Treatment of subclavian artery pseudoaneurysm with use of US-guided percutaneous thrombin injection

Ultrasound-guided thrombin injection for treatment of superficial traumatic pseudoaneurysms and associated expanding hematomas: experience in five patients

Background

Angiography allows for excellent characterization and treatment of traumatic pseudoaneurysms. However, ultrasound-guided thrombin injection for pseudoaneurysm thrombosis allows for radiation-free treatment of superficial pseudoaneurysms and superficial expanding hematomas.

Methods

A retrospective review of 5 patient cases treated under this paradigm was performed following institutional review board approval. Outcomes following intervention were recorded and compared amongst the patient cohort.

Results

Ultrasound-guided closure of traumatic pseudoaneurysms allowed for reduced procedural times and procedural invasiveness.

Conclusions

As demonstrated by the following cases, ultrasound guided thrombin injection is a good method of primary treatment for superficial pseudoaneurysms, or as an alternative treatment in cases where transcatheter embolization fails.

Endovascular Exclusion Of Subclavian Artery Pseudoaneurysm

Subclavian artery pseudoaneurysms are typically a rare occurrence commonly caused by iatrogenic injury and trauma. We describe an endovascular approach employing a brachiofemoral through-wire technique for the treatment of a left subclavian artery pseudoaneurysm in the presence of a hostile aortic arch and great vessel anatomy.

Traumatic axillary artery pseudoaneurysm treated with intravascular balloon occlusion and percutaneous thrombin injection

Axillary artery pseudoaneurysms are relatively rare, with few reported cases found in the literature. Furthermore, treatment with percutaneous thrombin injection has not yet been reported. We report the case of a 59-year-old man with a large (10 cm) post-traumatic pseudoaneurysm of the left axillary artery found five weeks after a motorcycle crash. The patient sustained multiple injuries, including fractures of the left scapula and clavicle. Edema was observed at the time of diagnosis. Arteriography with successful ultrasound-guided percutaneous thrombin injection was undertaken. The patient experienced no complications after the procedure.

Video-assisted thoracic surgery repair of subclavian artery injury following central venous catheterization: a new approach

OBJECTIVES

Iatrogenic subclavian artery puncture following central venous catheterization is a rare but potentially fatal complication. There are very few reports in the literature on this condition. We propose the use of video-assisted thoracic surgery (VATS) in the management of these injuries.

METHODS

The technique of VATS to manage subclavian artery injury was described. We presented the first reported case of successful repair of subclavian artery injury using VATS.

RESULTS

Using a two-incisional approach for VATS, the haemothorax was rapidly evacuated and the subclavian artery injury was successfully repaired using pledgetted sutures under direct thoracoscopic visualization. The patient had an uneventful postoperative recovery.

CONCLUSIONS

VATS can be successfully applied to repair subclavian artery injury. The advantages include rapid intrathoracic access, excellent thoracoscopic visualization of the thoracic inlet, and avoidance of the morbidity associated with open thoracotomy.

Anastomotic pseudoaneurysm formation after bypass grafting to porcelainized peroneal artery: successful treatment by percutaneous thrombin injection

We present a rare case of a distal anastomotic pseudoaneurysm after bypass grafting to a porcelainized peroneal artery. Successful management was achieved by percutaneous thrombin injection. This case illustrates the value of nonsurgical intervention for this rare but difficult problem.

Paravertebral Pseudoaneurysm Thrombosed after Percutaneous Thrombin Injection

We present a case of a lumbar pseudoaneurysm in a 62-year-old patient with myelofibrosis (agnogenic myeloid metaplasia). The patient was submitted to two anesthetic infiltrations for lumbar pain and one biopsy of a suspected hematopoietic site. Subsequently, a 4.5 cm lumbar pseudoaneurysm was diagnosed. The pseudoaneurysm was thrombosed with 1 ml (500 IU) thrombin injection with a successful clinical result. We discuss different treatment options along with several issues related to the most frequent complication of this technique, namely, native artery thrombosis.

Treatment of radial and ulnar artery pseudoaneurysms using percutaneous thrombin injection

Pseudoaneurysm formation is a recognized complication of arterial catheterization or traumatic arterial disruption, which may lead to considerable morbidity. Ultrasound-guided thrombin injection has been shown to be effective in the treatment of peripheral pseudoaneurysms; however, its application in the management of radial or ulnar artery pseudoaneurysms has not been well established. Arterial thrombosis and distal embolization are concerns when treating a pseudoaneurysm involving a small vessel. We performed successful ultrasound-guided thrombin injection of a 3-cm radial artery and a 2.5-cm ulnar artery pseudoaneurysm resulting from arterial catheterization and missed arterial trauma, respectively. Radial artery recannalization occurred 28 days after the procedure whereas the ulnar artery remained patent throughout the observation period.

Pseudoaneurysm of the subclavian-vertebral artery junction--case report and review of the literature

Pseudoaneurysm of the subclavian-vertebral artery junction (SVJ) is a rare complication of internal jugular vein catheter placement. Because of its retroclavicular location, arterial injury at the SVJ poses a significant therapeutic challenge. A case report and review of the literature are presented.

Percutaneous thrombin injection of carotid artery pseudoaneurysm

PURPOSE

To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection.

CASE REPORT

A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications.

CONCLUSIONS

Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.

Femoral artery thrombosis after percutaneous thrombin injection of an external iliac artery pseudoaneurysm

Ultrasound-guided percutaneous thrombin injection has been developed as a less invasive and highly successful treatment of iatrogenic femoral pseudoaneurysms. Most of these lesions have been the result of catheterization procedures. This method has proved to be highly effective, and few complications have been reported. Specifically, native arterial thrombosis, although recognized as a severe complication, has been mentioned only briefly in the literature. We present a case of the successful management of native arterial thrombosis after attempted percutaneous thrombin injection of a chronic external iliac artery pseudoaneurysm. This case serves to illustrate the risk factors for this complication and the treatment options once it occurs. The success of this treatment with acute iatrogenic femoral pseudoaneurysms may not necessarily translate into similar success in other anatomic locations and clinical situations.