Superselective embolization of deep femoral artery branch pseudoaneurysm with a coaxial microcatheter system

A Case of Profunda Femoris Artery Pseudoaneurysm Treated With Catheterization and Surgical Hematoma Removal

A pseudoaneurysm of the profunda femoris artery (PFA) is a rare disease induced by femoral trauma, proximal femoral fracture, or iatrogenic causes associated with orthopaedic surgery. Recently, transcatheter arterial embolism was reported as an effective treatment for profunda femoris artery pseudoaneurysm. This report presents the case of an 85-year-old male who underwent artificial head replacement for a left femoral neck fracture and was hospitalized with a peri-stem fracture four years later. Conservative treatment was conducted with a brace, though the swelling and pain in his left thigh increased one week after his hospital admission. Contrast-enhanced computed tomography (CT) led to a diagnosis of a left profunda femoris artery pseudoaneurysm, and the patient underwent emergency transcatheter arterial embolism and surgical hematoma removal. Since the emergency surgery, the patient's course has been good, and he has been undergoing rehabilitation.

Endovascular treatment of refractory iatrogenic femoral artery pseudoaneurysm using Amplatzer vascular plugs following unsuccessful retrograde Angio-Seal deployment

Iatrogenic common femoral artery pseudoaneurysm is a well-known vascular access complication of angiography and transfemoral intervention. Thrombin injection is a well-accepted technique in treating these pseudoaneurysms but possess a significant risk of distal lower extremity thrombosis leading to severe consequences. Several case reports described the novel approach to closing these pseudoaneurysms via a retrograde deployment of an Angio-Seal vascular closure device. We describe a case of a successful treatment of refractory iatrogenic femoral artery pseudoaneurysm using Amplatzer vascular plugs following unsuccessful retrograde deployment of an Angio-Seal vascular closure device.

Successful Percutaneous Transcatheter Closure of a Common Femoral Artery Pseudoaneurysm With Use of MicroVascular Plug Despite Continued Catheter-Directed Thrombolysis

Common femoral artery pseudoaneurysm is a known complication of percutaneous vascular access. Treatment options include surgical repair of the pseudoaneurysm or endovascular methods such as ultrasound-guided compression and direct thrombin injection into the pseudoaneurysm sac. Treatment of pseudoaneurysm is more challenging when a patient is undergoing concurrent catheter-directed or systemic thrombolytic therapy. This is a case report of endovascular treatment of an iatrogenic pseudoaneurysm of common femoral artery in a patient receiving concurrent catheter-directed thrombolytic therapy. This was performed successfully by precise deployment of a MicroVascular Plug into the pseudoaneurysm neck with immediate closure of pseudoaneurysm. Midterm follow-up confirmed sustained exclusion of the pseudoaneurysm sac with continued patency of the treated femoral artery.

Spontaneous Deep Femoral Artery False Aneurysm Simulating a Neoplasm: A Rare Case and Literature Review

A 70-year-old woman presented to our attention with a painless pulsating mass at the level of the upper left thigh without any previous history of trauma, arterial surgery, or puncture of the femoral artery. Duplex ultrasound showed a nodular angiomatous-like formation with deep venous compression; computed tomographic angiography and magnetic resonance imaging reported the presence of capsulated lesion vascularized by muscular branch of deep femoral artery (DFA). The patient underwent surgical excision of a very rare thrombized DFA branch false aneurysm. Spontaneous DFA false aneurysm, although rare, will be considered in absence of trauma or vascular catheterization or previous aneurysmal rupture.

Novel Technique to Treat Common Femoral Artery Pseudoaneurysm using Angio-Seal Closure Device

Iatrogenic common femoral artery pseudoaneurysm is a well-described vascular access complication. Several methods have been proposed to treat these pseudoaneurysms. In this report, we present three cases of successful pseudoaneurysm closure using a novel method of retrograde pseudoaneurysm access and thrombosis with Angio-Seal (St Jude Medical, St Paul, MN) closure device. This technique appears safe, effective, and reduces patient discomfort.

Posterior common femoral branch pseudoaneurysm: an unusual arterial complication following femoral venous access

A 70-year-old male presented with groin pain and swelling 11 days following a pulmonary vein isolation procedure via an unguided femoral venous puncture for atrial fibrillation. On the fourth visit, his haemoglobin level had dropped from 14.2 gl⁻¹ to 10.7g l⁻¹. Repeat duplex imaging revealed a large haematoma with deep flow. A CT angiogram revealed a pseudoaneurysm of a right common femoral branch artery. A subsequent angiogram revealed active bleeding, and the feeding artery was coiled. Pseudoaneurysms are recognized complications of vascular intervention, but more commonly occur anteriorly in major vessels. This elusive presentation reminds us of several important points. First, with the increasing use of interventional techniques across all medical specialties, the use of image guidance to aid vessel access is paramount for safety; not all specialties currently practise this routinely. Furthermore, we should consider arterial injury in all patients, including those who have had venous puncture. Injuries may not necessarily occur at the anterior vessel wall, and may well be deeper. Finally, there should be a low threshold for alternative imaging if symptoms are out of context with clinical findings.

Endovascular Stent Grafting of a Deep Femoral Artery Pseudoaneurysm

Introduction

Pseudoaneurysms (PSAs) are uncommon, but can occur as a complication of orthopedic procedures, usually associated with femur surgery. This report describes successful management of a PSA of the deep femoral artery (DFA) with an endovascular stent graft.

Report

This case reports an injury that presented as a false aneurysm secondary to a fractured neck of femur, which was initially confused with hematoma. Imaging confirmed the diagnosis of PSA, and the decision was taken to implant an endovascular stent graft.

Discussion

The endovascular stent graft was implanted based on radiological, anatomical, and clinical parameters. This case supports the feasibility, safety, and efficacy of stenting for PSA of the DFA.

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Pseudoaneurysms (PSAs) of the deep femoral artery (DFA) that are uncommon and can occur as a complication of orthopedic procedure.

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This report serves to highlight the need for an increased awareness for the possibility of PSA of the DFA in association with proximal femur fractures.

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Early outcomes data from deep femoral profunda artery revascularization with covered stents indicate that the procedure is safe with low complication rates.

Iatrogenic vascular injuries during arthroplasty of the hip

Vascular injuries during total hip arthroplasty (THA) are rare but when they occur, have serious consequences. These have traditionally been managed with open exploration and repair, but more recently there has been a trend towards percutaneous endovascular management.

We performed a systematic review of the literature to assess if this change in trend has led to an improvement in the overall reported rates of morbidity and mortality during the last 22 years in comparison with the reviews of the literature published previously.

We found a total of 61 articles describing 138 vascular injuries in 124 patients. Injuries because of a laceration were the most prevalent (n = 51, 44%) and the most common presenting feature, when recorded, was bleeding (n = 41, 53.3%). Delay in diagnosis was associated with the type of vascular lesion (p < 0.001) and the clinical presentation (p = 0.002).

Open exploration and repair was the most common form of management, however percutaneous endovascular intervention was used in one third of the injuries and more constantly during the last 13 years.

The main overall reported complications included death (n = 9, 7.3%), amputation (n = 2, 1.6%), and persistent ischaemia (n = 9, 7.3%). When compared with previous reviews there was a similar rate of mortality but lower rates of amputation and permanent disability, especially in patients managed by endovascular strategies.

Cite this article: Bone Joint J 2015;97-B:1447–55.

Iatrogenic false aneurysms. A rare complication of hip surgery

The purpose of this study was to determine the incidence of arterial false aneurysms following hip surgery diagnosed and treated in our hospital between January 1995 and January 2010. We conducted a retrospective analysis of all patients undergoing hip surgery (osteosynthesis, hemiarthroplasty, total arthroplasty, or revision arthroplasty) under our care. To determine the incidence of arterial false aneurysm, we identified patients with abnormal bleeding through the surgical wound postoperatively. Out of the 11,839 patients undergoing hip surgery during the study period, 321 had abnormal bleeding that aroused suspicion of an associated vascular lesion. Among these, the presence of a false aneurysm requiring specific treatment was confirmed in eight patients. False aneurysms are a rare and occasionally severe complication of hip surgery that typically manifest with significant haemorrhage during the postoperative period. The management of these lesions by interventional radiology is associated with few complications and permits rapid patient stabilisation and early recovery, avoiding more aggressive and sometimes fruitless surgical exploration.

Pseudoaneurysm Accompanied by Crowe Type IV Developmental Dysplasia of the Hip: A Case Report

We report the case of a 72-year-old woman whose pseudoaneurysm was difficult to diagnose and treat. The patient had a history of congenital dislocated hip and was undergoing anticoagulation therapy with warfarin due to the mitral valve replacement. Her chief complaint was pain and enlargement of the left buttock, and the laboratory tests revealed severe anemia. However, her elderly depression confused her chief complaint, and she was transferred to a psychiatric hospital. Two months after the onset of the symptoms, she was finally diagnosed with a pseudoaneurysm by contrast-enhanced CT and angiography. IDC coils were used for embolization. A plain CT showed hemostasis as well as a reduced hematoma at 2 months after the embolization. The possible contributing factors for the pseudoaneurysm included bleeding due to warfarin combined with an intramuscular hematoma accompanied by Crowe type IV developmental dysplasia of the hip that led to an arterial rupture by impingement between pelvis and femoral head. Since the warfarin treatment could not be halted due to the valve replacement, embolization was chosen for her treatment, and the treatment outcome was favorable.