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Kuo F, Park J, Chow K, Chen A, Walsworth MK. Avoiding peripheral nerve injury in arterial interventions. ACTA ACUST UNITED AC 2020; 25:380-391. [PMID: 31310240 DOI: 10.5152/dir.2019.18296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arterial access sites to avoid injury.
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Affiliation(s)
- Frank Kuo
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Park
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kira Chow
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Alice Chen
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Matthew K Walsworth
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
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Maybody M, Madoff DC, Thornton RH, Morales SA, Moskowitz CS, Hsu M, Brody LA, Brown KT, Covey AM. Catheter-directed endovascular application of thrombin: Report of 3 cases and review of the literature. Clin Imaging 2017; 42:96-105. [PMID: 27936421 PMCID: PMC5499980 DOI: 10.1016/j.clinimag.2016.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/15/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE To report 3 new cases of catheter-directed endovascular application of thrombin and explore trends by analysis of published case series. MATERIALS AND METHODS Institutional Review Board approved this retrospective study. All cases of non-tumoral arterial embolization performed from January 2003 to January 2015 at our institution were retrospectively reviewed. Thrombin was used in 7 of 589 cases. In 3 cases intra arterial thrombin was injected via catheter to treat active hemorrhage. Four cases were excluded due to percutaneous injection into visceral pseudoaneurysms (n=3) and making ex vivo autologous clot to be injected via catheter (n=1). Fisher's exact and the Wilcoxon rank sum tests were used to assess for association with acute nontarget thrombosis. RESULTS Catheter-directed thrombin was used in 3/589 (0.5%) cases at our institution. All three cases were technically successful with no further bleeding (100%). Nontarget thrombosis of proximal branches occurred in 2 patients (67%) with no significant clinical consequences. Including our 3 cases, a total of 28 cases were reviewed. Of the variables examined-location (p=0.99), size (p=0.66) and etiology of vascular lesion (p=0.92), pseudoaneurysm neck anatomy (p=0.14), thrombin units (p=0.47), volume (p=0.76) or technique of use of small doses (p=0.99), use of other embolic material (p=0.67) and use of adjunct techniques (p=0.99)-none were found to be significantly associated with acute nontarget thrombosis. Technical success was 96% with no reports of reperfusion after treatment. CONCLUSIONS Catheter-directed endovascular thrombin can be an additional tool to treat pseudoaneurysms not amenable to conventional embolization. Further studies are required to optimize technique and outcomes.
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Affiliation(s)
- Majid Maybody
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - David C Madoff
- Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA.
| | - Raymond H Thornton
- Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA.
| | - Steven A Morales
- University of Iowa Hospitals and Clinics, Department of Radiology, 200 Hawkins Drive, Iowa City, IO 52242, USA.
| | - Chaya S Moskowitz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA.
| | - Meier Hsu
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA.
| | - Lynn A Brody
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - Karen T Brown
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - Anne M Covey
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
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Treatment of Posttraumatic Aortic Pseudoaneurysms Using Detachable Hydrogel-Coated Coils. ACTA ACUST UNITED AC 2009; 66:1735-8. [DOI: 10.1097/01.ta.0000238622.53583.f1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Geckeis K, Eggebrecht H, Schmermund A, Kühl H, Niebel W, Omlor G, Erbel R. Percutaneous Repair of Abdominal Aortic Pseudoaneurysm by Catheter-Based Delivery of Thrombin. J Endovasc Ther 2006; 13:264-8. [PMID: 16643084 DOI: 10.1583/05-1767r.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To present a case in which thrombin was injected percutaneously to treat an aortic pseudoaneurysm. CASE REPORT A 63-year-old man developed a large pseudoaneurysm in the abdominal aorta after surgical fenestration and patch aortoplasty for acute type B aortic dissection with malperfusion syndrome. Transcatheter delivery of 1500 units of thrombin resulted in complete thrombosis of the pseudoaneurysm sac. No complications occurred. Twelve months after the procedure, the pseudoaneurysm was completely resolved on computed tomography. CONCLUSION Thrombin continues to prove its safety and efficacy for the treatment of pseudoaneurysms at numerous anatomical sites, including the abdominal aorta.
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Affiliation(s)
- Katrin Geckeis
- Department of Cardiology, West-German Heart Center Essen, Germany.
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Saad NEA, Saad WEA, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics 2006; 25 Suppl 1:S173-89. [PMID: 16227490 DOI: 10.1148/rg.25si055503] [Citation(s) in RCA: 334] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pseudoaneurysms are common vascular abnormalities that represent a disruption in arterial wall continuity. Some complications associated with pseudoaneurysms develop unpredictably and carry high morbidity and mortality rates. The advent of new radiologic techniques with a greater sensitivity for asymptomatic disease has allowed more frequent diagnosis of pseudoaneurysms. Conventional angiography remains the standard of reference for diagnosis but is an invasive procedure, and noninvasive diagnostic modalities (eg, ultrasonography [US], computed tomographic angiography, magnetic resonance angiography) should be included in the initial work-up if possible. A complete work-up will help in determining the cause, location, morphologic features, rupture risk, and clinical setting of the pseudoaneurysm; identifying any patient comorbidities; and evaluating surrounding structures and relevant vascular anatomy, information that is essential for treatment planning. Therapeutic options have evolved in recent years from the traditional surgical option toward a less invasive approach and include radiologic procedures such as US-guided compression, US-guided percutaneous thrombin injection, and endovascular management (embolization, stent-graft placement). The use of noninvasive treatment has led to a marked decrease in the morbidity and mortality rates for pseudoaneurysms.
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Affiliation(s)
- Nael E A Saad
- Departments of Radiology, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, USA.
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Maleux G, Bielen D, Heye S, Van Schaeybroeck P, Nevelsteen A, Vanbeckevoort D. Translumbar thrombin embolization of an aortic pseudoaneurysm complicating lumbar disk surgery. J Vasc Surg 2005; 42:163-7. [PMID: 16012467 DOI: 10.1016/j.jvs.2005.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a case of translumbar embolization of an aortic pseudoaneurysm complicating lumbar disk surgery. The iatrogenic pseudoaneurysm was initially treated by open repair, but due to failure of this treatment, we opted for direct translumbar thrombin injection under computed tomography (CT) guidance. The patient recovered completely, and follow-up CT scans showed progressive shrinkage of the residual retroperitoneal hematoma. This minimally invasive treatment should be considered in selected cases as a valuable treatment option for pseudoaneurysms that arise from the aorta.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Gasthuisberg, Belgium.
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Tshomba Y, Melissano G, Civilini E, Setacci F, Chiesa R. Fate of the Visceral Aortic Patch After Thoracoabdominal Aortic Repair. Eur J Vasc Endovasc Surg 2005; 29:383-9. [PMID: 15749039 DOI: 10.1016/j.ejvs.2004.12.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2004] [Accepted: 12/06/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the fate of a visceral aortic patch (VAP) in patients that underwent thoracoabdominal aortic aneurysm (TAAA) repair. METHODS We reviewed 204 consecutive patients (158 M, 46 F) treated for TAAA between 1988 and 2004. We performed VAP in 182 cases. Among the 149 survivors at 6 months, we followed 138 cases, mean follow-up 7 years (range 0.6-16 years). The mean graft diameter we used was 29mm (range 24-34mm) from 1988 to 1999 (83 patients), and 21.7mm (range 16-24mm) from 2000 to 2003 (55 patients). In 23% of cases we performed a separate bypass to the left renal artery. RESULTS We observed 16 (12%) VAP dilatations (<5cm), 6 (4%) VAP aneurysms (>5cm) and one VAP pseudoaneurysm, at a mean time of 6 years after atherosclerotic TAAA was atherosclerotic repair. There were no VAP dilatations/aneurysms in the group of patients with separate left renal revascularization. Five VAP aneurysms were treated electively. In four cases the operation was performed with thoracophrenolaparotomy, in one case with a bilateral subcostal laparotomy. In all cases the visceral aorta was re-grafted. Reimplantation of a single undersized VAP was performed in one case, separate revascularization of visceral arteries was performed in the other four cases. Selective intraoperative hypothermic perfusion of visceral and renal arteries was used in all the patients. There was 1 perioperative death; 2 patients with preoperative renal failure required dialysis. The last VAP aneurysm has remained asymptomatic and stable at annual CT surveillance. The VAP pseudoaneurysm was successfully treated with an emergency thoracophrenolaparotomy and refashioning the left side suture line. CONCLUSIONS Aneurysm of VAP is not uncommon in the patients operated on using larger grafts with a single VAP that includes the LRA (7.4%, 5/67 cases). Its treatment carries significant morbidity and mortality.
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Affiliation(s)
- Y Tshomba
- Vita-Salute University, Scientific Institute H. San Raffaele, Via Olgettina, 20132 Milan, Italy.
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Bashir F, Quaife R, Carroll JD. Percutaneous closure of ascending aortic pseudoaneurysm using Amplatzer septal occluder device: The first clinical case report and literature review. Catheter Cardiovasc Interv 2005; 65:547-51. [PMID: 15973675 DOI: 10.1002/ccd.20422] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report the first case of the use of an Amplatzer septal occluder device to close a large ascending aortic pseudoaneurysm. The patient had a complex cardiac history with redo coronary artery bypass graft surgery, severe left ventricular dysfunction, and end-stage renal disease requiring hemodialysis. The procedure was successfully performed under fluoroscopic and 2D/3D transthoracic echocardiographic guidance. Six-week follow-up with both transthoracic echocardiography and MRI showed the device was in proper position with complete closure of the pseudoaneurysm.
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Affiliation(s)
- Faran Bashir
- Division of Cardiology, University of Colorado Health Sciences Center, Denver, CO 80262, USA
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