; 120:456-460. [PMID: 28583682 DOI: 10.1016/j.amjcard.2017.04.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 12/17/2022]
Abstract
Vascular complications are common after transcatheter aortic valve replacement (TAVR) and are associated with increased morbidity and mortality. Stent graft implantation enables percutaneous treatment of access site bleeding; however, the efficacy and durability and of this approach are unknown. We studied the immediate outcome of stent graft implantation for control of access site bleeding and the need for repeat vascular interventions after stenting, in a cohort of consecutive patients with severe symptomatic aortic stenosis who underwent transfemoral TAVR. Predictors of access site complications requiring percutaneous or surgical vascular repair were identified. Transfemoral TAVR was performed in 194 patients. Access site complications requiring urgent vascular repair occurred in 34 patients (18%). Stent graft implantation was performed in 31 patients and vascular surgery in 3 patients. When patients who required surgical or percutaneous vascular repair were compared with those who did not, increased body mass index (30 ± 6 vs 28 ± 5, p = 0.035) and reduced activated clotting time (233 ± 47 vs 252 ± 47, p = 0.030) were the only predictors of need for vascular repair. Stenting achieved adequate hemostasis in all patients with a single minor vascular complication. During median follow-up of 797 days (interquartile range 585 to 1,173), no clinically significant vascular complications were detected after stenting. In conclusion, control of bleeding was achieved in all patients who underwent stent graft implantation for treatment of access site vascular complications after transfemoral TAVR. None of these patients needed further vascular interventions during follow-up.
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Clot injection for treatment of iatrogenic femoral arteriovenous fistula after percutaneous coronary intervention: a novel minimally invasive method. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:364-367. [PMID: 27980552 PMCID: PMC5133326 DOI: 10.5114/aic.2016.63638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/28/2016] [Indexed: 12/02/2022] Open
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Perrin N, Ellenberger C, Licker M, Hachulla AL, Cikirikcioglu M, Frei A, Roffi M, Noble S. Management of vascular complications following transcatheter aortic valve implantation. Arch Cardiovasc Dis 2016; 108:491-501. [PMID: 26073229 DOI: 10.1016/j.acvd.2015.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are frequent and their management is challenging. AIM To report the incidence, predictors and management of VCs following percutaneous transfemoral TAVI (TF-TAVI) at a single centre. METHODS We analyzed 102 consecutive patients who underwent percutaneous TF-TAVI between August 2008 and December 2013. All endpoints were evaluated at 30 days and 6 months according to Valve Academic Research Consortium-2 criteria. VC percutaneous treatment success was defined as residual stenosis<30%, absence of blood extravasation and absence of surgical or repeat endovascular intervention at 30 days. RESULTS Twenty-two patients (22%) experienced VCs, including five patients (5%) with major VCs. Mortality at 30 days was significantly higher in patients with major VCs than in patients without major VCs (60% vs 3%; P=0.001). Patients with VCs had more life-threatening or major bleeding (23% vs 5%; P=0.02), but no difference in terms of need for blood transfusion was observed. Endovascular treatment was used in 13 of 22 patients with VCs (59%) and was successful in 11 of these 13 patients (85%). Primary surgical repair was necessary in only 1/22 (5%) patients, for a common femoral artery pseudoaneurysm 2 weeks after the TAVI procedure. CONCLUSIONS VCs following TF-TAVI are frequent. Major but not minor VCs are associated with increased mortality. Percutaneous management of VCs is feasible and safe, and surgery is rarely needed.
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Affiliation(s)
- Nils Perrin
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
| | | | - Marc Licker
- Anaesthesiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Anne-Lise Hachulla
- Radiology Department, University Hospital of Geneva, Geneva, Switzerland
| | | | - Angela Frei
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Marco Roffi
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Stéphane Noble
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean J Radiol 2016; 17:351-63. [PMID: 27134524 PMCID: PMC4842855 DOI: 10.3348/kjr.2016.17.3.351] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/25/2016] [Indexed: 12/15/2022] Open
Abstract
Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks.
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Affiliation(s)
| | | | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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27
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Ierardi AM, Kehagias E, Piffaretti G, Piacentino F, De Marchi G, Tozzi M, Ioannou C, Tonolini M, Magenta Biasina A, Carrafiello G, Tsetis D. ePTFE stent graft in non-steno-occlusive arterial disease: 2 centers retrospective study. Radiol Med 2016; 121:482-93. [DOI: 10.1007/s11547-016-0623-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/19/2016] [Indexed: 11/30/2022]
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Ge BH, Copelan A, Scola D, Watts MM. Iatrogenic percutaneous vascular injuries: clinical presentation, imaging, and management. Semin Intervent Radiol 2015; 32:108-22. [PMID: 26038619 DOI: 10.1055/s-0035-1549375] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vascular interventional radiology procedures are relatively safe compared with analogous surgical procedures, with overall major complication rates of less than 1%. However, major vascular injuries resulting from these procedures may lead to significant morbidity and mortality. This review will discuss the etiology, clinical presentation, diagnosis, and management of vascular complications related to percutaneous vascular interventions. Early recognition of these complications and familiarity with treatment options are essential skills for the interventional radiologist.
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Affiliation(s)
- Benjamin H Ge
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Copelan
- Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Dominic Scola
- Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Micah M Watts
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Mehta V, Pandit BN, Mehra P, Nigam A, Vyas A, Yusuf J, Mukhopadhyay S, Trehan V. Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement. Cardiovasc Intervent Radiol 2015; 39:106-10. [PMID: 26021596 DOI: 10.1007/s00270-015-1125-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/22/2015] [Indexed: 11/26/2022]
Abstract
We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.
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Affiliation(s)
- Vimal Mehta
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
- Room No. 133, Department of Cardiology, G.B. Pant Institute of Postgraduate Medical Education and Research, Jawahar Lal Nehru Marg, New Delhi, 110002, India.
| | - Bhagya Narayan Pandit
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Pratishtha Mehra
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Arima Nigam
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Aniruddha Vyas
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Jamal Yusuf
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Saibal Mukhopadhyay
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Vijay Trehan
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Suri S, Nagarsheth KH, Goraya S, Singh K. A novel technique to retrieve a maldeployed vascular closure device. J Endovasc Ther 2015; 22:71-3. [PMID: 25775683 DOI: 10.1177/1526602814565773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a novel technique for endovascular retrieval of a maldeployed vascular closure device, obviating the need for a femoral cutdown. TECHNIQUE To remove a 6-F Angio-Seal device that embolized to the superficial femoral artery, the contralateral common femoral artery was accessed, and an 8-F, 65-cm-long sheath was inserted just proximal to the embolus. A second semistiff 0.035-inch buddy wire was advanced past the lesion along the sheath. A 0.014-inch wire was advanced past the embolus, and a SpiderFX embolic protection device was deployed 1 cm past the embolized Angio-Seal device. The sheath was advanced so as to push the embolus into the filter. The sheath and the filter containing the Angio-Seal device were then removed. CONCLUSION Endovascular retrieval of an embolized Angio-Seal device can be done using an embolic filter device, restoring arterial flow to the limb.
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Affiliation(s)
- Simrat Suri
- Staten Island University Hospital, Staten Island, NY, USA
| | | | - Sumeet Goraya
- Staten Island University Hospital, Staten Island, NY, USA
| | - Kuldeep Singh
- Staten Island University Hospital, Staten Island, NY, USA
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Treitl KM, König C, Reiser MF, Treitl M. Complications of Transbrachial Arterial Access for Peripheral Endovascular Interventions. J Endovasc Ther 2015; 22:63-70. [DOI: 10.1177/1526602814564363] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To prospectively assess current limitations and complication rates of the transbrachial access technique for endovascular treatment of peripheral vascular pathologies. Methods: In total, 150 patients (112 men; mean age 66.3±10.0 years) with arterial occlusive disease underwent endovascular therapy via a transbrachial access. Periprocedure data (sheath size, dose area product, fluoroscopy time, and procedure duration) were analyzed. Postprocedure complications of the puncture sites were categorized as minor (local hematoma, pseudoaneurysm, embolization, dissection, minor bleeding) and major (thrombotic occlusion, hematoma requiring surgery, major bleeding, nerve injury). Results: The minor and major complication rates were 14.0% (n=21) and 2.7% (n=4). The most frequent major complication was thrombotic occlusion of the brachial artery requiring surgical treatment (3/150, 2%). There was only one temporary palsy of the median nerve and no stroke. Local hematoma (15, 10%), pseudoaneurysm (3, 2%), or a combination of both (3, 2%) dominated the minor complications. The average dose area product and fluoroscopy time were 12,752.1±9524.5 cGy*cm2 and 24.3±18.4 minutes, respectively, though procedure duration was acceptable (121.8±48.9 minutes). Conclusion: Complication rates of the transbrachial access for endovascular treatment of peripheral or visceral artery occlusive disease are tolerably low, making it a safe and an important alternative to the transfemoral access in selected cases, though the radiation exposure is rather high.
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Affiliation(s)
| | - Cosima König
- Hospitals of the Ludwig-Maximilians University of Munich, Germany
| | | | - Marcus Treitl
- Hospitals of the Ludwig-Maximilians University of Munich, Germany
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Chen DH, Sammel AM, Jain P, Jepson NS. Cardiologist operated ultrasound guided thrombin injection as a safe and efficacious first line treatment for iatrogenic femoral artery pseudoaneurysms. Heart Lung Circ 2014; 24:165-72. [PMID: 25201028 DOI: 10.1016/j.hlc.2014.07.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/19/2014] [Accepted: 07/21/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of ultrasound guided thrombin injection (UGTI) as a first line treatment for post arterial cannulation iatrogenic femoral artery pseudoaneurysms (IFAP). BACKGROUND IFAPs complicate up to 1% of diagnostic and 8% of interventional cardiac catheterisation procedures. UGTI remains a second line or non-attempted treatment after ultrasound guided manual compression (UGMC) and surgical repair in many centres. METHODS A retrospective review was undertaken of 121 consecutive patients who received UGTI as a first line treatment for IFAPs following cardiac diagnostic, interventional or catheter ablation procedures between 1999 and 2011 at our centre. The mean patient age was 70.7 years and 63% were male. At the time of injection, 89% were on at least one antiplatelet or anticoagulant. Pseudoaneurysms had a mean maximum dimension of 26.7mm (range 10-122mm) and 25% were multilobed. UGTI was performed by an interventional cardiologist with a mean bovine thrombin dose of 648 IU (range 50-5000 IU). RESULTS Primary success, defined as immediate IFAP thrombosis with UGTI, was achieved in 111 (92%) patients. Recurrence occurred in seven patients, three of whom required surgical repair. Multilobed IFAPs had significantly lower primary success rates than unilobed IFAPs (80% vs. 96%, p=0.016). Antiplatelet and anticoagulant use and IFAP size did not significantly affect outcomes. UGTI was not associated with any serious complications (such as thromboembolism, aneurysm rupture, venous thrombosis or abscess formation). CONCLUSION Interventional cardiologist operated UGTI should be considered as a first line therapy for uncomplicated IFAPs following interventional and diagnostic cardiac procedures. Despite high rates of concomitant antiplatelet and antithrombotic therapy, initial thrombosis rates exceeded 90% and we did not experience serious complications.
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Affiliation(s)
- Daniel H Chen
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia.
| | - Anthony M Sammel
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
| | | | - Nigel S Jepson
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
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Dzijan-Horn M, Langwieser N, Groha P, Bradaric C, Linhardt M, Böttiger C, Byrne RA, Steppich B, Koppara T, Gödel J, Hadamitzky M, Ott I, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort. Circ Cardiovasc Interv 2014; 7:207-15. [PMID: 24692534 DOI: 10.1161/circinterventions.113.000836] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because of the risk of associated complications, femoral pseudoaneurysm (PSA) formation implies further treatment. Ultrasound-guided thrombin injection (UGTI) is becoming the accepted gold standard, but manual compression (MC) represents an established treatment option including PSAs not feasible for UGTI. This study aims to assess our experience in PSA treatment using MC or UGTI according to a potential algorithm based on morphological properties in a large patient cohort. METHODS AND RESULTS Between January 2007 and January 2011, a total of 432 PSAs were diagnosed in 29091 consecutive patients (1.49%) undergoing femoral artery catheterization. When compressible, small PSAs (<20 mm), PSAs without clearly definable neck, PSAs directly adjacent to vessels, and PSAs with concomitant arteriovenous fistula were referred to MC (n=145, 34%). All other PSAs were treated by UGTI (n=287, 66%). Follow-up duplex scans were performed within 12 to 14 hours after manual compression therapy and within 4 to 6 hours after UGTI or by the next morning and were available for 428 patients (99.1%). The overall success rate of our institutional therapeutic approach was 97.2%, which was achieved by 178 MC- and 357 UGTI-procedures, respectively. Procedural complications occurred in 5 cases (1.4%) after UGTI and in 3 cases (1.7%) after MC, respectively. The treatment algorithm was not successful in 12 patients, whereas 2 PSAs (0.5%) were successfully excluded by implantation of a covered stent-graft, and 10 patients necessitated surgical intervention (2.3%), which was associated with a high complication rate (30%). CONCLUSIONS The presented treatment algorithm facilitates effective and safe PSA elimination.
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Affiliation(s)
- Marijana Dzijan-Horn
- From the I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany (M.D.-H., N.L., P.G., C. Bradaric, N.v.B., K.-L.L., T.I.); Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (M.L., C. Böttiger, R.A.B., B.S., T.K., J.G., M.H., I.O., A.K.); and DZKH (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (M.D.-H., N.L., P.G., C. Bradaric, M.L., C.Böttiger, R.A.B., B.S., T.K., J.G., M.H., I.O., N.v.B., A.K., K.-L.L., T.I.)
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Treitl M, Eberhardt KM, Maxien D, Behrends B, Reiser MF. [Arterial closure devices. What device for which clinical situation?]. Radiologe 2013; 53:230-45. [PMID: 23456042 DOI: 10.1007/s00117-012-2423-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CLINICAL/METHODICAL ISSUE Access site complications after endovascular catheterization sometimes require open surgery and negatively impair safety, patient comfort and reimbursement. Increasing numbers of procedures and patients with multiple anticoagulants as well as cost pressure explain the demand for an immediate and stable access site closure. STANDARD RADIOLOGICAL METHODS Manual compression followed by compression bandage and bed rest for 4-24 h is still the gold standard but is unable to prevent access site complications in all cases. METHODICAL INNOVATIONS Arterial vascular closure devices allow immediate and stable closure of the puncture channel either by suture or by implantation of occluding foreign bodies or gluing fluids. PERFORMANCE The safety has been proven in several clinical trials. The main advantage lies in closing large lumen access sites without surgery and in patients treated with multiple anticoagulants as well as in outpatient procedures. ACHIEVEMENTS They have become a valuable supplement to the interventional arsenal. PRACTICAL RECOMMENDATIONS The physician, however, has to decide between different systems and mechanisms with respect to patient constitution, selected access vessel and level of calcification and diameter. Furthermore, all systems require a defined training prior the first use.
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Affiliation(s)
- M Treitl
- Institut für Klinische Radiologie, Klinikum Innenstadt der Ludwig-Maximilians-Universität München, Medizinische Poliklinik, Pettenkoferstrasse 8a, Munich, Germany.
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Vavuranakis M, Kariori M, Voudris V, Kalogeras K, Vrachatis D, Aznaouridis C, Moldovan C, Masoura C, Thomopoulou S, Lazaros G, Stefanadis C. Predictive Factors of Vascular Complications after Transcatheter Aortic Valve Implantation in Patients Treated with a Default Percutaneous Strategy. Cardiovasc Ther 2013; 31:e46-54. [DOI: 10.1111/1755-5922.12023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Manolis Vavuranakis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Maria Kariori
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Vassilis Voudris
- 2nd Department of Cardiology; Onassis Cardiac Surgery Center; Athens; Greece
| | - Konstantinos Kalogeras
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Dimitrios Vrachatis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Constantinos Aznaouridis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Carmen Moldovan
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Constantina Masoura
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Sophia Thomopoulou
- 2nd Department of Cardiology; Onassis Cardiac Surgery Center; Athens; Greece
| | - Georgios Lazaros
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Christodoulos Stefanadis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
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Management of Vascular Access in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2013; 6:767-76. [PMID: 23866177 DOI: 10.1016/j.jcin.2013.05.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/18/2013] [Accepted: 05/09/2013] [Indexed: 11/22/2022]
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Abstract
OPINION STATEMENT The incidence of vascular access site related complications ranges between 0.8 % to 1.8 % of diagnostic cardiac catheterization and up to 9 % of percutaneous coronary interventions (PCI) [1]. The femoral vessels at the groin are used as the access site for the majority of percutaneous coronary, peripheral arterial and venous, and electrophysiologic interventions. With emergence of endovascular abdominal aortic aneurysm repair (EVAR), thoracic endovascular aneurysm repair (TEVAR), and transcatheter aortic valve replacement (TAVR), larger access sheaths (up to 18Fr-24Fr) are required, which further increases the potential for access site complications. The true incidence of access site complications arising from non-coronary interventions is unknown; hence it is likely that the total incidence of vascular access site complications is greatly underestimated. Vascular closure devices (VCDs), radial artery access, fluoroscopic guidance, and ultrasound guidance have all been used with a hope to minimize these complications. Despite these attempts, vascular access complications have not been eliminated. Cardiovascular specialists must promptly identify these complications and manage them appropriately.
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Kumbhani DJ, Brilakis ES. Novel strategies for the diagnosis and treatment of arterial access perforations. Catheter Cardiovasc Interv 2012; 80:1033-4. [DOI: 10.1002/ccd.24691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 10/02/2012] [Indexed: 11/12/2022]
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Maluenda G, Mitulescu L, Ben-Dor I, Sardi G, Romaguera R, Satler LF, Pichard AD, Waksman R, Bernardo NL. Transcatheter "thrombin-blood patch" injection: a novel and effective approach to treat catheterization-related arterial perforation. Catheter Cardiovasc Interv 2012; 80:1025-32. [PMID: 23024065 DOI: 10.1002/ccd.24389] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 02/20/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to describe the safety and feasibility of transcatheter "thrombin-blood patch" (TBP) injection to treat catheterization-related arterial vascular access perforation. BACKGROUND Vascular access complications are infrequent but potentially life threatening conditions related to percutaneous procedures. Surgical vascular repair are associated with high rates of morbidity and mortality due to advanced cardiovascular disease. METHODS From October 2007 to July 2010 we studied 23 patients who presented active access arterial bleeding after percutaneous procedures and underwent transcatheter angiographic guided TBP injection across the entry site of the arterial perforation as a primary approach. RESULTS The mean age of the population was 67 years, predominantly female (78.3%) with high rate of comorbidities including diabetes (30.4%), prior coronary revascularization (50.0%), chronic renal failure (43.5%), and heart failure (56.5%). Thirteen patients (56.5%) developed severe hypotension after the index procedure. The repair procedure had a mean duration of 82 ± 57 minutes. TBP was injected in all patients. One case additionally required covered-stent to obtain hemostasis. Angiographic success was achieved in the 23 patients; however, one case required a second intervention due to recurrent bleeding, which was effectively treated using covered-stent. All patients were discharged alive and no major cardiovascular events, including myocardial infarction/stroke, were observed. CONCLUSIONS Transcatheter "thrombin-blood patch" injection is a safe, novel technique that allows prompt percutaneous approach to treat catheterization-related arterial perforation. This strategy appears particularly attractive to treat patients who cannot tolerate "open" vascular reconstruction and repair.
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Affiliation(s)
- Gabriel Maluenda
- Division of Cardiology, Department of Internal Medicine, Washington Hospital Center, Washington, District of Columbia 20010, USA
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Deitch SG, Gupta R. Radioembolization complicated by dissection of the common femoral artery. Semin Intervent Radiol 2012; 28:133-6. [PMID: 22654248 DOI: 10.1055/s-0031-1280650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The common femoral artery is the most frequently used access site for angiographic procedures in interventional radiology. Potential complications of common femoral arteriotomy include hematoma formation, pseudoaneurysm, uncontrolled groin or retroperitoneal bleeding, acute arterial occlusion, dissection, and arteriovenous fistula formation. In a case such as the one described here, with a common femoral artery dissection with intraluminal thrombus and vessel occlusion, the complication may have occurred at the time of access or at the time of closure, with both procedure-associated and patient-specific risk factors affecting the overall risk of complications. Though some studies have shown an increased risk of complications with the use of arterial closure devices, others have found no increase. In any patient with symptoms following a femoral arteriotomy, rapid diagnosis and treatment is necessary to avoid further complications. Both patient-specific and procedure-associated risk factors should be considered prior to arteriotomy and usage of an arterial closure device.
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Affiliation(s)
- Sarah G Deitch
- Department of Radiology, Northwestern University, Chicago, Illinois
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Xiao L, Shen J, Tong JJ. Emergency stent-graft implantation for iatrogenic peripheral arterial rupture. Radiol Med 2012; 118:152-7. [PMID: 22580807 DOI: 10.1007/s11547-012-0826-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/30/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated the experience with and efficacy of stent-grafting for iatrogenic peripheral arterial ruptures. MATERIALS AND METHODS From 2005 to 2009 we performed stent-grafting on four male patients (age 38-67 years) with iatrogenic peripheral arterial ruptures. In patient 1, grointissue necrosis followed a subcutaneous injection and led to femoral arterial rupture. Pseudoaneurysms ruptured in patients 2 and 3 who were undergoing femoral arteriotomy. Patient 1 experienced a ruptured carotid artery during neck surgery. Shock occurred in three of the four patients. Four patients underwent self-expanding stent-grafting (8 mm×60 mm or 8 mm×80 mm) under local anaesthesia. RESULTS Haemorrhages were controlled in all patients. No procedure-related complications occurred. Patient 1 died of lung metastases 13 months after stent-grafting. Follow-up examinations showed that the stent-graft remained patent in patients 1, 2 and 4, whereas stent occlusion occurred after 15 months in patient 3; in this case, a pseudoaneurysm proximal to the stent was identified, and although repeat stent-grafting successfully stopped the bleeding, the patient died of multiple organ failure 1 week later. CONCLUSIONS Emergency stent-grafting is a technically feasible and therapeutically effective modality for treating high-risk patients who experience iatrogenic peripheral arterial ruptures. The efficient treatment of hypotension and early endovascular intervention will improve the prognosis.
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Affiliation(s)
- L Xiao
- Department of Radiology, the First Hospital of China Medical University, 155 Nanjing North Road, Shenyang 110001, Liaoning, PR China.
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Shetty R, Lotun K. Treatment of an iatrogenic femoral artery pseudoaneurysm with concomitant arteriovenous fistula with percutaneous implantation of an amplatzer vascular plug. Catheter Cardiovasc Interv 2012; 81:E53-7. [DOI: 10.1002/ccd.24372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 02/09/2012] [Accepted: 02/12/2012] [Indexed: 11/06/2022]
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Maluenda G, Waksman R, Bernardo NL. Accepted TCT challenging case: common femoral artery perforation after primary percutaneous coronary intervention successfully treated with a novel transcatheter "thrombin-blood patch" injection technique. Catheter Cardiovasc Interv 2012; 79:805-8. [PMID: 21061252 DOI: 10.1002/ccd.22882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/11/2022]
Abstract
Severe vascular access complications are infrequent, yet potentially life-threatening, conditions related to percutaneous procedures approached via the femoral artery. Surgical vascular repair of such complications are associated with high rates of morbimortality due to advanced cardiovascular disease. Endovascular repair of the injured vessel appears to be the treatment of choice for patients who cannot tolerate vascular reconstruction and bleeding due to severe cardiovascular disease. We report a case that illustrates the feasibility of a novel technique: transcatheter "thrombin-blood patch" injection to access perforated arteries.
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Affiliation(s)
- Gabriel Maluenda
- Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
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Zvavanjanja RC, Odetoyinbo TO, Rowlands PC, Healey A, Abdelsalam H, Powell S, Evans JC, Hughes ML, Gould DA, McWilliams RG. Off label use of devices and drugs in interventional radiology. Clin Radiol 2011; 67:239-43. [PMID: 21978818 DOI: 10.1016/j.crad.2011.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/07/2011] [Accepted: 06/22/2011] [Indexed: 02/07/2023]
Abstract
AIM To establish how often off-label device and drug use occurs in interventional radiology (IR) in a UK tertiary referral hospital and consider the wider implications for the interventional radiologist. MATERIALS AND METHODS Prospective data were collected during interventional procedures for 1 working week in a university hospital. Out-of-hours procedures and procedures outside the department were excluded. Operators were asked to record the drugs and devices used, the indication, and method of use. The instructions for use/summary of product characteristics were then studied for each device/drug used to assess if the use was on or off-label. RESULTS During the study period 52 cases were performed and data were available on 26 cases (50%). In 22 of the 26 cases (84%) there was evidence of off-label use of devices or drugs. Off-label use of drugs included treatment of venous malformations with Fibrovein(©) (sodium tetradecyl sulphate), which is licensed for the treatment of varicose veins in the leg, and intra-arterial injection of heparin, which is licensed for intravenous and subcutaneous use. Off-label device use included placing vascular sheaths in the urinary tract, using angiographic catheters to guide wires in the urinary tract, using sheaths for thrombosuction, reshaping of the tip of most guidewires, and using angioplasty balloons to dislodge the arterial plug at fistula thrombectomy. CONCLUSION Off-label device and drugs use is common in a UK tertiary hospital IR department and literature suggests this is common in the wider IR community. There are important clinical and legal implications for off-label use for patients and physicians.
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Bhatty S, Cooke R, Shetty R, Jovin IS. Femoral vascular access-site complications in the cardiac catheterization laboratory: diagnosis and management. Interv Cardiol 2011. [DOI: 10.2217/ica.11.49] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Simionescu A, Schulte JB, Fercana G, Simionescu DT. Inflammation in cardiovascular tissue engineering: the challenge to a promise: a minireview. Int J Inflam 2011; 2011:958247. [PMID: 21755031 PMCID: PMC3132660 DOI: 10.4061/2011/958247] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/10/2011] [Indexed: 12/11/2022] Open
Abstract
Tissue engineering employs scaffolds, cells, and stimuli brought together in such a way as to mimic the functional architecture of the target tissue or organ. Exhilarating advances in tissue engineering and regenerative medicine allow us to envision in vitro creation or in vivo regeneration of cardiovascular tissues. Such accomplishments have the potential to revolutionize medicine and greatly improve our standard of life. However, enthusiasm has been hampered in recent years because of abnormal reactions at the implant-host interface, including cell proliferation, fibrosis, calcification and degeneration, as compared to the highly desired healing and remodeling. Animal and clinical studies have highlighted uncontrolled chronic inflammation as the main cause of these processes. In this minireview, we present three case studies highlighting the importance of inflammation in tissue engineering heart valves, vascular grafts, and myocardium and propose to focus on the endothelial barrier, the “final frontier” endowed with the natural potential and ability to regulate inflammatory signals.
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Affiliation(s)
- Agneta Simionescu
- Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, 304 Rhodes Center, Clemson, SC 29634, USA
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48
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Schellong SM. [The patient with pulmonary embolism or vascular emergency requiring intensive care]. Internist (Berl) 2011; 51:995-8, 1000-2. [PMID: 20596688 DOI: 10.1007/s00108-009-2541-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute pulmonary embolism requires ICU management only for patients with hemodynamic instability who need artificial ventilation, or for hemodynamically stable patients with significant right ventricular dysfunction. For both patient groups, echocardiography is the most relevant diagnostic method. The main therapeutic consideration is on systemic thrombolysis. It is indicated in almost all patients with hemodynamic instability but only in selected cases of right ventricular dysfunction. All other patients receive standard anticoagulation only. A second vascular emergency scenario is type 2 heparin-induced thrombocytopeniae (HIT II) which may cause venous as well as arterial complications. Alternative anticoagulation has to be established from the first moment of clinical suspicion. It has to be continued in a therapeutic dosage if HIT II is confirmed, and has to be stopped if the diagnosis is refuted. The latter case is by far more frequent. Regarding arterial occlusions (acute limb ischemia, acral gangrene, iatrogenic vascular trauma) hints are given for the management in the setting of intensive care.
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Affiliation(s)
- S M Schellong
- Medizinische Klinik, Krankenhaus Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany.
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Shams Vahdati S. Should a Double-Lumen Catheter be withdrawn? J Cardiovasc Thorac Res 2011; 3:97-9. [PMID: 24250963 DOI: 10.5681/jcvtr.2011.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 04/03/2011] [Indexed: 11/17/2022] Open
Abstract
Haemodialysis needs a credible and recurrent access to the systemic circulation which can be accomplished by way of central vein catheterization. We report the case of bleeding after withdrawal of the double lumen catheter. A 36-year-old woman who was a known case of end-stage renal disease referred to a dialysis center because of her arteriovenous fistula malfunction. A double-lumen catheter was inserted via the right internal jugular vein but failed to become functional so in the emergency department we decided to withdrawal catheter under cardiac monitoring and pulse oximetry but unfortunately A few minutes after the withdrawal of the double lumen Catheter the patient became agitated and confused. The resuscitation team after infusing IV fluid and blood decided to emergent thoracotomy. We control bleeding by direct pressure and repaired a rupture of the posterior aspect of the right internal jugular and right subclavian vein junction. Six hours later she became alert and one week after discharged, she was in well general condition.
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Affiliation(s)
- Samad Shams Vahdati
- Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Al Wahbi A. Stent-grafts in the management of life-threatening hemorrhage following inadvertent femoral catheterization in high-risk patients: report of two cases and review of the literature. Vasc Health Risk Manag 2010; 6:1111-4. [PMID: 21191431 PMCID: PMC3004514 DOI: 10.2147/vhrm.s15598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Indexed: 11/23/2022] Open
Abstract
Bleeding related to inadvertent femoral catheter insertion is an infrequent but morbid complication. We report two cases of acute life-threatening bleeding after attempts at femoral vein catheterization. Both patients were morbidly obese, had multiple comorbidities, and were at high risk for surgical intervention. Aggressive resuscitation failed to stabilize the patients. Emergency digital subtraction angiography diagnosed the site of the femoral artery bleeding. In one patient, the site of injury was the right profunda femoris artery. Both bleeding sites were controlled successfully with endovascular covered stent placement, without complication. Although prior publications have reported the concept of endovascular repair in femoral artery injuries, to the best of the author’s knowledge, covering the profunda femoris artery with no complications has not been described previously. In critically ill patients with life-threatening hemorrhage following inadvertent femoral catheterization, management with endovascular covered stents is safe and effective.
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Affiliation(s)
- Abdullah Al Wahbi
- Division of Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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