1
|
Jipa AM, Makary MS. Access Site Femoral Arterial Pseudoaneurysm. J Vasc Interv Radiol 2024; 35:629-630. [PMID: 38521563 DOI: 10.1016/j.jvir.2023.12.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/25/2024] Open
Affiliation(s)
- Andrei M Jipa
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| |
Collapse
|
2
|
Takajo D, Newkirk B, Shahanavaz S. Incidence, risk factors, and management following cardiac catheterization via carotid and axillary artery approaches: A single-center experience on pseudoaneurysms in young infants. Catheter Cardiovasc Interv 2024; 103:580-586. [PMID: 38353500 DOI: 10.1002/ccd.30966] [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] [Received: 06/07/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Use of alternate access for complex neonatal interventions has gained acceptance with carotid and axillary artery access being used for ductal and aortic interventions. METHODS This study was a retrospective, single-center study at Cincinnati Children's Hospital Medical Center. The study included infants, aged ≤90 days, who underwent cardiac catheterization with either carotid or axillary artery access between 2013 and 2022. Data encompassing demographics, clinical information, catheterization data, and the incidence of pseudoaneurysm as a procedural complication were collected. RESULTS Among 29 young infants (20 males, 69%), 4 out of 15 patients (27%) who underwent the carotid approach developed pseudoaneurysms, while 1 out of 14 patients (7.1%) who underwent the axillary approach developed one. Two patients required transcatheter intervention due to enlargement of pseudoaneurysms, involving the placement of transarterial flow-diverting stent and occlusion of left common carotid artery. Longer sheath in-to-out time (135 vs. 77 min, p = 0.001), and higher closing activated clotting times (ACT) (268 vs. 197 s, p = 0.021) were observed among patients with pseudoaneurysms compared to those without. CONCLUSIONS Young infants with alternative access via the carotid and axillary arteries may be at risk of pseudoaneurysm formation during longer procedures and with higher ACTs for closure. Ultrasound-guided compression can be employed to prevent the progression and in resolution of these lesions.
Collapse
Affiliation(s)
- Daiji Takajo
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Betsy Newkirk
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shabana Shahanavaz
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
3
|
Asemota D, Kassam Z, Voto C, Mangla A, Coven D, Lasic Z. Pseudoaneurysm Formation After "Preclose"-Assisted Impella Insertion in a Patient With Cardiogenic Shock. J Med Cases 2022; 13:202-206. [PMID: 35655626 PMCID: PMC9119370 DOI: 10.14740/jmc3841] [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: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022] Open
Abstract
The use of mechanical support devices such as the Impella CP (Abiomed, Danvers, MA) is a growing form of treatment for patients with cardiogenic shock (CS). Despite the increase in usage, there remains a dearth in literature regarding potential complications. Vascular complications such as pseudoaneurysms (PAs) are rare but important potential complications that can occur with use of the Impella. We present Impella-assisted percutaneous coronary intervention (PCI) in a patient with CS, "Preclosed" with the Perclose ProGlide (Abbott, Plymouth, MN) device complicated by development of a PA. A 62-year-old male patient with a history of diabetes and hypertension presented to our emergency room (ER) with chest pain and electrocardiogram (ECG) findings consistent with an acute anterior wall ST-elevation myocardial infarction (STEMI). This was further complicated by refractory CS. The patient was urgently taken to the cardiac catherization laboratory. After exchange of sequential dilators, a single Perclose device was used prior to the insertion of the Impella sheath. The patient then underwent a successful Impella-assisted PCI of his left anterior descending artery. Upon stabilization of hemodynamics, the patient was taken to the catheterization laboratory for Impella removal. After removal of Impella, imaging detected extravasation of contrast, without development of hematoma, later confirmed to be a PA via computed tomography (CT) scans and ultrasound Doppler imaging. The PA was successfully managed with injection of thrombin. The PA was likely caused by shearing forces of the dilators, the 14-F Impella sheath and foot of the device. We propose deploying the Perclose device earlier in the process of dilating the access site to avoid such complication. This is one of the first case reports that detail the occurrence and management of a PA with Impella insertion.
Collapse
Affiliation(s)
- Daniel Asemota
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Zain Kassam
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Christian Voto
- Department of Medicine, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Aditya Mangla
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - David Coven
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Zoran Lasic
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| |
Collapse
|
4
|
Loh EJ, Allen R. Endovascular treatment of refractory iatrogenic femoral artery pseudoaneurysm using Amplatzer vascular plugs following unsuccessful retrograde Angio-Seal deployment. Indian J Radiol Imaging 2021; 29:211-214. [PMID: 31367094 PMCID: PMC6639869 DOI: 10.4103/ijri.ijri_332_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Eu Jhin Loh
- Department of General Surgery, Calvary Mater Hospital, Waratah, NSW, Australia
| | - Robert Allen
- Department of Medical Imaging, The Canberra Hospital, Garran, ACT, Australia
| |
Collapse
|
5
|
Rammos C, Rassaf T. Insight in the treatment of iatrogenic femoral artery pseudoaneurysms. VASA 2021; 50:163-164. [PMID: 33938229 DOI: 10.1024/0301-1526/a000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
6
|
Steppich B, Schürmann F, Bruskina O, Hadamitzky M, Kastrati A, Schunkert H, Fusaro M, Ott I. Ultrasound-guided thrombin injection for treatment of femoral artery pseudoaneurysm with concomitant AV-fistula - a retrospective single centre experience. VASA 2018; 47:507-512. [PMID: 30175945 DOI: 10.1024/0301-1526/a000732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Increasing volume of complex percutaneous endovascular procedures in highly anticoagulated patients generate a not negligible percentage of femoral pseudoaneurysms (PSA) with concomitant arteriovenous fistulas (AVF). While ultrasound-guided thrombin injection (UGTI) is the therapy of choice for PSA, concomitant AVF is regarded as a contraindication for UGTI, as venous thromboembolism is feared. In this retrospective, register-based cohort study, we report on and evaluate the use of UGTI for the treatment of PSA with AFV. PATIENTS AND METHODS All patients (n = 523), who underwent UGTI for femoral PSA at the German Heart Centre Munich from January 2011 until January 2018, were retrospectively reviewed for the presence of a concomitant AVF and outcomes were recorded. RESULTS Forty femoral PSA/AVFs treated by UGTI were identified. The mean enddiastolic arterial-flow-velocity above the AVF, an estimate of the AVF size, was 14.61 ± 1.7 cm/sec. The Majority of patients exhibited flow-velocities < 25 cm/sec (n = 31; 77.5 %) and were on either uninterrupted oral anticoagulation (n = 32; 80 %) or dual antiplatelet therapy (n = 8). Twenty-eight (70 %) PSA/AVFs could be successfully closed by UGTI. In eight multicompartmental PSAs, partial obliteration necessitated combined treatment with manual compression, while one partial occlusion was treated by observation. There were three failures, of which two underwent covered-stent-graft-implantation and one surgical repair. One DVT (2.5 %) occurred two days after UGTI in the by far largest AVF (60 cm/sec) included in the study. Besides two late PSA recurrences treated by surgery, no other complications were observed. AVF persisted in 65 %, all of them asymptomatic. The mean follow-up was 6 ± 15.5 months. CONCLUSIONS UGTI appears to be a treatment option in femoral PSA/AVF, at least under oral anticoagulation in small fistulas with enddiastolic arterial-flow-velocities ≤ 25 cm/sec. However, caution is necessary in larger AVFs, which should remain a contraindication for UGTI.
Collapse
Affiliation(s)
- Birgit Steppich
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | | | - Olga Bruskina
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Martin Hadamitzky
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Adnan Kastrati
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Heribert Schunkert
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Massimiliano Fusaro
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| | - Ilka Ott
- 1 Deutsches Herzzentrum der Technischen Universität München, Munich, Germany
| |
Collapse
|
7
|
Amin S, Schnabel J, Eldergash O, Chavan A. [Endovascular aneurysm repair (EVAR) : Complication management]. Radiologe 2018; 58:841-849. [PMID: 30083939 DOI: 10.1007/s00117-018-0437-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A variety of complications may be experienced during or after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). Acute procedure-related complications include injury to the access vessels, improper endograft placement, ischaemic and systemic complications as well as the postimplantation syndrome. Femoral pseudoaneurysms, endograft migration, kinking or occlusion, endoleaks and endograft infection are complications that have been observed at follow-up. Meticulous patient selection and preprocedural work-up can reduce the incidence of these complications. The majority of the complications, acute as well those at follow-up, can be dealt with endoluminally. It is of essence, however, that a wide variety of catheters, guidewires, stents, stent-grafts and embolics are readily available in the repertoire of the interventionalist. In a small number of patients with endograft occlusion or infection or with bleeding complications/pseudoaneurysms of the access vessels, open surgical intervention may become necessary. To obtain optimal results, close interdisciplinary co-operation, especially between the interventionist, the vascular surgeon and the anaesthetist is mandatory.
Collapse
Affiliation(s)
- S Amin
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - J Schnabel
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - O Eldergash
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - A Chavan
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland.
| |
Collapse
|
8
|
Abstract
Abstract. In addition to haematoma and arteriovenous fistula, the iatrogenic pseudoaneurysm is a common complication of vascular access that is caused by a perforation in the arterial wall. Iatrogenic pseudoaneurysms can progress in size and lead to rupture and active bleeding. Over the previous few decades, therapeutic methods have evolved from surgical repair to less invasive options, such as ultrasound-guided compression therapy (UGCT) and ultrasound-guided thrombin injection (UGTI). This paper presents an overview of the diagnostic and treatment modalities used in femoral pseudoaneurysms as well as a comprehensive summary of previous studies that analysed the success and complication rates of UGCT and UGTI.
Collapse
Affiliation(s)
- Maria Stolt
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Germany
| | | | - Joerg Herold
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Germany
| |
Collapse
|
9
|
Brachial Arterial Pressure Monitoring during Cardiac Surgery Rarely Causes Complications. Anesthesiology 2017; 126:1065-1076. [DOI: 10.1097/aln.0000000000001626] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Brachial arterial catheters better estimate aortic pressure than radial arterial catheters but are used infrequently because complications in a major artery without collateral flow are potentially serious. However, the extent to which brachial artery cannulation promotes complications remains unknown. The authors thus evaluated a large cohort of cardiac surgical patients to estimate the incidence of related serious complications.
Methods
The institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database and Perioperative Health Documentation System Registry of the Cleveland Clinic were used to identify patients who had brachial artery cannulation between 2007 and 2015. Complications within 6 months after surgery were identified by International Classification of Diseases, Ninth Revision diagnostic and procedural codes, Current Procedural Terminology procedure codes, and Society of Thoracic Surgeons variables. The authors reviewed electronic medical records to confirm that putative complications were related plausibly to brachial arterial catheterization. Complications were categorized as (1) vascular, (2) peripheral nerve injury, or (3) infection. The authors evaluated associations between brachial arterial complications and patient comorbidities and between complications and in-hospital mortality and duration of hospitalization.
Results
Among 21,597 qualifying patients, 777 had vascular or nerve injuries or local infections, but only 41 (incidence 0.19% [95% CI, 0.14 to 0.26%]) were potentially consequent to brachial arterial cannulation. Vascular complications occurred in 33 patients (0.15% [0.10 to 0.23%]). Definitely or possibly related infection occurred in 8 (0.04% [0.02 to 0.08%]) patients. There were no plausibly related neurologic complications. Peripheral arterial disease was associated with increased risk of complications. Brachial catheter complications were associated with prolonged hospitalization and in-hospital mortality.
Conclusions
Brachial artery cannulation for hemodynamic monitoring during cardiac surgery rarely causes complications.
Collapse
|
10
|
Mishra A, Rao A, Pimpalwar Y. Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms. J Clin Diagn Res 2017; 11:TC04-TC06. [PMID: 28571227 DOI: 10.7860/jcdr/2017/25582.9512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/10/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Arterial pseudoaneurysms are well known iatrogenic complication of percutaneous angiographic or interventional vascular procedures. In the past, the definitive treatment option was open surgical repair which is a relatively invasive procedure. In the last few years, Ultrasound (US) guided percutaneous thrombin injection has been gaining popularity as definitive treatment of pseudoaneurysms. AIM To evaluate efficacy and safety of US guided percutaneous injection of thrombin for treatment of iatrogenic femoral pseudoanurysms at a tertiary care interventional radiological and cardiology centre. MATERIALS AND METHODS A retrospective analysis was conducted on 38 consecutive patients, diagnosed to have iatrogenic femoral artery pseudoaneurysms by Doppler study, in the period from Jan 2013 to Jun 2016. All these patients were treated by US guided percutaneous injection of thrombin solution inside the pseudoaneurysm sac till contents became echogenic and flow inside the pseudoaneurysm stopped completely. One month further follow up in all these patients was done. RESULTS The dose of thrombin injected varied from 200-1000 IU (mean 300 IU). Immediate thrombosis was seen in all the pseusdoaneurysms. Follow up at 24-48 hours showed complete thrombosis and regression of pseudoaneurysm in all the patients except one in whom a small residual sac was seen which thrombosed completely on second thrombin injection. Further follow up at one month showed regression of aneurysms in all the cases. No significant post procedural clinically significant complications were seen in any of the patients. CONCLUSION US guided percutaneous thrombin injection is a highly successful and safe procedure for the treatment of iatrogenic femoral pseudoaneurysms.
Collapse
Affiliation(s)
- Atul Mishra
- Interventional Radiologist, Department of Radiodiagnosis and Interventional Radiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Akhilesh Rao
- Radiologist, Department of Radiodiagnosis and Interventional Radiology, Command Hospital (CC), Lucknow, Uttar Pradesh, India
| | - Yayati Pimpalwar
- Radiologist, Department of Radiodiagnosis and Interventional Radiology, Command Hospital (CC), Lucknow, Uttar Pradesh, India
| |
Collapse
|
11
|
Kontopodis N, Tsetis D, Tavlas E, Dedes A, Ioannou C. Ultrasound Guided Compression Versus Ultrasound Guided Thrombin Injection for the Treatment of Post-Catheterization Femoral Pseudoaneurysms: Systematic Review and Meta-Analysis of Comparative Studies. Eur J Vasc Endovasc Surg 2016; 51:815-23. [DOI: 10.1016/j.ejvs.2016.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/11/2016] [Indexed: 12/20/2022]
|
12
|
Filipiak-Strzecka D, Michalski B, Kasprzak JD, Lipiec P. Pocket-size imaging devices allow for reliable bedside screening for femoral artery access site complications. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2753-2758. [PMID: 25308945 DOI: 10.1016/j.ultrasmedbio.2014.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/08/2014] [Accepted: 06/30/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to validate pocket-size imaging devices (PSIDs) as a fast screening tool for detecting complications after femoral artery puncture. Forty patients undergoing femoral artery puncture for arterial access related to percutaneous coronary intervention were enrolled. Twenty-four hours after percutaneous coronary intervention, the involved inguinal region was assessed with PSIDs enabling 2-D gray-scale and color Doppler imaging. Subsequently, examination with a stationary high-end ultrasound system was performed to verify the findings of bedside examination in all patients. In 37 patients, PSID imaging had good diagnostic quality. False aneurysms (one asymptomatic) occurred in four patients, and all were recognized during bedside screening with PSID. One case of femoral artery thrombosis was confirmed with PSID and during standard ultrasonographic examination. Physical examination augmented with the quick bedside PSID examination had a sensitivity of 100% and specificity of 91%. PSID facilitated rapid bedside detection of serious access site complications in the vast majority of patients, including asymptomatic cases.
Collapse
Affiliation(s)
| | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | - Piotr Lipiec
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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: 36] [Impact Index Per Article: 3.6] [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.
Collapse
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.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Percutaneous fluoroscopically guided n-butyl cyanoacrylate (NBCA) injection for iatrogenic femoral arterial pseudoaneurysm under temporary balloon occlusion of arterial blood flow. Jpn J Radiol 2012; 30:365-9. [PMID: 22228148 DOI: 10.1007/s11604-011-0049-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 12/25/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of n-butyl cyanoacrylate (NBCA) injection under fluoroscopy for iatrogenic femoral artery pseudoaneurysms under temporary balloon occlusion. MATERIALS AND METHODS This treatment was approved by the Ethics Committee of our institute, and informed consent was obtained from the patients. Three male patients aged 82, 77, and 51 years developed femoral arterial pseudoaneurysms after catheterization. The pseudoaneurysms (diameter: 30, 12, and 15 mm; neck diameter: 1.8, 5.2, and 1.4 mm) were treated with percutaneous NBCA injection under fluoroscopy after failed ultrasound (US)-guided compression. First, a 4-Fr balloon catheter was inserted into the responsible femoral artery via the contralateral approach. An 18-gauge needle was placed in the pseudoaneurysm under US guidance, and a test injection of contrast medium was performed under fluoroscopic guidance to evaluate the extent of the pseudoaneurysm. NBCA-lipiodol (Lp) (ratio, 1:3) was then injected under balloon inflation. The balloon catheter was deflated and withdrawn after treatment. RESULTS The total volume of the injected NBCA-Lp was 0.4-1.5 ml. In each case, angiography immediately after NBCA-Lp injection showed eradication of the pseudoaneurysm, and color Doppler US revealed no blood flow signal. No complications were observed. Color Doppler US showed no recurrence in the three patients at their last follow-ups at 6, 12, and 12 months. CONCLUSION Percutaneous NBCA injection under fluoroscopy with the support of balloon inflation was safe, feasible, and useful for eradicating iatrogenic femoral artery pseudoaneurysms in three cases following failed US compression.
Collapse
|
16
|
Juranic J, Protic A, Sokolic J, Sustic A. Noninvasive technique of preventing thrombin escape into the systemic circulation during ultrasound-guided thrombin injection (UGTI) of the postcatheterization pseudoaneurysms. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Abstract
Introduction
Iatrogenic, postcatheterization pseudoaneurysms (PSA) of the femoral artery are a common complication after diagnostic and interventional procedures, with up to 7.7% incidence. Treatment includes surgical repair, ultrasound-guided compression (USGC) repair of the tract of the PSA, or recently ultrasound-guided thrombin injection (UGTI). Large (>1.8 cm) PSA sac with short (<3 mm) and/or wide (>3 mm) tract has higher complication ratio such as thromboembolic events after UGTI. Those cases are considered for protective balloon inflation during thrombin injection. The aim of our study was to evaluate the success rate of preventing escape of the thrombin during UGTI with simultaneous manual compression on ipsilateral iliac artery.
Methods and results
We reported 46 patients, 17 males and 29 females, aged 53–74 years, with iatrogenic, postcatheterization femoral artery PSA. Out of 46 patients, 7 were successfully treated with USGC. The rest of the patients were treated with UGTI with simultaneous manual compression on ipsilateral iliac artery to stop the flow in PSA, and to avoid thrombin escape into the native circulation. Success rate of UGTI with manual compression of ipsilateral iliac artery was 97% with the complication rate of 2.6%.
Conclusion
Our study confirms that UGTI treatment of the PSA of the femoral artery combined with compression of the ipsilateral iliac artery could be a safe and reliable method of the thrombin escape prevention into the systemic circulation, as good as more invasive and demanding methods.
Collapse
|
17
|
Preparation and characterization of injectable fibrillar type I collagen and evaluation for pseudoaneurysm treatment in a pig model. J Vasc Surg 2010; 52:1330-8. [DOI: 10.1016/j.jvs.2010.05.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 05/28/2010] [Accepted: 05/30/2010] [Indexed: 12/27/2022]
|
18
|
Hoke M, Koppensteiner R, Schillinger M, Haumer M, Minar E, Wiesbauer F, Huber CD, Mlekusch W. D-dimer testing in the diagnosis of transfemoral pseudoaneurysm after percutaneous transluminal procedures. J Vasc Surg 2010; 52:383-7. [PMID: 20488641 DOI: 10.1016/j.jvs.2010.02.275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 02/18/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Pseudoaneurysms are characterized by extravascular circulation and therefore may lead to an activation of the coagulation cascade. We investigated d-dimer levels in patients with and without postcatheterization femoral pseudoaneurysms and hypothesized that d-dimer levels correlate with the presence of pseudoaneurysms at the vascular access site. METHODS Patients with clinical suspected groin pseudoaneurysms after transluminal procedures were eligible. We compared prospectively-collected laboratory values of quantitative d-dimer testing in patients with and without pseudoaneurysms as assessed by color-coded duplex sonography. Furthermore, we measured the peak systolic velocity at the arterial fistula of each pseudoaneurysm. RESULTS In 48 (40%) of 120 consecutive patients, a pseudoaneurysm was found. The level of d-dimer values was significantly higher in patients with postcatheterization femoral pseudoaneurysms compared with controls (1.9 microg/mL [interquartile range (IQR), 1.34-2.78 microg/mL] vs 0.8 microg/mL [IQR, 0.53-1.14 microg/mL]; P < .001). Values of d-dimer below 0.67 microg/mL have been calculated with a sensitivity of 94% (87%-100%), a specificity of 38% (27%-50%), a positive predictive value of 50% (40%-60%), a negative predictive value of 90% (82%-99%), and a likelihood ratio of 1.52 (1.25-1.85) with regard to the presence of pseudoaneurysms. We also found a significant correlation of the peak systolic velocity at the arterial fistula and increasing d-dimer levels (r = 0.98, P < .0001). CONCLUSION We found a significantly higher level of d-dimer values in patients with femoral pseudoaneurysms at the vascular access site. Therefore, d-dimer levels could be a potential serological marker in the diagnosis of pseudoaneurysms. A confirmation is warranted in a larger patient sample.
Collapse
Affiliation(s)
- Matthias Hoke
- Department of Angiology, Medical University, Vienna, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Treatment of refractory iatrogenic femoral artery pseudoaneurysm with a vascular closure device. J Vasc Interv Radiol 2009; 20:1639-40. [PMID: 19854067 DOI: 10.1016/j.jvir.2009.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 08/20/2009] [Accepted: 08/26/2009] [Indexed: 10/20/2022] Open
|
20
|
Femoral pseudoaneurysms and current cardiac catheterization: evaluation of risk factors and treatment. Int J Cardiol 2008; 141:75-80. [PMID: 19095321 DOI: 10.1016/j.ijcard.2008.11.111] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 11/26/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We sought to determine the incidence of femoral pseudoaneurysm (FPA) following cardiac catheterization, identify the risk factors for FPA and factors influencing therapeutic strategy. METHODS 11,992 consecutive patients who underwent cardiac catheterization via femoral artery were studied over a period of four years in one University Hospital. Our prospective case control group analysis registered patients who developed FPA after the procedure. Patient-related factors, procedure related factors and peri-procedure treatment were compared between the two groups. RESULTS 76 FPA were diagnosed over the study period accounting for a global incidence of 0.6% procedures. By univariate analysis, interventional procedure (p<0.01), rhythmologic procedure (p=0.03), sheath>or=6F (p=0.04) and left groin puncture (p<0.001) were FPA risk factors. By multivariate analysis, interventional procedure (adjusted odds ratio [OR]=1.99; 95% confidence interval [CI]1.14-3.44 p=0.01) and left groin puncture (OR=4.65; 95% CI, 1.78-12.1 p=0.001) are independent predictive factors of FPA. FPA thrombosis was obtained by ultrasound guided compression (UGC) in 71% of the cases. By univariate analysis, PFA diameter larger than 4 cm (p<0.001), the use of anticoagulation (p<0.01) or GPIIbIIIa inhibitors (p=0.001) and UGC under anticoagulation (p=0.01) are predictive factors of need for FPA surgical repair. By multivariate analysis, FPA diameter>4 cm and use of GPIIbIIIa inhibitors are independent predictive factors of FPA's surgical treatment. Superficial femoral puncture was predictive of successful UGC both by uni and multivariate analysis. CONCLUSIONS Our study shows that FPA occurrence is mainly due to by procedure-related factors. FPA size, level of puncture and the use of GPIIbIIIa inhibitors are independent predictive factors of need for surgical therapy.
Collapse
|
21
|
Postcatheterization femoral artery pseudoaneurysms: therapeutic options. A case-controlled study. Int J Surg 2008; 6:214-9. [PMID: 18455971 DOI: 10.1016/j.ijsu.2008.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 02/29/2008] [Accepted: 03/12/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Postcatheterization femoral artery pseudoaneurysm is a troublesome complication following percutaneous canulations of the femoral artery. Both diagnostic and therapeutic options in the management of these pseudoaneurysms have changed dramatically, with surgery being required only rarely. We aimed to perform a comprehensive review of our experience, techniques and results in treating postcatheterization femoral artery pseudoaneurysms. METHODS A retrospective study of all patients presenting with local complications following invasive percutaneous femoral artery canulations over a five-year period was performed. Physical examination with color Doppler ultrasound analysis identified 29 femoral artery pseudoaneurysms. Surgery, duplex-guided compression, and thrombin injection were the main therapeutic options. RESULTS Fourteen cases of femoral artery pseudoaneurysms were treated by duplex-guided compression obliteration with a 78.5% success rate. Four patients had spontaneous thrombosis of their pseudoaneurysms. Five patients underwent percutaneous thrombin injection. Six patients had conventional surgery. Three cases failed duplex-guided compression: one closed with thrombin injection, and two were repaired surgically. Follow-up US showed no recurrent pseudoaneurysms for patients who underwent successful duplex-guided compression. CONCLUSION Despite the voluminous data in the literature of treating postcatheterization femoral artery pseudoaneurysms by thrombin guided injection, as a quick and effective method of therapy, with infrequent failures and complications, our study confirms the clinical usefulness of duplex-guided compression in the management of these pseudoaneurysms. The possibility of spontaneous thrombosis of small pseudoaneurysms is emphasized.
Collapse
|