1
|
Wu J, Xu J, Yu Q, Chen C, Xiao Y, Bao J, Yuan L. Transbrachial Artery as Single or Combined Approach for Complex Interventions in Patients with Peripheral Artery Disease. Ann Vasc Surg 2024; 102:209-215. [PMID: 37922962 DOI: 10.1016/j.avsg.2023.09.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND This study aimed to assess the safety and efficacy of the transbrachial approach as a single or combined procedure for complex interventions in peripheral artery disease (PAD). METHODS Between March 2011 and April 2021, 169 patients with PAD underwent endovascular therapy via the transbrachial approach as a single or dual procedure. Univariate and multivariate analyses were performed to evaluate the predictors of adverse events at the brachial puncture site. All demographic, clinical, and perioperative data were acquired from electronic medical records and retrospectively analyzed. RESULTS Brachial artery access was used alone and in combination in 87 and 82 patients, respectively. Patients in the combined-approach group underwent more intraoperative stent implantations and had more vascular closure devices (VCD). Multivariate logistic regression analysis revealed that hypertension was an independent factor for higher rates of brachial puncture site adverse events (odds ratio, 4.76; 95% confidence interval, 1.33-16.97; P = 0.016). Brachial artery access-site complications occurred in 26 patients, including 6 (23.1%) major and 20 (76.9%) minor entry-site complications. Entry-site complications were observed in 21 (16.8%) and 5 (11.4%) patients assigned to manual compression and VCD groups, respectively. There were no significant intergroup differences in the incidence of major or minor complications. Interestingly, patients assigned to the VCD group did not experience major entry-site complications. CONCLUSIONS The transbrachial approach, as a single or combined procedure, is a safe alternative to complex interventions in patients with PAD. Complications of brachial access progressively decrease with improved blood pressure control.
Collapse
Affiliation(s)
- Jiawen Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai City, China; Department of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical Univsersity, Quzhou People's Hospital, Quzhou City, Zhejiang Province, China
| | - Jinyan Xu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai City, China
| | - Qingyuan Yu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai City, China
| | - Cheng Chen
- ChangZheng Hospital, Navy Military Medical University, Shanghai City, China
| | - Yu Xiao
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai City, China
| | - Junmin Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai City, China
| | - Liangxi Yuan
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai City, China.
| |
Collapse
|
2
|
Ok T, Seo KD, Lee IH. Fatal Femoral Pseudoaneurysm Rupture after Endovascular Intervention: A Case Report and Literature Review. Neurointervention 2024; 19:52-56. [PMID: 38303611 PMCID: PMC10910178 DOI: 10.5469/neuroint.2024.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
A rupture of a femoral pseudoaneurysm is an extremely rare complication of endovascular procedures, but its outcome can be life-threatening. In this report, we present a case of a femoral pseudoaneursym rupture in a patient in their early 90s following intra-arterial mechanical thrombectomy for acute ischemic stroke. Despite receiving medical and surgical interventions, the patient subsequently developed multiple organ failure, ultimately resulting in death. This case emphasizes the critical role of appropriate selection of vascular closure technique and careful post-procedural monitoring, particularly in high-risk patients.
Collapse
Affiliation(s)
- Taedong Ok
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwon-Duk Seo
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Il Hyung Lee
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| |
Collapse
|
3
|
Verelst H, Bonne L, Mufty H, Claus E, Houthoofd S, Verhamme P, Fourneau I, Maleux G. Direct puncture versus contralateral femoral artery approach for catheter-directed thrombolysis of occluded infra-inguinal arterial bypass grafts. Clin Radiol 2023; 78:e1001-e1009. [PMID: 37806817 DOI: 10.1016/j.crad.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
AIM To compare the safety, effectiveness, and clinical outcome of percutaneous direct puncture approach versus contralateral femoral native vessel approach for catheter-directed thrombolysis of occluded infra-inguinal bypass grafts. MATERIALS AND METHODS A retrospective analysis was performed comprising a cohort of patients who underwent catheter-directed thrombolysis procedures of occluded infra-inguinal bypass grafts between January 2013 and January 2022, with a follow-up period until June 2022. This included 55 procedures via the native vessel approach and 18 procedures via the direct puncture approach. Primary outcomes were technical success and procedural safety; secondary outcomes included re-intervention rate, limb salvage, and mortality as assessed by log-rank testing and Kaplan-Meier curves. RESULTS There were no differences between the two groups with regard to patient demographics, except for the number of previous vascular procedures (n=6.83 ± 3.07 direct approach versus n=4.96 ± 2.79 native vessel approach, p=0.025). Thrombolysis was comparably successful in both groups (n=13/18; 72% direct approach versus n=42/55; 76%, p=0.723). There were no differences in the duration of thrombolysis administration. The rate of adverse events was slightly lower in the direct approach group, but without significance (p=0.092). There were no adverse events related to the puncture site in the direct approach group. No differences were found between the time-to-event values for re-occlusion, re-intervention, amputation, or mortality respectively (p=0.662; p=0.520; p=0.816; p=0.462). CONCLUSION The direct puncture approach seems to be a safe and efficient approach for catheter-directed thrombolysis procedures in infra-inguinal occluded bypass grafts, with clinical outcomes comparable to the native vessel approach.
Collapse
Affiliation(s)
- H Verelst
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - L Bonne
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - H Mufty
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - E Claus
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - S Houthoofd
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - P Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology and Vascular Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - I Fourneau
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - G Maleux
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
| |
Collapse
|
4
|
El Naamani K, Khanna O, Mastorakos P, Momin AA, Yudkoff CJ, Jain P, Hunt A, Pedapati V, Syal A, Lawall CL, Carey PM, El Fadel O, Zakar RM, Ghanem M, Muharremi E, Jreij G, Abbas R, Amllay A, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH, Tjoumakaris SI. Predictors of Transfemoral Access Site Complications in Neuroendovascular Procedures: A large Single-Center Cohort Study. Clin Neurol Neurosurg 2023; 233:107916. [PMID: 37651797 DOI: 10.1016/j.clineuro.2023.107916] [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: 05/27/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE The transfemoral (TF) route has historically been the preferred access site for endovascular procedures. However, despite its widespread use, TF procedures may confer morbidity as a result of access site complications. The aim of this study is to provide the rate and predictors of TF access site complications for neuroendovascular procedures. METHODS This is a single center retrospective study of TF neuroendovascular procedures performed between 2017 and 2022. The incidence of complications and associated risk factors were analyzed across a large cohort of patients. RESULTS The study comprised of 2043 patients undergoing transfemoral neuroendovascular procedures. The composite rate of access site complications was 8.6 % (n = 176). These complications were divided into groin hematoma formation (n = 118, 5.78 %), retroperitoneal hematoma (n = 14, 0.69 %), pseudoaneurysm formation (n = 40, 1.96 %), and femoral artery occlusion (n = 4, 0.19 %). The cross-over to trans radial access rate was 1.1 % (n = 22). On univariate analysis, increasing age (OR=1.0, p = 0.06) coronary artery disease (OR=1.7, p = 0.05) peripheral vascular disease (OR=1.9, p = 0.07), emergent mechanical thrombectomy procedures (OR=2.1, p < 0.001) and increasing sheath size (OR=1.3, p < 0.001) were associated with higher TF access site complications. On multivariate analysis, larger sheath size was an independent risk factor for TF access site complications (OR=1.8, p = 0.02). CONCLUSION Several pertinent factors contribute towards the incidence of TF access site complications. Factors associated with TF access site complications include patient demographics (older age) and clinical risk factors (vascular disease), as well as periprocedural factors (sheath size).
Collapse
Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Panagiotis Mastorakos
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Arbaz A Momin
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Clifford J Yudkoff
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Paarth Jain
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Adam Hunt
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vinay Pedapati
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amit Syal
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Charles L Lawall
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Preston M Carey
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Omar El Fadel
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rida M Zakar
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marc Ghanem
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - E Muharremi
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - George Jreij
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Abdelaziz Amllay
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael R Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | |
Collapse
|
5
|
Noory E, Böhme T, Krause L, Ruile P, Salm J, Beschorner U, Bollenbacher R, Westermann D, Zeller T. Evaluation of the MYNX CONTROL™ Arterial Closure System for Achieving Primary Hemostasis after Arterial Femoral Access Following Peripheral Arterial Interventions, Compared to the FemoSeal TM Closure System. J Clin Med 2023; 12:5255. [PMID: 37629297 PMCID: PMC10455888 DOI: 10.3390/jcm12165255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Background: In addition to manual compression, various vascular closure devices (VCD) are available to seal the puncture site following arterial vascular procedures. Purpose: To evaluate the efficacy and safety of the extravascular MYNX CONTROL closure system for achieving primary hemostasis after femoral arterial access following peripheral arterial procedures, compared to the intravascular FemoSeal Aclosure system. Patients and Methods: A retrospective analysis of consecutive patients who underwent endovascular intervention between April and November 2022 was performed. The primary endpoint was the incidence of significant puncture site complication defined as a complication resulting in medical treatment. Secondary endpoints included peri-interventional incidence of hematoma, peri-interventional changes in hemoglobin, incidence of emergency diagnostics and predictors for closure system failure. Results: Five hundred and forty-eight patients were included in this analysis. False aneurysm occurred in 18/273 cases (6.6%) following the use of the MYNX closure system, compared to 6/275 cases after using the FemoSeal closure system (2.2%, p = 0.006). The incidence of post-interventional hematoma was not significantly different (28 (10.3%) in the MYNX group versus 32 (11.6%) in the FemoSeal group, p = 0.358). Peri-interventional hemoglobin drop did not differ between groups (p = 0.449). Emergency diagnostics were not significantly performed more often in the MYNX group (14 (5.1%) versus 8 (2.9%), p = 0.134). A post-interventional duplex sonography showed stenosis at the puncture site in one patient after use of the MYNX system. For the entire cohort, oral anticoagulation was the only predictor for the failure of the closure device (p = 0.036). Conclusions: Device failure was more common after using the extravascular MYNX CONTROL system than after using the intravascular FemoSeal system. However, the need for surgical or interventional therapy due to device failure was low.
Collapse
Affiliation(s)
- Elias Noory
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, 79189 Bad Krozingen, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Thieme M, Krankenberg H, Schilling T, Betge S, Korosoglou G, Rammos C, Vosseler M, Espinola-Klein C, Heilmeier B, Müller OJ, Langhoff R, Malyar N, Blessing E, Caspary L, Linnemann B, Heiss C, Ito W. Endovascular interventions in outpatient care. VASA 2023; 52:141-146. [PMID: 36935626 DOI: 10.1024/0301-1526/a001067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Endovascular arterial revascularisations for the treatment of symptomatic peripheral arterial disease are constantly increasing in importance and number due to the changing age structure and high numbers of comorbidities in the German population. Patients with peripheral artery disease are often at increased risk for peri- and post-procedural complications including severe cardiovascular events. Due to limited financial and human resources and considerable risks of hospitalization, endovascular interventions that were previously reserved for hospitalized patients are now progressively considered to be performed as day case procedures. More than one third of these procedures are performed in Germany by internists with a specialization in angiology. In the current position paper the German Society of Angiology endorsed by the European Society of Vascular Medicine, summarizes the requirements and risk factors to be considered for the planning, safe performance and post procedural care of endovascular revascularizations in outpatients. The performance of endovascular procedures for peripheral artery disease both in hospitalised and outpatients should be accompanied by a mandatory quality assurance process that should not only capture procedural data, but also require documentation of complications and longterm outcome.
Collapse
Affiliation(s)
- Marcus Thieme
- Regiomed Vascular Center and Department of Internal Medicine, REGIOMED-Hospital GmbH, Sonneberg, Germany.,Department of Internal Medicine I, University Hospital Jena, Germany.,School of Medicine, University of Split, Croatia
| | - Hans Krankenberg
- Regiomed Vascular Center and Department of Internal Medicine, REGIOMED-Hospital GmbH, Sonneberg, Germany.,School of Medicine, University of Split, Croatia
| | - Tom Schilling
- Center for Internal Medicine, Harz-Hospital Wernigerode, Germany
| | - Stefan Betge
- Department of Internal Medicine and Angiology, HELIOS-Hospital Salzgitter, Germany
| | | | - Christos Rammos
- Department of Cardiology and Angiology, University Hospital Essen, Germany
| | | | | | | | - Oliver J Müller
- Department of Internal Medicine III, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ralf Langhoff
- Department of Angiology, St. Gertrauden Hospital, Berlin, Germany
| | - Nasser Malyar
- Department of Cardiology I, University Hospital Münster, Germany
| | - Erwin Blessing
- Department of Vascular Medicine, University Hospital Hamburg, Germany
| | | | - Birgit Linnemann
- Department of Angiology, University Vascular Center East Bavaria, University Hospital Regensburg, Germany
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.,Vascular Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Wulf Ito
- Heart and Vascular Center, Allgäu Hospital gGmbH, Immenstadt, Germany
| | | |
Collapse
|
7
|
Koziarz A, Kennedy SA, El-Karim GA, Tan KT, Oreopoulos GD, Jaberi A, Rajan DK, Mafeld S. The Use of Vascular Closure Devices for Brachial Artery Access: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2022; 34:677-684.e5. [PMID: 36526077 DOI: 10.1016/j.jvir.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To estimate the rates of technical success and adverse events of vascular closure devices (VCDs) in the brachial artery and compare the rates of adverse events with manual compression. MATERIALS AND METHODS MEDLINE and Embase were searched for observational studies examining VCDs in the brachial artery. Meta-analyses were performed using random effects for the following outcomes: (a) technical success, (b) hematoma at the access site, (c) pseudoaneurysm, (d) local neurological adverse events, and (e) total number of adverse events. A pairwise meta-analysis compared VCD with manual compression for the outcomes of hematoma and the total number of adverse events. RESULTS Of 1,761 eligible records, 16 studies including 510 access sites were included. Primary procedures performed were peripheral arterial disease interventions, percutaneous coronary intervention, and endovascular thrombectomy for ischemic stroke. The technical success rate was 93% (95% CI, 87%-96%; I2 = 47%). Data on the following adverse events were obtained via meta-analysis: (a) hematoma, 9% (5%-15%; I2 = 54%); (b) stenosis or occlusion at access site, 3% (1%-14%; I2 = 51%); (c) infection, 0% (0%-5%; I2 = 0%); (d) pseudoaneurysm, 4% (1%-13%; I2 = 61%); (e) local neurological adverse events, 5% (2%-13%; I2 = 54%); and (f) total number of adverse events, 15% (10%-22%; I2 = 51%). Angio-Seal success rate was 96% (93%-98%; I2 = 0%), whereas the ExoSeal success rate was 93% (69%-99%; I2 = 61%). When comparing VCD and manual compression, there was no difference in hematoma formation (relative risk, 0.75; 95% CI, 0.35-1.63; I2 = 0%; P = .47) or the total number of adverse events (relative risk, 0.75; 95% CI, 0.35-1.58; I2 = 76%; P = .45). CONCLUSIONS Despite being off-label, studies suggest that VCDs in the brachial artery have a high technical success rate. There was no significant difference in adverse events between VCDs and manual compression in the brachial artery.
Collapse
Affiliation(s)
- Alex Koziarz
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Sean A Kennedy
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ghassan Awad El-Karim
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Kong T Tan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - George D Oreopoulos
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, University Health Network, Toronto, Ontario, Canada
| | - Arash Jaberi
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Dheeraj K Rajan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
8
|
Safety of Right and Left Ventricular Endomyocardial Biopsy in Heart Transplantation And Cardiomyopathy Patients. JACC: HEART FAILURE 2022; 10:963-973. [DOI: 10.1016/j.jchf.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
|
9
|
Li L, Xiu J, Yuan L, Zhang X, Li Y. Single ultrasound-guided local high-dose thrombin injection in the treatment of giant brachial artery pseudoaneurysm: A case report. Medicine (Baltimore) 2022; 101:e30103. [PMID: 35984187 PMCID: PMC9387992 DOI: 10.1097/md.0000000000030103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pseudoaneurysm (PSA) is a common complication related to vascular intervention, and surgical therapy is the primary method. However, a giant brachial artery PSA over 2 weeks is rarely observed. Due to the adhesion of surrounding tissue, thrombus organization, the extensive injury, and the high expense of transluminal stent-graft placement, a single ultrasound-guided local high-dose thrombin injection can be a therapy option. Such cases are rarely reported. PATIENT CONCERNS A 71-year-old man with a history of left elbow fossa interventional puncture presented to our hospital with a pulsatile mass in the left elbow fossa. He had a history of cerebral infarction 32 years prior without sequelae, emphysema for more than 2 years, hyperlipidemia for 3 months, and prostatic hyperplasia for 8 months. After conservative therapy, the lumbar compression fracture produced by trauma 24 years ago healed, and the intracranial hematoma induced by trauma ten years ago was absorbed. DIAGNOSIS Ultrasound examination showed giant mixed echoes on the posterior medial side of the left brachial artery. INTERVENTIONS The patient underwent a single ultrasound-guided local high-dose thrombin injection to treat giant brachial artery PSA. OUTCOMES Following therapy, the ultrasonography revealed that extensive thrombosis immediately formed in the cavity, and the internal blood flow signals had completely vanished. A week later, a physical examination showed that the PSA had shrunk with no apparent tenderness and that the texture had hardened. Pulsation and vascular murmurs disappeared. Ultrasound showed that the PSA was reduced, and no blood flow signals were found. LESSONS A single ultrasound-guided local high-dose thrombin injection had a considerable effect in curing large iatrogenic PSA. However, when deciding on the best therapy, specificity must be taken into account.
Collapse
Affiliation(s)
- Liang Li
- Department of Ultrasound, Guang’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Junqing Xiu
- Oncology Department, South area of Guang’anmen Hospital, Academy of Traditional Chinese Medicine, China
| | - Lian Yuan
- Surgery Department, Guang’anmen Hospital, China Academy of Traditional Chinese Medicine
| | - Xing Zhang
- Oncology Department, South area of Guang’anmen Hospital, Academy of Traditional Chinese Medicine, China
| | - Yue Li
- Oncology Department, South area of Guang’anmen Hospital, Academy of Traditional Chinese Medicine, China
- *Correspondence: Yue Li, Guang’anmen Hospital, China Academy of Traditional Chinese Medicine, No.5, Beixian Pavilion, Xicheng District, Beijing, China (e-mail: )
| |
Collapse
|
10
|
Thieme M, Moebius-Winkler S, Franz M, Baez L, Schulze CP, Butter C, Edlinger C, Kretzschmar D. Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience. Front Cardiovasc Med 2021; 8:725079. [PMID: 34869628 PMCID: PMC8634400 DOI: 10.3389/fcvm.2021.725079] [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: 06/14/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has rapidly developed over the last decade and is nowadays the treatment of choice in the elderly patients irrespective of surgical risk. The outcome of these patients is mainly determined not only by the interventional procedure itself, but also by its complications. Material and Methods: We analyzed the outcome and procedural events of transfemoral TAVI procedures performed per year at our institution. The mean age of these patients is 79.2 years and 49% are female. All the patients underwent duplex ultrasonography of the iliac arteries and inguinal vessels before the procedure and CT of the aorta and iliac arteries. Results: Transfemoral access route is associated with a number of challenges and complications, especially in the patients suffering from peripheral artery disease (PAD). The rate of vascular complications at our center was 2.76% (19/689). Typical vascular complications (VC) include bleeding and pseudoaneurysms at the puncture site, acute or subacute occlusion of the access vessel, and dissection or perforation of the iliac vessels. In addition, there is the need for primary PTA of the access pathway in the presence of additional PAD of the common femoral artery (CFA) and iliac vessels. Balloon angioplasty, implantation of covered and uncovered stents, lithoplasty, and ultrasound-guided thrombin injection are available to treat the described issues. Conclusion: Interventional therapy of access vessels can preoperatively enable the transfemoral approach and successfully treat post-operative VC in most of the cases. Training the heart team to address these issues is a key focus, and an interventional vascular specialist should be part of this team.
Collapse
Affiliation(s)
- Marcus Thieme
- Clinic for Internal Medicine I, University Hospital Jena, Jena, Germany.,REGIOMED Vascular Center, Sonneberg, Germany
| | | | - Marcus Franz
- Clinic for Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Laura Baez
- Clinic for Internal Medicine I, University Hospital Jena, Jena, Germany
| | | | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Immanuel Klinikum Bernau, Bernau, Germany.,Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg, Immanuel Klinikum Bernau, Bernau, Germany.,Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | |
Collapse
|