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Koyama T, Tobita K, Kawaguchi T, Uchida S, Koyama E, Kodera N, Tamaki Y, Otomaru Y, Miyashita H, Yamashita T, Mizuno S, Murakami M, Saito S. Incidence, clinical course, and risk factors in the development of femoral pseudoaneurysm after atrial fibrillation ablation. J Arrhythm 2023; 39:894-900. [PMID: 38045461 PMCID: PMC10692832 DOI: 10.1002/joa3.12950] [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] [Received: 07/16/2023] [Revised: 10/15/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023] Open
Abstract
Background Previous studies have revealed the risk factors for femoral pseudoaneurysms (FPA). Most data on FPA are based on coronary and peripheral interventions, with limited studies focusing on atrial fibrillation (AF) ablation. However, patient backgrounds, anticoagulation regimens, and vascular access methods differ. In addition, a standard for managing FPA after AF ablation remains elusive due to the difficult nature of achieving thrombosis in pseudoaneurysms. Methods This single-center, retrospective, observational study included 2805 consecutive patients who underwent AF ablation between January 2016 and December 2021. All patients underwent femoral artery and vein punctures. Puncture sites were checked 1 day post-procedure. Results A total of 23 FPA patients were identified during the study period. Multivariate logistic regression analysis showed that hypertension (odds ratio 4.66, 95% confidence interval: 1.38-15.71; p = .0032) and warfarin use (odds ratio 3.83, 95% confidence interval: 1.40-10.45; p = .021) were significantly associated with the occurrence of FPA. The compression success rate was low (22%). There were nine and six patients in the endovascular treatment (EVT) and ultrasound-guided thrombin injection (UGTI) groups, respectively. The success rates were 100% and 84% in the EVT and UGTI groups, respectively. The length of hospital stay after FPA treatment was 2.1 days in the EVT group and 1.3 days in the thrombin group. Conclusion We must be careful about post-procedural FPA, especially for hypertension and warfarin-using patients. Treatment of pseudoaneurysms with anticoagulants is unlikely to achieve hemostasis, and an early switch to invasive treatments, such as EVT, should be considered.
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Affiliation(s)
- Takafumi Koyama
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Kazuki Tobita
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Tatsuto Kawaguchi
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Shuhei Uchida
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Eiji Koyama
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Nobuhisa Kodera
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Yusuke Tamaki
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Yuri Otomaru
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | | | | | - Shingo Mizuno
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Masato Murakami
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
| | - Shigeru Saito
- Department of CardiologyShonan Kamakura General HospitalKamakuraJapan
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Metzger PB, Paixão FAF, de Carvalho SFC, Fernandez MG, Metzger SL, Brandão MFL, Monteiro RB, Rossi FH. Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge. J Vasc Bras 2023; 22:e20230073. [PMID: 37790887 PMCID: PMC10545236 DOI: 10.1590/1677-5449.202300732] [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] [Received: 04/25/2023] [Accepted: 06/06/2023] [Indexed: 10/05/2023] Open
Abstract
Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.
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Awad M, Ascher E, Marks N, Hingorani A. Ultrasound-Guided thrombin injection of a pseudoaneurysm with concomitant deep vein thrombosis. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_124_21] [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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Spazier M, Meyer F, Bauersachs R, Herold J. Das moderne befund- und patientenadaptierte Management von peripheren Pseudoaneurysmen nach arteriellem Zugang. Zentralbl Chir 2020; 145:438-444. [DOI: 10.1055/a-1096-1327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungPseudoaneurysmen (PSA) zählen zusammen mit den Hämatomen zu den häufigsten Komplikationen nach kathetergestützten Eingriffen.
Ziel und Methode Die narrative kompakte Kurzübersicht umreißt sowohl die Entstehung und Charakteristika von Pseudoaneurysmen sowie die Optionen der Diagnostik und Therapie als auch deren mögliche Komplikationen.
Ergebnisse Ätiopathogenese: Durch den nicht verschlossenen Stichkanal der Punktion kommt es zum kontinuierlichen Blutausstrom aus dem Gefäß, der im umliegenden Gewebe eine Pseudoaneurysmahöhle formt. Diese wird nicht wie beim wahren Aneurysma durch eine Gefäßwand begrenzt, sondern nur durch die umliegenden Gewebestrukturen eingedämmt. Dies ist aber meist nicht suffizient und es kommt zu einer raschen Ausbreitung und diffusen Einblutungen. Dadurch können umliegende Strukturen wie Nerven und Venen durch das expandierende Pseudoaneurysma komprimiert werden, woraus sich irreversible Schäden entwickeln können. Diagnostik: Die Duplexsonografie steht dominierend absolut im Vordergrund. Die CT-A, MR-A und DSA bleiben speziellen Fragestellungen oder klinischen Fallkonstellationen (z. B. Begleiterkrankungen etc.) vorbehalten – eine DSA ist stets mit Interventionsbereitschaft zu verbinden. Therapie: Mit der manuellen Kompression und der darauffolgenden Anlage eines
Druckverbandes, einer ultraschallgestützten Kompression, der Thrombininjektion und der operativen Sanierung stehen mehrere Verfahren zur Auswahl. Die ultraschallgestützte Kompression sollte dabei immer sofort eingesetzt werden, da sie höchst effizient und ubiquitär verfügbar ist. Additiv zur Kompression kann die Thrombininjektion bei PSA ohne Nerven-/Gewebeirritation mit eingesetzt werden und bietet noch bessere Verschlussraten, ist jedoch anspruchsvoller in der Anwendung. Die operative Ausschaltung ist die effektivste Methode, bietet aber neben dem größten Aufwand die meisten Begleitkomplikationen wie Wundheilungsstörung bei mazeriertem Gewebe und den längsten Krankenhausaufenthalt. Alternative Verfahren zu den genannten haben sich bisher nicht durchsetzen können.
Schlussfolgerung Das diagnostische und therapeutische Management von Pseudoaneurysmen stellt eine Herausforderung im interdisziplinären befund- und patientenadaptierten Vorgehen dar, das den erfahren Gefäßmediziner erfordert.
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Affiliation(s)
- Max Spazier
- Klinik für Gefäßmedizin – Angiologie und Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
| | - Frank Meyer
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Rupert Bauersachs
- Klinik für Gefäßmedizin – Angiologie und Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
| | - Joerg Herold
- Klinik für Gefäßmedizin – Angiologie und Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
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de Oliveira Leite TF, Bortolini E, Linard B, Boueri BA, Carnevale FC, Nomura CH, da Motta Leal Filho JM. Evaluation of Morphological and Clinical Factors Related to Failure of Percutaneous Treatment with Thrombin Injection of Femoral Pseudoaneurysms from Cardiac Catheterization. Ann Vasc Surg 2019; 59:173-183. [DOI: 10.1016/j.avsg.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/12/2019] [Accepted: 01/26/2019] [Indexed: 11/25/2022]
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Cantwell CP, Murray OM, Murray JG. Scintigraphic assessment of arterial embolism at mixed thrombin and technetium 99m injection therapy for femoral pseudoaneurysms. Ir J Med Sci 2019; 189:133-137. [PMID: 31165346 DOI: 10.1007/s11845-019-02037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinically evident arterial thrombosis is rare following thrombin injection therapy for femoral pseudoaneurysm. However, it is unclear to what extent injected thrombin may pass to the ipsilateral lower limb arteries. AIMS To assess if technetium 99m injected at the time of thrombin injection for femoral artery pseudoaneurysm therapy passes into the adjacent lower limb arteries. METHODS This was a prospective trial with institutional review board approval. Four consecutive patients with common femoral pseudoaneurysms and failed manual compression were enrolled. Under real-time colour flow doppler ultrasound, a mixture of 1000 IU thrombin and approximately 200 MBq technetium 99m was injected in 0.1-mL doses into the pseudoaneurysm until thrombosis occurred. Gamma camera imaging of the syringe before injection, the injected groin after thrombosis and the syringe after injection were performed. Analysis of the gamma camera information was performed to determine the amount of technetium 99m deposited in the arterial tree. RESULTS All the procedures were technically successful. A mean of 33% (range 3-50%; SD 21) of the administered technetium 99m dose was deposited in the arterial circulation during pseudoaneurysm therapy. No clinically evident arterial thrombosis was identified. CONCLUSION Technetium 99m is routinely deposited in the arterial circulation following injection of a mixture of thrombin and technetium for therapy of common femoral artery pseudoaneurysms. This suggests that arterial passage of thrombin is more common than clinically evident.
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Affiliation(s)
- Colin P Cantwell
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Department of Radiology, St Vincent's University Hospital, Donnybrook, Dublin 4, Ireland
| | - Orla M Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - John G Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.
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Sprynger M, Rigo F, Moonen M, Aboyans V, Edvardsen T, de Alcantara ML, Brodmann M, Naka KK, Kownator S, Simova I, Vlachopoulos C, Wautrecht JC, Lancellotti P. Focus on echovascular imaging assessment of arterial disease: complement to the ESC guidelines (PARTIM 1) in collaboration with the Working Group on Aorta and Peripheral Vascular Diseases. Eur Heart J Cardiovasc Imaging 2019; 19:1195-1221. [PMID: 30239635 DOI: 10.1093/ehjci/jey103] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 12/24/2022] Open
Abstract
The main goal of the present document is to provide a set of practical recommendations for ultrasound imagers who are interested in artery diseases or for physicians who intend to undertake vascular procedures. This is the first part of the work. It is dedicated to general principles of ultrasonography, cervicoencephalic, subclavian, aortoiliac and lower extremity arteries, abdominal aorta, and popliteal aneurysms. It also discusses miscellaneous items such as medial arterial calcinosis, arterial embolism, arteritis, arterial stents and bypasses, false aneurysms, aortic dissection, popliteal entrapment syndrome, and iliac endofibrosis.
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Affiliation(s)
- Muriel Sprynger
- Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, B35, Avenue de l'Hôpital, 1, Liege, Belgium
| | - Fausto Rigo
- Division of Cardiology, dell'Angelo Hospital Mestre-Venice, Venezia, Italy
| | - Marie Moonen
- Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, B35, Avenue de l'Hôpital, 1, Liege, Belgium
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, avenue Martin Luther King, 2, Limoges, France
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Sognsvannsveien, 20, OSLO, Norway
| | - Monica L de Alcantara
- Department of Cardiology, Americas Medical City Hospital, avenue Jorge Curi, 550, Rio de Janeiro, Brasil
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz, 27, Graz, Austria
| | - Katerina K Naka
- 2nd Cardiology Department, University of Ioannina Medical School, University Campus, Loannina, Greece
| | - Serge Kownator
- Centre Cardiologique et Vasculaire, rue de Longwy, 12, Thionville, France
| | - Iana Simova
- Department of Cardiology, Acibadem City Clinic Cardiovascular Center, University Hospital, Okolovrasten pat Str, 127, Sofia, Bulgaria
| | | | - Jean-Claude Wautrecht
- Department of Vascular Diseases, Hôpital Erasme, route de Lennik, 808, Brussels, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, B35, Avenue de l'Hôpital, 1, Liege, Belgium
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Delf J, Ramachandran S, Mustafa S, Saeed A, Kandiyil N. Factors associated with pseudoaneurysm development and necessity for reintervention: a single centre study. Br J Radiol 2019; 92:20180893. [PMID: 30982331 DOI: 10.1259/bjr.20180893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Evaluate the factors associated with pseudoaneurysm development and morphology. Measure ultrasound-guided thrombin injection (UGTI) and surgical treatment outcomes for pseudoaneurysms, and the necessity for post-primary intervention (reintervention). METHODS Retrospective analysis of ultrasound scans and CT angiography of peripheral pseudoaneurysm interventions from February 2011 to April 2017. 99 patients (61.6% female) were identified; median age 72 years (range 12-89). Multivariate analysis of patient demographics, including pre-intervention anticoagulant and antiplatelet medication was performed. RESULTS Primary intervention for peripheral pseudoaneurysms (62.6% common femoral artery) included 93 UGTI and 6 surgical repairs; with 12 reinterventions (9 UGTI and 3 surgical). Pseudoaneurysm incidence for vascular interventional radiology (VIR) was 0.48% (31/6451) and cardiology was 0.24% (60/25,229). Rates for primary success, immediate complications, 30-day mortality and reintervention were measured respectively for UGTI (98.9%, 3.0%, 2.0%, and 11.8%) and surgical repair (100%, 0.0%, 22.2% and 16.7%). Reintervention risk factors included pre-intervention thrombocytopaenia (<150 × 109/L) ( p = 0.025) and pseudoaneurysms following vascular surgery (p = 0.033). Other positive associations for reintervention (non-significant) included use of a sheath size > 6 Fr ( p = 0.108) or arterial closure device ( p = 0.111) during the pseudoaneurysm causative procedure. The pre-intervention warfarin subgroup developed a larger mean pseudoaneurysm sac size (4.21 cm, range 0.9-7.6), compared to no treatment (p = 0.003), aspirin (p = 0.005) and clopidogrel (p = 0.026) subgroups. UGTI dosage for thrombosis had a positive correlation with incremental sac size increase (p < 0.001). CONCLUSION The main reintervention risk factor was pre-intervention thrombocytopaenia, with additional positive associations including pseudoaneurysms caused by surgery, increased sheath size and arterial closure devices. Warfarinized patients developed larger sac-sized pseudoaneurysms compared with other pre-intervention regimens, with positive correlation of higher UGTI dosage required for thrombosis. ADVANCES IN KNOWLEDGE Patients with pre-intervention thrombocytopaenia and pseudoaneurysms attributed to vascular surgery are subgroups that may benefit from post-intervention imaging surveillance due to significant reintervention risk.
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Affiliation(s)
- Jonathan Delf
- 1 University Hospitals of Leicester NHS Trust and University of Leicester , Leicestershire, United Kingdom
| | - Sanjeev Ramachandran
- 1 University Hospitals of Leicester NHS Trust and University of Leicester , Leicestershire, United Kingdom
| | - Syed Mustafa
- 2 Vascular radiology department, University Hospitals of Leicester NHS Trust and University of Leicester , Leicestershire, United Kingdom
| | - Abdullah Saeed
- 2 Vascular radiology department, University Hospitals of Leicester NHS Trust and University of Leicester , Leicestershire, United Kingdom
| | - Neghal Kandiyil
- 2 Vascular radiology department, University Hospitals of Leicester NHS Trust and University of Leicester , Leicestershire, United Kingdom
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Abstract
Pseudoaneurysms (PSAs) are commonly known as complications associated with invasive interventions. Because of the pulsatile in- and outflow of blood through the neck of PSAs, they tend to grow and, in the worse cases, can rupture. Therapeutic options are compression therapy, using a compression bandage and ultrasound-guided compression, and thrombin injection. Manual ultrasound-guided compression is widely performed and is successful in most cases. In general, it is combined with a subsequently applied compression bandage. Thrombin injection is a more difficult technique, but it has a higher success rate. This article gives an overview of the characteristics of PSAs, their diagnostic characteristics and the therapeutic methods used to treat them. Complications associated with compression or thrombin injection are also explained in detail.
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Affiliation(s)
- Sophie Peters
- 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
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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.
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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
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Giannakakis S, Sachmpazidis I, Papapetrou A, Galyfos G, Sachsamanis G, Papacharalampous G, Maltezos C. A Rare Case of Axillary Artery Pseudoaneurysm Due to Shoulder Dislocation Treated With Percutaneous Thrombin Injection. Vasc Endovascular Surg 2018. [DOI: 10.1177/1538574418762653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence of combined neurovascular injuries among patients with high-energy shoulder trauma ranges from 27% to 44%. However, the presentation of an axillary artery pseudoaneurysm (PSA) due to shoulder dislocation without an associated osseous fracture is a very rare condition. Moreover, treatment of combined neurologic and vascular injuries of the shoulder remains controversial. Additionally, minimally invasive treatments such as thrombin injection have been mainly evaluated in patients with iatrogenic femoral artery PSAs. Therefore, we aim to report a rare case of axillary artery PSA associated with brachial plexus injury after shoulder dislocation treated with percutaneous thrombin injection.
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Affiliation(s)
| | | | | | - George Galyfos
- Department of Vascular Surgery, KAT General Hospital, Athens, Greece
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Awan MU, Omar B, Qureshi G, Awan GM. Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature. Cardiol Res 2017; 8:246-253. [PMID: 29118889 PMCID: PMC5667714 DOI: 10.14740/cr596w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022] Open
Abstract
Retroperitoneal hemorrhage from iliac artery injury is a potentially serious complication of vascular interventional procedures leading to hemorrhagic shock and death if not diagnosed early and treated promptly. We report a 70-year-old male admitted to our facility with non-ST-elevation myocardial infarction, whose heart catheterization revealed left anterior descending artery (LAD) with 80% proximal, 95% mid and 100% distal disease. The left circumflex and right coronary arteries were 100% occluded proximally and received collaterals from the LAD. The patient declined coronary artery bypass surgery; therefore, the decision was made to perform high-risk percutaneous coronary intervention (PCI) of the LAD with Impella left ventricular assist device support. Left femoral artery angiogram revealed severely tortuous and calcified aorta, left external iliac and left common iliac arteries, and was accessed with 14-inch Impella sheath. He developed groin pain with mild hypotension thought to be due to sedation, which responded to intravenous fluids and dopamine. He underwent successful rotational atherectomy of the proximal and mid LAD with deployment of drug-eluting stents. Following PCI, he suffered acute profound hypotension necessitating intravenous fluids and vasopressor support with epinephrine. Emergency transthoracic echocardiogram did not reveal any pericardial effusion, and showed normal left ventricle and right ventricle systolic function. The Impella device was removed and selective left common iliac angiogram from the right femoral access revealed a vascular injury site with shift of the bladder to the right indicative of retroperitoneal hematoma. A digital subtraction angiogram revealed extravasation of blood at the vascular injury site. An 8.0 × 59 mm iCAST covered stent was deployed to the left external iliac artery with successful sealing of the perforation. The Impella device site was closed with two Perclose devices. The patient required 4 units of packed red blood cell transfusion. His hospital course was complicated by transient acute kidney injury, with return of his renal function to baseline at discharge 10 days later. This case underscores the importance of prompt recognition and treatment of vascular complications associated with interventional procedures, and highlights some of the risk predictors of such complications, which should be anticipated and planned for prior to intervention.
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Affiliation(s)
- Muhammad Umer Awan
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
| | - Bassam Omar
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
| | - Ghazanfar Qureshi
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
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Esterson YB, Pellerito JS. Recurrence of Thrombin-Injected Pseudoaneurysms Under Ultrasound Guidance: A 10-Year Retrospective Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1617-1624. [PMID: 28407277 DOI: 10.7863/ultra.16.09063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/14/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultrasound-guided thrombin injection has become standard treatment for extremity pseudoaneurysms. Our specific aims were to determine the procedural success rate, the procedural complication rate, and the factors associated with pseudoaneurysm recurrence. METHODS A total of 262 consecutive cases of ultrasound-guided thrombin repair of pseudoaneurysms were identified between January 1, 2006, and March 20, 2016. The procedural and follow-up ultrasound studies were reviewed. Outcomes of interest included procedural success (defined as complete thrombosis at the time of injection and on a follow-up examination), incomplete pseudoaneurysm thrombosis, and postprocedural recurrence. Postprocedural pseudoaneurysm recurrences were compared to procedural successes with regard to patient demographics, pseudoaneurysm characteristics, amount of thrombin injected, and periprocedural laboratory values. RESULTS Procedural success occurred in 85.7% of cases. Complications occurred in 3.0% of cases. The mean patient age ± SD was 72.3 ± 11.3 years. The median amount of thrombin injected was 500 U (interquartile range, 400 U). The median follow-up time was 1 day (interquartile range, 0 days). A pseudoaneurysm size of 2 cm or larger and thrombocytopenia were significant independent predictors of pseudoaneurysm recurrence (P = .003 and .03, respectively). The odds ratios for pseudoaneurysm recurrence were 2.29 for pseudoaneurysm size of 2 cm or larger (P = .03) and 1.04 for thrombocytopenia (P = .04). CONCLUSIONS Thrombin injection of pseudoaneurysms is an off-label procedure with few complications and a high success rate. Follow-up imaging is recommended in all pseudoaneurysms that are 2 cm or larger and in patients with thrombocytopenia.
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Affiliation(s)
- Yonah B Esterson
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, Manhasset, New York, USA
| | - John S Pellerito
- Department of Radiology, Northwell Health System, Hofstra Northwell School of Medicine, Manhasset, New York, USA
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14
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Böge G, Laroche JP, Alric P. [Treatment of post-catheterization pseudoaneurysms by ultrasound-guided thrombin injection: A single-center experience and practical guideline]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:198-203. [PMID: 28705337 DOI: 10.1016/j.jdmv.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/30/2017] [Indexed: 11/25/2022]
Abstract
Ultrasound-guided thrombin injection has been shown to be a safe and effective treatment for iatrogenic post-catheterization pseudoaneurysms, but still is underused in France. We report our single-center experience and propose a technical guideline for ultrasound-guided thrombin injection. Ultrasound-guided thrombin injection should be considered to be the first-line treatment of iatrogenic pseudoaneurysms.
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Affiliation(s)
- G Böge
- Service de chirurgie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
| | - J P Laroche
- Service des maladies vasculaires et médecine interne, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - P Alric
- Service de chirurgie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
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Giant iatrogenic pseudoaneurysm of the brachial artery: A case report. Int J Surg Case Rep 2017; 37:193-195. [PMID: 28704745 PMCID: PMC5508487 DOI: 10.1016/j.ijscr.2017.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/17/2017] [Accepted: 06/18/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Pseudoaneurysms are a pulsatile hematoma caused by hemorrhage on soft tissues. It is an uncommon condition with many different etiologies. We report a case of a giant pseudoaneurysm caused by iatrogenic injury on the brachial artery. PRESENTATION OF CASE A 42 year-old male was submitted to our Vascular Surgery service with an enlargement of the right upper limb and a history of myocardial infarction. 60days before the patient reached our service, he was submitted to a cardiac catheterization performed by another medical team, since the catheter was placed on the right brachial artery near the cubital fossa, we suspected an iatrogenic pseudoaneurysm, which was confirmed by his clinical history and physical exam. It was opted to treat the pseudoaneurysm with an implant of polytetrafluoroethylene prosthesis. There were no complications whatsoever and the patient was discharged. DISCUSSION Pseudoaneurysms are more common after interventional procedures than diagnostic procedures, although brachial artery pseudoaneurysms are rare. Complications of pseudoaneurysms can cause serious threat to the afflicted limb and the patient's life. The management of any pseudoaneurysm is dependent on its size, location and pathogenesis. CONCLUSION Pseudoaneurysms develop slowly and should be diagnosed as early as possible in order to avoid complications and a better outcome. Due to an increase in recent endovascular procedures and the fact that brachial artery puncture is being performed more routinely, incidence of brachial artery pseudoaneurysms among overall population may rise.
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Mohammad F, Kabbani L, Lin J, Karamanos E, Esmael F, Shepard A. Post-procedural pseudoaneurysms: Single-center experience. Vascular 2016; 25:178-183. [PMID: 27370682 DOI: 10.1177/1708538116654837] [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: 11/16/2022]
Abstract
Objectives Pseudoaneurysms are a well-recognized complication of percutaneous angiographic procedures. Ultrasound-guided thrombin injection is currently the preferred treatment modality. This study was undertaken to evaluate our experience with the management of post-procedure pseudoaneurysms. Methods A retrospective study was undertaken of all patients who developed a post-procedure pseudoaneurysm between March 2004 and January 2013. Data were obtained from our prospectively maintained non-invasive vascular laboratory data base. Results Overall, 167 patients (80 men) with post-procedure pseudoaneurysms were identified. The mean age was 66 years. Post-procedure pseudoaneurysms developed following diagnostic coronary angiography (38%), coronary angioplasty (37%), peripheral vascular interventions (14.7%), or other access procedures (7.6%). Mean post-procedure pseudoaneurysm diameter was 2.8 ± 1.8 cm. One hundred forty-two post-procedure pseudoaneurysms were injected with thrombin under ultrasound guidance. Primary success rate was 93.5%. There were 12 (8.5%) procedural failures of which seven (58%) responded to reinjection, three (25%) required operative management, one was treated with ultrasound-guided compression, and one (8.3%) was simply observed. On multivariate analysis, failures were associated with increased aneurysm diameter ( p = 0.006; odds ratio 2.23, 95% CI 1.25 to 3.96), end-stage renal disease ( p = 0.013; odds ratio 1.15, 95% CI 1.09 to 1.78) and superficial femoral artery aneurysm origin ( p = 0.031; odds ratio 0.20, 95% CI 0.04 to 0.86). There were two episodes of thrombus formation in the femoral artery; one resolved with anticoagulation alone, and the other required thrombectomy. Conclusions Percutaneous ultrasound-guided thrombin injection is an effective and safe method for managing post-procedure pseudoaneurysms. Failure rates are low and associated with large aneurysm size, superficial femoral artery origin and end-stage renal disease.
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Affiliation(s)
- Farah Mohammad
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Loay Kabbani
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Judith Lin
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Efstathios Karamanos
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Fatema Esmael
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Alexander Shepard
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
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Kurzawski J, Sadowski M, Janion-Sadowska A. Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:188-195. [PMID: 26179719 DOI: 10.1002/jcu.22274] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To study the complications of ultrasound-guided thrombin injection of pseudo-aneurysms occurring after interventional cardiovascular procedures. METHOD We prospectively studied 353 patients who developed post-catheterization femoral artery pseudo-aneurysms and were treated with ultrasound-guided thrombin injection. RESULTS Arterial micro-embolization occurred in 53 patients (15%) and pulmonary embolism in 1 patient (0.3%). None of the patients developed significant peripheral arterial embolism. The length of the communicating channel between the arterial lumen and the pseudo-aneurysm was inversely correlated with the risk of embolization (p < 0.0001). A 4.6 mm increase in channel length decreased the odds of embolization by 14%, and patients with a channel less than 2 mm long were at greater risk. Repeated thrombin injection also increased the risk of embolization (p = 0.02). CONCLUSION Thrombin injection for the treatment of post-catheterization femoral pseudo-aneurysm is feasible and safe, but it must be performed with caution, especially when the sac is directly communicating with the artery, or when success cannot be achieved with a single injection.
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Affiliation(s)
- Jacek Kurzawski
- Świȩtokrzyskie Cardiology Center, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Marcin Sadowski
- Świȩtokrzyskie Cardiology Center, Grunwaldzka 45, 25-736 Kielce, Poland
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Femoral artery pseudoaneurysm following trivial trauma: a rare case scenario. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0322-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Vergaro G, Emdin M, Del Corso A. Correction of procedural arterial pseudoaneurysms: established and novel procedures. Expert Rev Cardiovasc Ther 2014; 12:843-50. [DOI: 10.1586/14779072.2014.923308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Crean SM, Michels SL, Reynolds MW. Exogenous bovine thrombin as a biomarker of exposure and outcome. Expert Rev Mol Diagn 2014; 8:651-61. [DOI: 10.1586/14737159.8.5.651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, but sometimes definitive treatment is needed. Surgery has traditionally been considered the 'gold standard' treatment, although it is not without risk in patients with severe cardiovascular disease. Less invasive treatment options such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited. This is an update of a Cochrane review first published in 2006. OBJECTIVES To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as blind manual or mechanical compression, ultrasound-guided compression, or percutaneous thrombin injection. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Four studies were included in the analyses comparing: manual compression versus ultrasound-guided compression; ultrasound-guided application of a mechanical device (FemoStop) versus blind application; and ultrasound-guided compression versus percutaneous thrombin injection (two studies). There were no studies with a surgical intervention arm. Data were extracted independently by both authors. MAIN RESULTS Compression (manual or FemoStop) was effective in achieving pseudoaneurysm thrombosis although ultrasound-guided application failed to confer any benefit (risk ratio (RR) 0.96; 95% confidence interval (CI) 0.88 to 1.04).Percutaneous thrombin injection was more effective than a single session of ultrasound-guided compression in achieving primary pseudoaneurysm thrombosis within individual RCTs but merged data failed to show statistical significance (RR 2.81; 95% CI 0.44 to 18.13). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported apart from one deep vein thrombosis in the compression group. AUTHORS' CONCLUSIONS The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use compression (blind or ultrasound-guided) as first-line treatment, reserving thrombin injection for those in whom the compression procedure fails.
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Recalcitrant peroneal artery pseudoaneurysm in a patient with Hemophilia B. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:359-62. [PMID: 23773548 DOI: 10.1016/j.carrev.2013.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/20/2022]
Abstract
Pseudoaneurysms (PAs) of arteries in the lower extremities are uncommon. In most cases, a PA of the common femoral artery develops following percutaneous access and treatment with ultrasound guided thrombin injection achieves success rates approaching 98%. In contrast, the management of a PA of the distal leg vessels is more complex and may require additional endovascular and/or surgical treatments. We present a case of a recalcitrant PA involving the distal peroneal artery that developed following blunt trauma in a patient with Hemophilia B who failed ultrasound guided thrombin injection, para-aneurysmal saline injection and required two coil embolization procedures. Our observations suggest that Factor IX supplementation combined with aggressive coil embolization is the most effective treatment approach.
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Percutaneous treatment of iatrogenic pseudoaneurysms by cyanoacrylate-based wall-gluing. Cardiovasc Intervent Radiol 2012; 36:669-75. [PMID: 23161362 DOI: 10.1007/s00270-012-0502-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA. MATERIAL AND METHODS During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up. RESULTS PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 ± 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary. CONCLUSION PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.
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Malgor RD, Labropoulos N, Gasparis AP, Landau DS, Tassiopoulos AK. Results of a New Human Recombinant Thrombin for the Treatment of Arterial Pseudoaneurysm. Vasc Endovascular Surg 2012; 46:145-9. [DOI: 10.1177/1538574411431346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate the results of a new thrombin sealant (Recothrom) for the treatment of arterial pseudoaneurysms (PDAs). Methods: We reviewed 47 consecutive patients prospectively entered in a dedicated data set who underwent ultrasound-guided percutaneous thrombin injection to treat PDA. End points were PDA recurrence, need for reintervention, and related complications such as limb ischemia or allergic reactions. Results: Twenty-six patients were females (55%) and the median age of the entire group was 71 years (range, 45-87). The mean size of the PDA was 2.3 ± 0.9 cm. The mean injected volume was 2.4 ± 1.4 mL containing 500 ± 320 units. Recurrence of the PDA occurred in 4 (8.5%) patients and was not related to anticoagulation status, body habitus, platelets levels, or use of antiplatelets. All recurred PDAs were successfully sealed with a second (n = 3) and a third injection (n = 1). There was no distal embolization or allergic reactions and no surgical intervention was required. Conclusion: The new human recombinant thrombin (Recothrom) is a safer nonimmunogenic option with similar success rates of other fibrin glue sealants.
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Affiliation(s)
- Rafael D. Malgor
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Antonios P. Gasparis
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - David S. Landau
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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Al-Wahaibi KN, Aquil S, Al-Sukaiti R, Al-Riyami D, Al-Busaidi Q. Transplant renal artery false aneurysm: case report and literature review. Oman Med J 2011; 25:306-10. [PMID: 22043364 DOI: 10.5001/omj.2010.88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 04/28/2010] [Indexed: 12/27/2022] Open
Abstract
This is a case report of a 59 years old male who had a commercial non-related living renal transplantation for his end stage renal insufficiency secondary to adult polycystic kidney disease. He suffered an immediate and early post-operative bleeding, which was managed conservatively. He was presented at Sultan Qaboos University Hospital four months after his transplant with abdominal pain, nausea, loss of appetite and a rise in serum creatinine levels. Ultrasonography and angiography have shown a 4 cm false aneurysm of the transplant renal artery at the anastomotic site with the external iliac artery. Surgical exploration with resection of the false aneurysm and reanastomosis of the donor renal artery to the external iliac artery was carried out successfully with preservation of the renal allograft. This is a rare case of an extra-renal false aneurysm at the anastomotic site of the transplant renal artery to the external iliac artery four months after renal allotransplantation. Literature review on the management and outcome of false aneurysms after renal transplant was carried out.
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26
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Bellmunt S, Dilmé J, Barros A, Escudero JR. Compression assisted by removable coils as a new treatment for iatrogenic femoral pseudoaneurysms. J Vasc Surg 2011; 53:236-8. [DOI: 10.1016/j.jvs.2010.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/01/2010] [Accepted: 07/01/2010] [Indexed: 12/01/2022]
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Choi HJ, Lee CC, Lim TH, Singer AJ. Traumatic subperiosteal pseudoaneurysm: rare cause of subperiosteal hematoma. Am J Emerg Med 2010; 27:1172.e5-7. [PMID: 19931786 DOI: 10.1016/j.ajem.2009.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 01/09/2009] [Indexed: 11/18/2022] Open
Abstract
Subperiosteal hematoma arises usually after blunt trauma to the bone. It is due to disinsertion or rupture of a muscle tendon or injury of nutrient artery of bone. Subperiosteal hematoma is a rare condition and develops mainly in the orbit because the periosteum is more loosely attached to the bone. Thus, few cases of subperiosteal hematoma in iliac bone are reported. Traumatic pseudoaneurysm develops mainly after penetrating or blunt trauma. It can be easily diagnosed by intravenous contrast computed tomography or magnetic resonance imaging by seen extravasation of contrast dye. We present a case of subperiosteal hematoma with subperiosteal pseudoaneurysm after blunt pelvic trauma in a 17-year-old adolescent boy. The pseudoaneurysm arose from a branch of superior gluteal artery, but it was not seen in the initial contrast computed tomography scan.
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Affiliation(s)
- Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University Hospital, Seoul 133-792, South Korea
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28
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Crean S, Michels SL, Moschella K, Reynolds MW. Bovine Thrombin Safety Reporting: An Example of Study Design and Publication Bias. J Surg Res 2010; 158:77-86. [DOI: 10.1016/j.jss.2008.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 08/12/2008] [Accepted: 09/04/2008] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, but sometimes definitive treatment is needed. Surgery has traditionally been considered the 'gold standard' treatment, although it is not without risk in patients with severe cardiovascular disease. Less invasive treatment options such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited. This is an update of a Cochrane review first published in 2006. OBJECTIVES To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as blind manual or mechanical compression, ultrasound-guided compression, or percutaneous thrombin injection. SEARCH STRATEGY The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched December 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4). Additional searches were also made of the bibliographies of papers found through the electronic searches, and by handsearching relevant journals. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Four studies were included in the analyses comparing: manual compression versus ultrasound-guided compression; ultrasound-guided application of a mechanical device (FemoStop) versus blind application; and ultrasound-guided compression versus percutaneous thrombin injection (two studies). There were no studies with a surgical intervention arm. Data were extracted independently by both authors. MAIN RESULTS Compression (manual or FemoStop) was effective in achieving pseudoaneurysm thrombosis although ultrasound-guided application failed to confer any benefit (risk ratio (RR) 0.96; 95% confidence interval (CI) 0.88 to 1.04).Percutaneous thrombin injection was more effective than a single session of ultrasound-guided compression in achieving primary pseudoaneurysm thrombosis within individual RCTs but merged data failed to show statistical significance (RR 2.81; 95% CI 0.44 to 18.13). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported apart from one deep vein thrombosis in the compression group. AUTHORS' CONCLUSIONS The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use compression (blind or ultrasound-guided) as first-line treatment, reserving thrombin injection for those in whom the compression procedure fails.
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Affiliation(s)
- Paul V Tisi
- Department of Vascular Surgery, Bedford Hospital, Kempston Road, Bedford, Bedfordshire, UK, MK42 9DJ.
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Interventional radiology in the diagnosis, management, and follow-up of pseudoaneurysms. Cardiovasc Intervent Radiol 2008; 32:2-18. [PMID: 18923864 DOI: 10.1007/s00270-008-9440-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 08/15/2008] [Accepted: 09/03/2008] [Indexed: 02/05/2023]
Abstract
Arterial wall disruption, as a consequence of inflammation/infection, trauma (penetrating or blunt), or iatrogenic causes, may result in pseudoaneurysm formation. Currently, iatrogenic causes are increasing as a result of the growth of endovascular intervention. The frequency of other causes also seems to be increasing, but this may simply be the result of increased diagnosis by better imaging techniques, such as multidetector contrast-enhanced computed tomography. Clinically, pseudoaneurysms may be silent, may present with local or systemic signs, or can rupture with catastrophic consequences. Open surgical repair, previously the mainstay of treatment, has largely been replaced by image-guided occlusion methods. On the basis of an experience of over 100 pseudoaneurysms, treatments at various anatomical sites, imaging modalities used for accurate diagnosis, current changing therapeutic options for pseudoaneurysm management, approved embolization agents, and clinical follow-up requirements to ensure adequate treatment will be discussed. Image-guided direct percutaneous and endovascular embolization of pseudoaneurysms are established treatment options with favorable success rates and minimal morbidity. The pendulum has now swung from invasive surgical repair of pseudoaneurysms to that of image-guided interventional radiology.
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Ahmad F, Turner SA, Torrie P, Gibson M. Iatrogenic femoral artery pseudoaneurysms--a review of current methods of diagnosis and treatment. Clin Radiol 2008; 63:1310-6. [PMID: 18996260 DOI: 10.1016/j.crad.2008.07.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 07/02/2008] [Accepted: 07/03/2008] [Indexed: 12/18/2022]
Abstract
The common femoral artery is commonly used as arterial access for a wide range of radiological and cardiological procedures. Pseudoaneurysm formation is the most common arterial complication of femoral artery catheterization, and is diagnosed using colour Doppler ultrasound. Ultrasound-guided thrombin injection has replaced ultrasound-guided compression as the first-line treatment. The practicalities of thrombin injection (technique and types of thrombin available) and other treatment options are discussed. Awareness of pseudoaneurysm formation and the treatment options allows prompt diagnosis and successful treatment.
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Affiliation(s)
- F Ahmad
- Department of Interventional Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK.
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Shojaiefard A, Khorgami Z, Kouhi A, Kohan L. Surgical management of aneurismal dilation of vein and pseudoaneurysm complicating hemodialysis arteriovenuos fistula. Indian J Surg 2008; 69:230-6. [PMID: 23132993 DOI: 10.1007/s12262-007-0032-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Pseudoaneurysm (PS) and aneurismal dilation of vein (ADV) are recognized complications of arteriovenous fistulas (AVF) in patients on hemodialysis. We present our experience about surgical management of these complications, which resulted in AVF preservation for continuing hemodialysis. MATERIAL AND METHODS Twenty-two patients underwent surgical repair of an aneurismal dilation of vein or a pseudoaneurysm arising from a native AVF. In 14 patients the aneurismal dilation of vein arose from the venous limb of AVF and in eight patients the pseudoaneurysm arose from an arteriovenous anastomotic site in the antecubital and anterior part of arm. The mean follow-up period was 15 months. Clamp Aneurysm Repair (CAR) was performed to repair the aneurismal dilation of venous limb of AVF and Tourniquet Aneurysm Repair (TAR) was performed to repair PS that arose from AVF in the antecubital and anterior part of arm. RESULTS In eight of the 14 patients with aneurismal dilation of vein, who underwent CAR procedure, vascular access was preserved. In three patients with aneurismal dilation of vein in snuffbox and one in forearm, the AVF had failed due to prior venous thrombosis of AVF. In two of 14 patients, there was no need for preservation of AVF because of renal transplantation. The technical success rate and patency rate during follow up period in CAR method was 100%. In seven of eight patients with psudoaneurysm in the antecubital and anterior part of arm, who underwent TAR procedure, the AVF remained patent. The technical success rate in TAR method was 87.5%, and the patency rate was 87.5%. Overall, technical success rate was 95.45% and patency rate was 93.75%. During the 15 months of follow up period hemodialysis program through the repaired AVF sustained as desired. CONCLUSIONS The surgical methods used in our study could effectively repair the aneurismal dilation of vein and psudoaneurysm arising from a native AVF, and it lead to preservation of the AVF patency for continuing hemodialysis. These methods are technically feasible, safe and cost-effective procedures. It does not require dissection and additional incision for control of the vein and artery proximal and distal to the aneurismal dilation of vein and pseudoaneurysm; result in shorter time of procedure without complications.
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Affiliation(s)
- A Shojaiefard
- Department of Surgery, Shariati hospital, Tehran University of Medical Science, Tehran, Iran ; Karegar Shomali AVE., Shariati Hospital, Tehran, Iran
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Schneider C, Malisius R, Küchler R, Lampe F, Krause K, Bahlmann E, Kuck KH. A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms. Int J Cardiol 2008; 131:356-61. [PMID: 18192040 DOI: 10.1016/j.ijcard.2007.10.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/13/2007] [Accepted: 10/26/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate prospectively the safety and efficacy of bovine thrombin injection for the treatment of iatrogenic post-catheterisation pseudoaneurysms. METHODS AND RESULTS A total of 274 patients (90 women, 184 men, 69.8+/-7 years) with iatrogenic femoral pseudoaneurysms were treated by ultrasound-guided thrombin injection (UGTI). The deepest pseudoaneurysm chamber was entered with a 0.90x40 mm or 90 mm needle and bovine thrombin (solution of 1000 U/ml) was injected. Pseudoaneurysms were associated with diagnostic cardiac catheterisation, percutaneous coronary intervention or invasive electrophysiologic investigation. The majority of the patients were under antiplatelet therapy with aspirin or clopidogrel or both, and additional low dose heparin therapy. A total of 52 patients were treated with either phenprocoumon or enoxaparine body weight adjusted. UGTI was primary successful in 267 of 274 patients (97%). In 3 of 7 patients with a remaining pseudoaneurysm a second injection was required. Three patients were treated by ultrasound-guided compression. One patient was treated by surgical repair of the pseudoaneurysm 1 day after UGTI because a further pseudoaneurysm developed under phenprocoumon therapy. UGTI-related complications such as significant arterial thrombotic events or allergic reactions did not occur. 75 patients (27%) were evaluated by an additional sonography after 3 months to assess the long-term effect. CONCLUSION UGTI was well tolerated, safe and primarily effective in 97% of patients with iatrogenic femoral pseudoaneurysms. Anticoagulant use did not hinder successful thrombosis. UGTI should be considered as first-line therapy for the treatment of post-catheterisation pseudoaneurysms.
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Affiliation(s)
- Carsten Schneider
- Department of Cardiology, Asklepios Klinik St.Georg, Hamburg, Germany.
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Affiliation(s)
- Geoffrey W Webber
- Zena and Michael A. Wiener Cardiovascular Institute and the Marie-José and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, One Gustave L. Levy Pl, Box 1033, New York, NY 10029, USA
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Kendrick AS, Sprouse LR. Repair of a Combined Femoral Pseudoaneurysm and Arteriovenous Fistula Using a Covered Stent Graft. Am Surg 2007. [DOI: 10.1177/000313480707300306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our purpose was to demonstrate clinical efficacy of covered stent use in the peripheral vasculature. A 68-year-old man was transferred from an outlying hospital for evaluation and treatment of a pulsatile mass in his right groin after cardiac catheterization. Imaging with duplex ultrasound and diagnostic arteriogram demonstrated a 6-cm pseudoaneurysm (PSA) of the right superficial femoral artery (SFA) and an arteriovenous fistula (AVF) of the SFA and the profunda vein. Using a covered stent extending from the proximal SFA across the origins of the AVF and PSA, complete exclusion was attained. Follow-up ultrasound at 6 weeks revealed a patent stent, no AVF, and thrombosis of the PSA. Endovascular treatment of peripheral lesions (AVF/PSA) in an elective to semi-elective setting offers patients a safe, less invasive treatment option to consider over traditional open surgery. Consequently, a formidable reduction in incision length, wound infection, and postoperative immobility can be expected.
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Affiliation(s)
- Aaron S. Kendrick
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee 37403
| | - L. Richard Sprouse
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee 37403
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Fornaro J, Marincek B, Jungius KP. Pseudoaneurysm in the iliac fossa after renal transplantation—treatment with ultrasound-guided thrombin injection. ACTA ACUST UNITED AC 2006; 32:50-2. [PMID: 16845559 DOI: 10.1007/s00261-006-9016-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the case of a 57-year-old female who developed a large pseudoaneurysm of the right circumflex iliac artery 15 months after renal transplantation. Minimal invasive treatment was successfully performed with ultrasound-guided thrombin injection using the B-flow mode.
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Affiliation(s)
- J Fornaro
- Institute of Diagnostic Radiology, University Hospital Zürich, Zürich, Switzerland
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Stone PA, Aburahma AF, Flaherty SK. Reducing duplex examinations in patients with iatrogenic pseudoaneurysms. J Vasc Surg 2006; 43:1211-5. [PMID: 16765241 DOI: 10.1016/j.jvs.2006.02.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 02/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Ultrasound-guided thrombin injection has become the initial treatment of choice for femoral access-related pseudoaneurysms. Patients typically undergo serial duplex examinations to assess for spontaneous resolution of small iatrogenic pseudoaneurysms (IPSAs) (<2.5 cm), or may require repeated diagnostic, therapeutic, and follow-up studies for larger IPSAs (>2.5 cm). We evaluated the impact of a revised treatment algorithm that includes primary treatment of both small (<2.5 cm) and larger pseudoaneurysms (>2.5 cm), rather than observation of smaller ones, and attempts to establish a single duplex examination via a point-of-care treatment strategy. METHODS We reviewed 105 consecutive patients treated with ultrasound-guided thrombin injection from July 2001 through September 2004. Patient, IPSAs, characteristics, and treatment methods were examined. The number of duplex examinations per patient was evaluated over the treatment interval. Also, published cost data were used to compare primary treatment of small ISPAs vs observation with serial duplex examinations. RESULTS Successful thrombosis occurred in 103 (98.1%) of 105 treated pseudoaneurysms. No minor or major complications occurred after thrombin injection in either small or large ISPAs, and both failures requiring operation were in the large aneurysm group. The recurrence rate for the series was 1.9% (2/105), and both recurrences were successfully treated with an additional thrombin injection. A single injection was successful in treating 43 (97.7%) of 44 small (<2.5 cm) IPSAs, and one required a second injection. Patients had an average of 3.3 duplex examinations in our first year of treatment experience, which declined to 1.5 by our third year with the institution of a point-of-care service model for all pseudoaneurysms. Based on this decreased use of duplex examination and an average treatment cohort of 35 IPSA patients per year our institution, we determined this results in a reduction of 35 hours of laboratory time and nearly 70 ultrasounds per year. Similarly for small pseudoaneurysms, a point-of-service primary treatment program rather than observation results in an estimated cost savings of $12,000, based on treating 15 small IPSAs per year. CONCLUSIONS Ultrasound-guided thrombin injection is safe and effective for the treatment of nearly all iatrogenic pseudoaneurysms. We recommend primary treatment of small pseudoaneurysms by ultrasound-guided thrombin injection rather than observation with serial duplex scans. A point-of-care treatment algorithm can result in cost savings by reducing the number of necessary duplex examinations.
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Affiliation(s)
- Patrick A Stone
- Division of Vascular and Endovascular Surgery, Department of Surgery, West Virginia University (Charleston Division), USA.
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WRC, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 2006; 47:1239-312. [PMID: 16545667 DOI: 10.1016/j.jacc.2005.10.009] [Citation(s) in RCA: 740] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WRC, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 113:e463-654. [PMID: 16549646 DOI: 10.1161/circulationaha.106.174526] [Citation(s) in RCA: 2182] [Impact Index Per Article: 121.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary. Circulation 2006. [DOI: 10.1161/circulationaha.106.173994] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.02.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
BACKGROUND Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, while others need definitive treatment. Surgery is considered the gold-standard treatment, although is not without risk in patients with severe cardiovascular disease. Less invasive treatment options, such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited. OBJECTIVES To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as ultrasound-guided compression or percutaneous thrombin injection. SEARCH STRATEGY We searched the Cochrane Peripheral Vascular Diseases Review Group's Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 3, 2005 (last searched October 12, 2005). Additional searches were also made of bibliographies of papers found through these searches and by handsearching relevant journals. SELECTION CRITERIA Randomised controlled trials comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Two studies were included in the analysis: ultrasound-guided application of a mechanical device (FemoStop) versus blind application; ultrasound-guided compression versus percutaneous thrombin injection. Data were extracted independently by both authors. MAIN RESULTS Mechanical compression with a FemoStop was effective in achieving thrombosis of the pseudoaneurysm although ultrasound-guided application of this failed to confer any benefit (relative risk (RR) 1.07; 95% confidence intervals (CI) 0.75 to 1.53, P = 0.7). Percutaneous thrombin injection was more effective than ultrasound-guided compression in achieving thrombosis of a pseudoaneurysm (RR 7.50; 95% CI 2.06 to 27.25, P = 0.002 at 24 hours after treatment; RR 2.50; 95% CI 1.35 to 4.65, P = 0.004 at 48 hours after treatment). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported. AUTHORS' CONCLUSIONS The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use ultrasound-guided compression as first-line treatment, reserving thrombin injection for those in whom the procedure fails.
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Affiliation(s)
- P V Tisi
- Bedford Hospital, Department of Vascular Surgery, Kempston Road, Bedford, Bedfordshire, UK, MK42 9DJ.
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Poplausky MR, Durrani H, Rozenblit G, Maddineni S, Crea G, Goldberg B, Areman D. Traumatic subperiosteal pseudoaneurysm: a case report. ACTA ACUST UNITED AC 2005; 57:1115-8. [PMID: 15580043 DOI: 10.1097/01.ta.0000061235.97670.e8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
MESH Headings
- Adolescent
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/therapy
- Angiography
- Contrast Media
- Embolization, Therapeutic/instrumentation
- Embolization, Therapeutic/methods
- Hematoma, Subdural/diagnostic imaging
- Hematoma, Subdural/etiology
- Hematoma, Subdural/therapy
- Hip Injuries/complications
- Hip Injuries/diagnostic imaging
- Hip Injuries/therapy
- Humans
- Iliac Artery/injuries
- Male
- Pelvis/injuries
- Skating/injuries
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/diagnostic imaging
- Wounds, Nonpenetrating/therapy
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Affiliation(s)
- Maurice R Poplausky
- Department of Radiology, New York Medical College, Westchester Medical Center, Grasslands Reservation, Valhalla, New York 10595, USA
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Affiliation(s)
- Joseph A Franklin
- Department of Surgery, Section of Vascular Surgery, University of Health Systems of Eastern Carolina and Brody School of Medicine at East Carolina University, Pitt County Memorial Hospital, Greenville, NC 27858, USA
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Padidar AM, Kee ST, Razavi MK. Treatment of femoral artery pseudoaneurysms using ultrasound-guided thrombin injection. Tech Vasc Interv Radiol 2003; 6:96-102. [PMID: 12903004 DOI: 10.1053/tvir.2003.36447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Femoral artery pseudoaneurysms, a complication of femoral arterial puncture, is increasing in frequency with the proliferation of endovacular interventions. Pseudoaneurysms have historically been treated by open surgical repair, and more recently by ultrasound-guided compression. Ultrasound-guided compression is painful, and has a relatively low success rate of 51% to 73%. Since 1991, ultrasound-guided thrombin injection has become a treatment option. During injection of thrombin into a pseudoaneurysm, immediate thrombosis can be demonstrated within seconds. The entire procedure can be accomplished within 5 minutes, is simple to learn, and can be performed safely on an outpatient basis.
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Affiliation(s)
- Arash M Padidar
- Cardiovascular Interventional Radiology, Department of Radiology, Stanford Medical Center, Stanford, CA 94305-5105, USA
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Abstract
Pseudoaneurysms are a recognized complication of arterial catheterization. Until recently, the standard method of treatment has been surgical. The past decade has seen the introduction of several minimally invasive techniques that have largely replaced surgical treatment of pseudoaneurysms. The most commonly used methods are ultrasound-guided compression and percutaneous injection of thrombin into the pseudoaneurysm. This review article describes all the methods available for the treatment of postcatheterization pseudoaneurysms, presents results from the largest published series, and discusses the relative merits of each technique.
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Affiliation(s)
- Robert Morgan
- Department of Vascular Radiology, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom.
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