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Khan K, Amir E, Akano O, Borucki J, Al Thaher A, Stather P, Ali T. Challenging the Controversy Surrounding Percutaneous Brachial Artery Access Related Complications: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2024:15385744241278048. [PMID: 39210681 DOI: 10.1177/15385744241278048] [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: 09/04/2024]
Abstract
BACKGROUND Endovascular therapy has become increasingly preferred in the diagnosis and treatment of various conditions. The choice of arterial access usually depends on the type of procedure being performed with most via the common femoral artery and increasingly via the radial artery. Percutaneous access via the brachial artery has however been approached with caution due to the perceived increased risk for development of complications. Percutaneous brachial artery access (pBAA) has insufficient evidence when compared to femoral and radial access, with no large-scale studies available. The objective of this study is to review the literature and report the clinical and radiological complications associated with pBAA. METHODS EMBASE, EMCARE, CINAHL and Medline were searched for existing data on the complications associated with pBAA. Systematic review and meta-analysis were carried out on the data of 31 studies. RESULTS The results of this systematic review and meta-analysis indicates that the probability of post procedural haematoma was 4.76%, haemorrhage 1.43%, perforation 1.11% pseudoaneurysm 1.06%, spasm 0.9%, thrombus 0.55%, neuropathy 0.53%, occlusion 0.51%, ischaemia 0.37% and infection 0.24 %. Non-target vessel puncture, stenosis and stroke had a 0% incidence among the assessed population. CONCLUSION This study provides evidence to support clinical decision making when it comes to the utility of pBAA in endovascular diagnosis or therapy. The results demonstrate that pBAA is relatively safe with a low incidence of serious complications and thereby provide the clinician with the option of an alternate access point when planning treatment.
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Affiliation(s)
- Khuzaima Khan
- Department of Radiology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | - Eiman Amir
- Department of Radiology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | - Omobolaji Akano
- Department of Radiology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | - Joseph Borucki
- Department of General Surgery, Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | | | - Philip Stather
- Department of Vascular Surgery, Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | - Tariq Ali
- Department of Interventional Radiology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
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2
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Mansouri MH, Mansouri P, Hashemi M, Hashemi SM, Mirshafiee S, Amirpour A. Compare efficacy and safety of autologous blood clot injection with C-clamp vascular closure device in treatment of iatrogenic pseudoaneurysm after femoral artery puncture. J Vasc Access 2024:11297298241273641. [PMID: 39180356 DOI: 10.1177/11297298241273641] [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: 08/26/2024] Open
Abstract
INTRODUCTION Iatrogenic femoral artery pseudoaneurysm (FAP) is a complication following femoral artery puncture, with an incidence rate of 0.2%-5.5% post-cardiac catheterization procedures. Management typically involves observation or interventional treatments such as ultrasound-guided compression (UGC) or ultrasound-guided thrombin injections. This study compares the efficacy and safety of ultrasound-guided autologous blood clot injection (UGCI) with C-clamp vascular closure device-assisted UGC in treating FAP. MATERIALS AND METHODS Conducted at a high-volume training and research center, this prospective study enrolled patients with iatrogenic FAP post-femoral artery puncture. Patients were randomized into two treatments: UGC with a C-clamp device or UGCI. Primary endpoints were thrombosis induction within 24 h, average procedure time, and length of hospital stay (LOS). RESULTS The study included 105 patients with 51 undergoing UGCI and 54 undergoing UGC. UGCI achieved a primary success rate of 96% versus 63% for UGC. The mean procedure duration for UGCI was significantly shorter (22 min) compared with UGC (49 min, p ⩽ 0.0001). LOS was also reduced in the UGCI group (1.5 days) compared to the UGC group (4.5 days). Complication rates were low for both procedures, with one deep vein thrombosis and one infection observed in the UGC group. CONCLUSION UGCI demonstrated to be a safe, efficient, and faster alternative for treating iatrogenic FAPs with a higher success rate, reduced LOS, and similar low complication rates compared to UGC. This study suggests that UGCI could be considered a preferred method for the management of FAP post-femoral artery catheterization.
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Affiliation(s)
- Mohammad Hadi Mansouri
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pejman Mansouri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hashemi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Shayan Mirshafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Amirpour
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Yamauchi H, Kageyama S, Kojima A, Morita H, Ohashi T. Hybrid Repair of Infected Femoral Artery Pseudoaneurysm: Stent Graft Placement and Artificial Graft Replacement. Cureus 2024; 16:e65657. [PMID: 39077675 PMCID: PMC11285423 DOI: 10.7759/cureus.65657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 07/31/2024] Open
Abstract
A femoral artery pseudoaneurysm is the most prevalent complication of femoral access due to the artery's accessibility and frequent use for catheterization and blood tests. An infected femoral artery pseudoaneurysm is often life-threatening and challenging to manage. A 70-year-old male with a history of tongue cancer treatments, including resection, lymph node dissection, and radiation chemotherapy, visited his previous physician for a fever and was prescribed oral antibiotics, but the fever persisted, accompanied by pain and a mass in the left groin. An enhanced CT revealed an infected pseudoaneurysm of the left femoral artery. The fever's etiology was unclear but likely stemmed from a blood draw from the femoral artery during a prior visit, resulting in a pseudoaneurysm that became infected. The patient was transferred to our hospital due to management challenges. Blood cultures from the previous hospital were positive, and laboratory tests indicated an active infection. The initial strategy was to continue antibiotic therapy to control the infection. After approximately a month of antibiotic treatment, blood cultures remained negative, and laboratory results improved significantly. However, the aneurysm had clearly enlarged, necessitating emergency surgery. Typically, surgical intervention requires opening the abdomen to replace the external iliac artery to its extent, a considerably invasive procedure for the patient. Thus, we opted for a hybrid treatment, implanting a stent graft from the external iliac artery to the proximal common femoral artery and replacing artificial blood vessels from there to the femoral artery bifurcation. The postoperative course was favorable. In this case, we provided the optimal treatment for the patient's condition, despite the impossibility of a radical cure due to the cancer's progression. We believe the infected pseudoaneurysm was adequately controlled, and the hybrid therapy is effective for patients who cannot endure more invasive treatments.
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Affiliation(s)
- Hirotaka Yamauchi
- Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
| | - Soichiro Kageyama
- Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
| | - Akinori Kojima
- Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
| | - Hideo Morita
- Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
| | - Takeki Ohashi
- Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
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4
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Tsurumaki N, Suzuki M, Izumi S, Hojo M. Rupture of a bronchial artery pseudoaneurysm after radiotherapy. BMJ Case Rep 2024; 17:e259825. [PMID: 38471708 PMCID: PMC10936474 DOI: 10.1136/bcr-2024-259825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Affiliation(s)
- Nozomu Tsurumaki
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| | - Manabu Suzuki
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| | - Shinyu Izumi
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
| | - Masayuki Hojo
- Respiratory Medicine, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Japan
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5
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Patel RK, Alagapan A, Tripathy T, Vats P, Rangarh P, Mohanty S, Sathia S. Lower extremity pseudoaneurysms and their interventional radiological management: a pictorial review. Emerg Radiol 2023:10.1007/s10140-023-02151-8. [PMID: 37335348 DOI: 10.1007/s10140-023-02151-8] [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: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
Lower extremity pseudoaneurysms (PsAs) are mostly developed after traumatic or iatrogenic injury to the arteries. Unless treated, they can be complicated by adjacent mass effects, distal embolism, secondary infection, and rupture. Imaging helps in the diagnosis and planning of therapeutic intervention. Ultrasonography (USG) is often diagnostic, while CT angiography aids in vascular mapping required for intervention. Image-guided therapy offers to manage these pseudoaneurysms in a minimally invasive approach, obviating the need for surgery. A smaller, superficial, and narrow-necked PsA can easily be managed with local USG-guided compression or thrombin injection. When the percutaneous approach is not a feasible option, PsA from expendable arteries can also be managed with coiling or glue injection. Wide-necked PsA from an unexpendable artery necessitates stent graft placement, although coiling of the neck may be a viable and cheaper alternative for a long- and narrow-necked PsA. Presently, vascular closure devices are also used to seal a small arterial rent through a direct percutaneous approach. This pictorial review entails various techniques to deal with lower extremity pseudoaneurysms. An idea about the various intervention radiological approaches will help in choosing appropriate methods to tackle lower extremity pseudoaneurysms.
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Affiliation(s)
- Ranjan Kumar Patel
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019
| | - Alamellu Alagapan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019
| | - Taraprasad Tripathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019.
| | - Prayas Vats
- Department of Interventional Radiology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Pulkit Rangarh
- Department of Vascular and Interventional Radiology, Asian Institute of Medical Sciences, Uttar Pradesh, Faridabad, India
| | - Satyapriya Mohanty
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Siddharth Sathia
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
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6
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Lee SH, Kim DR, Lee JS, Nam IC, Ko SY. [Delayed Bilateral Common Femoral Pseudoaneurysm after Percutaneous Access with Interventional Management: A Case Report]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:705-712. [PMID: 37324985 PMCID: PMC10265233 DOI: 10.3348/jksr.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 06/17/2023]
Abstract
Common femoral artery pseudoaneurysm is a potentially serious complication of peripheral angiography. There have been few prior reports of simultaneous pseudoaneurysm in both common femoral arteries after percutaneous access. Here we report the case of a 58-year-old male patient who presented with phlegmon or abscess a few days after bilateral femoral access, after which newly developed bilateral femoral pseudoaneurysm with wide neck was observed on CT angiography 2 months after infection treatment. Because the patient refused surgery for pseudoaneurysm, a stent-graft was inserted in the left side, and percutaneous thrombin injection under US guidance with balloon occlusion was performed for the right side. Most pseudoaneurysms occur immediately after the causative procedure. However, there have been some cases in which pseudoaneurysms may occur several weeks or months later; it is therefore necessary to check the risk factors and to carefully observe the hemostasis site.
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7
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Tong F, Sun Z. Strategies for Safe Implantation and Effective Performance of Single-Chamber and Dual-Chamber Leadless Pacemakers. J Clin Med 2023; 12:jcm12072454. [PMID: 37048538 PMCID: PMC10094832 DOI: 10.3390/jcm12072454] [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: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
Leadless pacemakers (LPMs) have emerged as an alternative to conventional transvenous pacemakers to eliminate the complications associated with leads and subcutaneous pockets. However, LPMs still present with complications, such as cardiac perforation, dislodgment, vascular complications, infection, and tricuspid valve regurgitation. Furthermore, the efficacy of the leadless VDD LPMs is influenced by the unachievable 100% atrioventricular synchrony. In this article, we review the available data on the strategy selection, including appropriate patient selection, procedure techniques, device design, and post-implant programming, to minimize the complication rate and maximize the efficacy, and we summarize the clinical settings in which a choice must be made between VVI LPMs, VDD LPMs, or conventional transvenous pacemakers. In addition, we provide an outlook for the technology for the realization of true dual-chamber leadless and battery-less pacemakers.
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Affiliation(s)
- Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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8
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Ullmark G, Ribers H, Haller O. Management of bleeding with a temporary arterial occlusion balloon in revision total hip arthroplasty. Hip Int 2023; 33:262-266. [PMID: 33885334 DOI: 10.1177/11207000211011363] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE Perioperative bleeding is an undesirable surgical phenomenon. An effective way of diminishing bleeding is by use of a temporary arterial occlusion balloon (TAOB) to produce regional hypotension. We analysed TAOB-related complications at our institution occurring with total hip arthroplasties between years 2000 and 2016. We also compared the effect on bleeding for a TAOB group and a matched group during this same time. PATIENTS AND METHODS 76 consecutive cases had a total hip arthroplasty (THA) combined with a TAOB. In an analysis of all complications connected to the use of TAOB, 48 of them were revision THAs. The matched reference group consisted of 20 patients with revision surgery, but without TAOB. We analysed and compared perioperative bleeding, surgery, and balloon occlusion time for these 2 groups. RESULTS No thromboembolic complications or other severe complications were recorded. 1 case had bleeding from the insertion site after catheter removal. 3 cases had balloon failure without the consequences of this complication. The TAOB group had significantly less haemoglobin loss, total perioperative bleeding, bleeding per minute, and total transfusion than the matched reference group. INTERPRETATION The use of TAOB in elective THA surgery is safe and effective in reducing intraoperative bleeding.
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Affiliation(s)
- Gösta Ullmark
- Department of Orthopaedics, Gävle Hospital and Center for Research & Development County Council of Gävleborg, Gävle, Sweden
| | - Hanna Ribers
- Department of Orthopaedics, Gävle Hospital and Center for Research & Development County Council of Gävleborg, Gävle, Sweden
| | - Olov Haller
- Department of Radiology, Gävle Hospital, Gävle, Sweden
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9
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Tayebi P, Mahmoudlou F, Ershad N. Autologous Blood-Clot Embolisation of Iatrogenic Femoral Artery Pseudoaneurysm Caused by Arterial Sheath Placement; A Case Report. Vasc Endovascular Surg 2023:15385744231152707. [PMID: 36688265 DOI: 10.1177/15385744231152707] [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: 01/24/2023]
Abstract
Iatrogenic Femoral Artery Pseudoaneurysm (FAP) is a common complication that occurs in diagnostic and therapeutic catheterization procedures and can cause morbidity and even mortality in patients. Aneurysm larger than 2 cm, symptomatic or complicated should be treated. Here we report a 59-year-old man with post-catheterization FAP following femoral artery angiography, treated successfully by direct transcatheter autologous blood clot embolisation. To the best of our knowledge, our case report is the first to demonstrate that FAP can be successfully treated endovascularly by autologous blood clot embolisation.
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Affiliation(s)
- Pouya Tayebi
- Department of Vascular and Endovascular Surgery, Rouhani Hospital, 114456Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Mahmoudlou
- Student Research Committee, 114456Babol University of Medical Sciences, Babol, Iran
| | - Negin Ershad
- Department of Surgery, 114456Babol University of Medical Sciences, Babol, Iran
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10
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Transaneurysmal Occlusion of Complicated Common Femoral Artery Pseudoaneurysms Using the Angio-Seal Closure Device-A Promising Technique. Cardiovasc Intervent Radiol 2023; 46:268-273. [PMID: 36526800 PMCID: PMC9892075 DOI: 10.1007/s00270-022-03332-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Pseudoaneurysm (PSA) developing after catheter examinations is one of the most frequent vascular complications and a nonsurgical technique with utmost low risk of complications is warranted. Our aim was to investigate the technical feasibility, success, and safety of transaneurysmal occlusion of complicated post-interventional common femoral artery (CFA) PSA using the Angio-Seal Closure Device (ASCD) and a technique that we describe as the transaneurysmal (TA) maneuver. MATERIAL AND METHODS We used the Angio-Seal (Terumo, Tokyo, Japan) Closure System to manage complicated PSAs in patients who would otherwise have needed surgery after failure of all conservative therapies. The TA maneuver was performed in 14 consecutive patients from July 2021 to July 2022. After ultrasound-guided puncture of the PSA close to its neck, the CFA was entered radiographically with micro-guidewires, and the neck of the PSA was closed with the ASCD after changing the sheaths and wires. All patient had to wear a pressure dressing until the next day, when successful closure was verified by sonography. RESULTS All procedures were performed with technical success and without any complications. No patient had to undergo surgery. All sonographies on the next day confirmed complete absence of perfusion within the PSA and normal flow conditions of the CFA and vessels below. CONCLUSION The TA maneuver a promising minimally invasive procedure for closing complicated PSA of the CFA after catheter examination.
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11
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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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12
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Sokhal BS, Ma Y, Rajagopalan S. Femoral artery aneurysms. Br J Hosp Med (Lond) 2022; 83:1-10. [PMID: 36594777 DOI: 10.12968/hmed.2022.0258] [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: 12/14/2022]
Abstract
True aneurysms are dilatations of blood vessels, bounded by the tunica intima, tunica media and tunica adventitia. False aneurysms are dilatations bounded by the tunica adventitia only, and are more common than true aneurysms. The femoral artery is the second most common location for true peripheral artery aneurysms, and the most common site of false aneurysms. If left untreated, devastating complications can occur, such as infection, rupture, ischaemia and limb loss. Femoral artery aneurysms should be identified early and managed by a vascular specialist. This article outlines the evidence for the epidemiology, investigation and management of femoral artery aneurysms.
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Affiliation(s)
| | - Yangmyung Ma
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Sriram Rajagopalan
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
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13
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Watanabe S, Kanazawa R, Uchida T, Higashida T, Yamazaki K, Kono T. Endovascular Embolization of Femoral Pseudoaneurysm Associated with Therapeutic and Diagnostic Neuroendovascular Procedures. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 17:8-14. [PMID: 37501887 PMCID: PMC10370512 DOI: 10.5797/jnet.oa.2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/10/2022] [Indexed: 07/29/2023]
Abstract
Objective We aimed to evaluate the usefulness of endovascular embolization for femoral iatrogenic pseudoaneurysms (PAs) following therapeutic and diagnostic neuroendovascular procedures. Methods This study included 12 patients with femoral PA due to femoral puncture at our department between May 2014 and April 2021. We performed an analysis of baseline characteristics, treatment, and outcome of these cases. Results Endovascular embolization was performed in 10 of the 12 PAs using coils and/or N-butyl-2-cyanoacrylate. Of these, 10 PAs were treated with endovascular embolization and 9 were successfully occluded, whereas complete occlusion was not achieved in 1 case of PA (success rate: 90%). No new intraoperative or postoperative complications or postoperative recurrences occurred. Conclusion Endovascular embolization for PA can be immediately performed under local anesthesia without discontinuation of antithrombotic therapy and may be a safe and effective option for access site complication treatment.
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Affiliation(s)
- Saiko Watanabe
- Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
| | - Ryuzaburo Kanazawa
- Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
| | - Takanori Uchida
- Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
| | - Tetsuhiro Higashida
- Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
| | - Kei Yamazaki
- Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
| | - Takao Kono
- Department of Neurosurgery, Nagareyama Central Hospital, Nagareyama, Chiba, Japan
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14
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Cho HJ, Jeon CH, Kim MH, Lee JM, Hwang JK. Ultrasonography-guided endovascular management of femoral artery pseudoaneurysm after unintended dialysis catheterization with suture-mediated vascular closure devices. J Vasc Access 2022:11297298221130895. [PMID: 36262020 DOI: 10.1177/11297298221130895] [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: 12/07/2022] Open
Abstract
Although iatrogenic pseudoaneurysm is an infrequent complication, it can be life threatening if ruptured. There are several treatment methods for managing this complication. This case report demonstrates a technique using ultrasonography-guided suture-mediated vascular closure devices without angiography to successfully treat iatrogenic superficial femoral pseudoaneurysm following an unintended hemodialysis catheter insertion. In particular, when it is difficult to use a contrast due to a patient's condition as in this case, suture-mediated vascular closure device with ultrasonography guidance can be used as a therapeutic method.
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Affiliation(s)
- Hyung-Jin Cho
- Division of Vascular and Tranplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Ho Jeon
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Hyeong Kim
- Division of Vascular and Tranplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Min Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Kye Hwang
- Division of Vascular and Tranplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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15
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Sarkadi H, Csőre J, Veres DS, Szegedi N, Molnár L, Gellér L, Bérczi V, Dósa E. Incidence of and predisposing factors for pseudoaneurysm formation in a high-volume cardiovascular center. PLoS One 2021; 16:e0256317. [PMID: 34428222 PMCID: PMC8384184 DOI: 10.1371/journal.pone.0256317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate factors associated with pseudoaneurysm (PSA) development. Methods Between January 2016 and May 2020, 30,196 patients had invasive vascular radiological or cardiac endovascular procedures that required arterial puncture. All patients with PSA were identified. A matched (age, gender, and type of the procedure) control group of 134 patients was created to reveal predictors of PSA formation. Results Single PSAs were found in 134 patients. Fifty-three PSAs developed after radiological procedures (53/6555 [0.8%]), 31 after coronary artery procedures (31/18038 [0.2%]), 25 after non-coronary artery cardiac procedures (25/5603 [0.4%]), and 25 due to procedures in which the arterial puncture was unintended. Thirty-four PSAs (25.4%) were localized to the upper extremity arteries (vascular closure device [VCD], N = 0), while 100 (74.6%) arose from the lower extremity arteries (VCD, N = 37). The PSA prevalence was 0.05% (10/20478) in the radial artery, 0.1% (2/1818) in the ulnar artery, 1.2% (22/1897) in the brachial artery, and 0.4% (99/22202) in the femoral artery. Treatments for upper and lower limb PSAs were as follows: bandage replacement (32.4% and 14%, respectively), ultrasound-guided compression (11.8% and 1%, respectively), ultrasound-guided thrombin injection (38.2% and 78%, respectively), and open surgery (17.6% and 12%, respectively). Reintervention was necessary in 19 patients (14.2%). The prevalence of PSA for the punctured artery with and without VCD use was 37/3555 (1%) and 97/27204 (0.4%), respectively (OR, 2.94; 95% CI, 1.95–4.34; P<0.001). The effect of red blood cell (RBC) count (P<0.001), hematocrit value (P<0.001), hemoglobin value (P<0.001), international normalized ratio (INR; P<0.001), RBC count—INR interaction (P = 0.003), and RBC count—VCD use interaction (P = 0.036) on PSA formation was significant. Conclusion Patients in whom the puncture site is closed with a VCD require increased observation. Preprocedural laboratory findings are useful for the identification of patients at high risk of PSA formation.
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Affiliation(s)
- Hunor Sarkadi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Csőre
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dániel Sándor Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Viktor Bérczi
- Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Hungarian Vascular Radiology Research Group, Semmelweis University, Budapest, Hungary
- * E-mail:
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Affiliation(s)
| | - John Pascoe
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Joseph John
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Tom Coats
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
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Zilinyi RS, Sethi SS, Parikh MA, Parikh SA. Iatrogenic Arteriovenous Fistula Following Femoral Access Precipitating High-Output Heart Failure. JACC Case Rep 2021; 3:421-424. [PMID: 34317549 PMCID: PMC8311044 DOI: 10.1016/j.jaccas.2020.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
Iatrogenic complications may manifest in a variety of ways. We present the case of an 86-year-old woman who underwent a percutaneous coronary intervention with a drug-eluting stent for non-ST-segment elevation myocardial infarction followed by leadless pacemaker placement through a femoral approach. Her post-procedure course was complicated by new onset high-output heart failure secondary to iatrogenic arteriovenous fistula formation, requiring covered stent placement. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Robert S Zilinyi
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Sanjum S Sethi
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Manish A Parikh
- Division of Cardiology, Department of Medicine, Brooklyn Methodist Hospital/ Weill Cornell Medical, New York, New York, USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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Kim MS, Kim GB, Kwon HW, An HS, Song MK, Lee SY, Bae EJ. Successful Sonography-Guided Thrombin Injection Treatment for Scrotal Hematoma after Cardiac Catheterization in an Adolescent. Chonnam Med J 2021; 57:87-88. [PMID: 33537224 PMCID: PMC7840354 DOI: 10.4068/cmj.2021.57.1.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Min Seung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Hye Won Kwon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Hyo Soon An
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Mi Kyung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, Korea
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Matsubara N, Fukuo Y, Yoshimura K, Kashiwagi H, Futamura G, Park Y, Kuroiwa T, Wanibuchi M. A Case of Puncture-Site Giant Pseudoaneurysm Following Recanalization Therapy for Acute Ischemic Stroke: Marked Growth and Rupture of a Femoral Artery Pseudoaneurysm. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:366-372. [PMID: 37502415 PMCID: PMC10370960 DOI: 10.5797/jnet.cr.2020-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/21/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of the marked growth and rupture of a giant femoral artery pseudoaneurysm at the puncture site that developed after recanalization therapy for acute basilar artery occlusion. Case Presentation A 79-year-old woman developed acute ischemic stroke due to atherosclerotic basilar artery occlusion. Endovascular intervention was performed and recanalization of the affected vessel was achieved. However, she developed brainstem infarction and consciousness disturbance persisted. The femoral access site was treated using a vascular closure device at the end of the procedure. A right femoral artery pseudoaneurysm of approximately 5 cm in size was found 2 weeks after onset during the examination for deep venous thrombosis with right lower extremity edema. Manual compression did not achieve thrombotic occlusion of the aneurysm due to obesity and leg edema. Considering the severe neurological status of the patient, the pseudoaneurysm was followed up without surgical treatment. Dual antiplatelet therapy and direct oral anticoagulant agents were administered. Four weeks after onset, the pseudoaneurysm presented rapid growth, and on the 35th day after onset, it exceeded 15 cm in size and ruptured, causing hemorrhagic shock with massive femoral hematoma. Pseudoaneurysm resection and hematoma removal were performed surgically, and the patient recovered. However, improvement of neurological manifestations was poor and the modified Rankin Scale at 90 days after onset was 5. Conclusion A case of giant femoral artery pseudoaneurysm following recanalization therapy for acute ischemic stroke was reported. Pseudoaneurysms at the puncture site can rupture after significant growth. Curative treatment is required without delay.
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Affiliation(s)
- Noriaki Matsubara
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yusuke Fukuo
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kohei Yoshimura
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hideki Kashiwagi
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Gen Futamura
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yangtae Park
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Toshihiko Kuroiwa
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
- Department of Neurosurgery, Tesseikai Neurosurgical Hospital, Shijonawate, Osaka, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
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Thapa P, Karmacharya R, Singh A, Vaidya S, Dahal S, Dhakal P, Bhandari N, Bade S. A case report of iatrogenic radial artery true aneurysm. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_12_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Paul S. Iatrogenic arteriovenous fistula involving the radial artery and cephalic vein of the right upper limb: Manifesting as concomitant aneurysms of the same. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_46_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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