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Mansouri MH, Mansouri P, Hashemi M, Hashemi SM, Mirshafiee S, Amirpour A. Compare efficacy and safety of autologous blood clot injection with C-clamp vascular closure device in treatment of iatrogenic pseudoaneurysm after femoral artery puncture. J Vasc Access 2024:11297298241273641. [PMID: 39180356 DOI: 10.1177/11297298241273641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2024] Open
Abstract
INTRODUCTION Iatrogenic femoral artery pseudoaneurysm (FAP) is a complication following femoral artery puncture, with an incidence rate of 0.2%-5.5% post-cardiac catheterization procedures. Management typically involves observation or interventional treatments such as ultrasound-guided compression (UGC) or ultrasound-guided thrombin injections. This study compares the efficacy and safety of ultrasound-guided autologous blood clot injection (UGCI) with C-clamp vascular closure device-assisted UGC in treating FAP. MATERIALS AND METHODS Conducted at a high-volume training and research center, this prospective study enrolled patients with iatrogenic FAP post-femoral artery puncture. Patients were randomized into two treatments: UGC with a C-clamp device or UGCI. Primary endpoints were thrombosis induction within 24 h, average procedure time, and length of hospital stay (LOS). RESULTS The study included 105 patients with 51 undergoing UGCI and 54 undergoing UGC. UGCI achieved a primary success rate of 96% versus 63% for UGC. The mean procedure duration for UGCI was significantly shorter (22 min) compared with UGC (49 min, p ⩽ 0.0001). LOS was also reduced in the UGCI group (1.5 days) compared to the UGC group (4.5 days). Complication rates were low for both procedures, with one deep vein thrombosis and one infection observed in the UGC group. CONCLUSION UGCI demonstrated to be a safe, efficient, and faster alternative for treating iatrogenic FAPs with a higher success rate, reduced LOS, and similar low complication rates compared to UGC. This study suggests that UGCI could be considered a preferred method for the management of FAP post-femoral artery catheterization.
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Affiliation(s)
- Mohammad Hadi Mansouri
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pejman Mansouri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hashemi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Shayan Mirshafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Amirpour
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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BELCARO G, CESARONE MR, DUGALL M, CORSI M, HOSOI M, BAVERA PM, COTELLESE R, FERAGALLI B, IPPOLITO E. Effects of the collagen modulator Centellicum® and spinal elongation exercises on subclinical abdominal aneurysmal dilatation. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.22.01537-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Golouh V, Kobilica N, Breznik S. Superficial Femoral Artery Pseudoaneurysm and Arterial Wall Destruction After Drug-Coated Balloon Treatment. Cureus 2020; 12:e10527. [PMID: 33094068 PMCID: PMC7574979 DOI: 10.7759/cureus.10527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022] Open
Abstract
Drug-coated balloon angioplasty may present an efficient alternative to traditional balloon angioplasty and stenting, which suffer from high rates of restenosis and increased risk of stent fractures in the anatomically unfavorable regions, such as the superficial femoral artery in the adductor canal. Although pseudoaneurysms are the most common vascular access site complications, they are considerably rarer at the site of the endovascular treatment. They can be caused by several mechanisms, including stent fractures, usage of oversized balloons, high-pressure inflations, and infections. In addition, paclitaxel, the drug released from drug-coated balloons, may also play a significant role in the formation and exacerbation of pseudoaneurysms. The exact pathophysiology remains unclear, but it may be due to a combination of paclitaxel's suppression of neointimal healing and immune response, cytotoxic properties, and hypersensitivity-related inflammation.
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Affiliation(s)
- Valentin Golouh
- Department of Radiology, University Medical Centre Maribor, Maribor, SVN
| | - Nina Kobilica
- Department of Vascular Surgery, University Medical Centre Maribor, Maribor, SVN
| | - Silva Breznik
- Department of Radiology, University Medical Centre Maribor, Maribor, SVN
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Rashaideh MA, Janho KE, Shawaqfeh JS, Ajarmeh E, As'ad M. Ultrasound-guided thrombin injection versus ultrasound-guided compression therapy of iatrogenic femoral false aneurysms: Single center experience. Med J Armed Forces India 2020; 76:293-297. [PMID: 32773931 DOI: 10.1016/j.mjafi.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/24/2019] [Indexed: 11/15/2022] Open
Abstract
Background Iatrogenic femoral pseudoaneurysm (false aneurysm) due to arterial access following cardiovascular procedures is becoming common because of the increase in number and complexity of the procedures. Recently, percutaneous thrombin injection is becoming a popular treatment of these false aneurysms.The aim of this study was to assess the efficacy and safety of femoral pseudoaneurysm closure using ultrasound-guided thrombin injection in comparison to ultrasound-guided compression. Methods A retrospective analysis was undertaken of 65 patients who presented to our vascular department with iatrogenic femoral pseudoaneurysm between January 2015 and March 2019. Twenty-five patients underwent ultrasound-guided thrombin injection, and 40 were treated using ultrasound-guided compression therapy. The primary outcome measured was efficacy, while other outcomes examined were safety, procedure duration, and cost. Results A total of 65 patients (45 males, 20 female) were identified with a mean age of 62 years. Out of the 65, 40 patients (28 males, 12 female) underwent ultrasound-guided compression therapy (group A) with a mean aneurysm size of 2.9 cm, and 25 (17 male, 8 female) underwent ultrasound-guided thrombin injection (group B) with a mean pseudoaneurysm sac size of 3.7 cm. The success rate of thrombosis in group A was 70% and in group B was 92%. No significant complications were reported in both groups. Conclusions Ultrasound-guided thrombin injection should be considered as the first line of treatment for uncomplicated femoral pseudoaneurysms because it has a higher thrombosis and lower recurrence rates, when compared with ultrasound-guided compression treatment.
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Affiliation(s)
| | - Kristi E Janho
- Vascular Surgery, King Hussin Medical Center, Amman, Jordan
| | | | - Eyad Ajarmeh
- Vascular Surgery, King Hussin Medical Center, Amman, Jordan
| | - Mohammed As'ad
- Vascular Surgery, King Hussin Medical Center, Amman, Jordan
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Altoijry A, Alghofili H, Al-Salman M, Alsheikh S, Aljabri B, Iqbal K, Altuwaijri T. Ultrasound-guided thrombin injections for arterial pseudoaneurysms: a 14-year study conducted at King Khalid University Hospital Vascular Lab. Minerva Cardioangiol 2020; 68:271-276. [PMID: 32107892 DOI: 10.23736/s0026-4725.20.05112-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Arterial pseudoaneurysms are a well-known complication resulting from procedures requiring arterial wall puncture. Previously, surgical repair was the definitive treatment option for arterial pseudoaneurysms despite being relatively invasive and time-consuming. Ultrasound-guided thrombin injection (UGTI) has become the standard of care since its initial description back in 1997. We aimed to evaluate the safety and efficacy of UGTI for the treatment of arterial pseudoaneurysms at the King Khalid University Hospital Vascular Lab. METHODS A retrospective analysis of prospectively maintained data was conducted on all patients diagnosed with arterial pseudoaneurysms by Doppler ultrasound between 2006 and 2019. Patients with large arterial pseudoaneurysms (>1.5 cm) qualified for thrombin injections. Individuals with a known hypersensitive to thrombin were excluded. All included patients were treated with UGTI until resolution and were followed at postoperative days 7 and 30. RESULTS In all, 35 patients qualified for thrombin injections. The mean age of the included patient population was 56.5 (range, 24-81) years. The majority of them were hypertensive (N.=26, 74.3%), and a quarter of them were on anticoagulant treatment (N.=9, 25%). The mean thrombin injection dose was 1000 U (range, 500-1500 U). In 34 of 35 (97.1%) patients, a thrombin injection resulted in complete thrombosis of the pseudoaneurysm lumen within a few seconds. There were no complications or recurrence of pseudoaneurysm after UGTI during the follow-up period. CONCLUSIONS Throughout the study period of 14 years, we did not encounter any procedural complications or arterial pseudoaneurysm recurrence. This is attributed to a safe procedural technique and proper patient selection. UGTI for arterial pseudoaneurysms is a safe, successful, and convenient treatment for both patients and surgeons.
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Affiliation(s)
- Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia -
| | - Hesham Alghofili
- Division of Vascular Surgery, Department of Surgery, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mussaad Al-Salman
- Division of Vascular Surgery, Department of Surgery, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sultan Alsheikh
- Division of Vascular Surgery, Department of Surgery, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Badr Aljabri
- Division of Vascular Surgery, Department of Surgery, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Kaisor Iqbal
- Division of Vascular Surgery, Department of Surgery, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Talal Altuwaijri
- Division of Vascular Surgery, Department of Surgery, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
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Shin JH, Song Y, Sheen JJ, Lee D, Chung J, Lee GY, Jeong H, Han S, Choi JH, Hwang SM, Lee DH. Safety and Effectiveness of Percutaneous Low-Dose Thrombin Injection for Femoral Puncture Site Pseudoaneurysms in Neurointervention: Single-Center Experience. Neurointervention 2020; 15:25-30. [PMID: 31893630 PMCID: PMC7105095 DOI: 10.5469/neuroint.2019.00206] [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: 08/24/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We present ultrasound-guided percutaneous low-dose thrombin (200-250 IU) injection for the treatment of iatrogenic femoral pseudoaneurysms. Second, we compared patient and procedure factors between subcutaneous hematoma and pseudoaneurysm groups. MATERIALS AND METHODS From April 2012 to May 2018, 8425 patients underwent neurointervention. Among these patients, 18 had small subcutaneous hematomas and 6 had pseudoaneurysms. Pseudoaneurysms in the neck and entire sac were visualized, and low-dose thrombins were injected while visualizing a "whirlpool" hyperechoic core in the pseudoaneurysm sac. Subcutaneous hematomas were treated with simple compression. We compared the following parameters between the subcutaneous hematoma group and pseudoaneurysm group: sex, age, body mass index (BMI), type of procedure, heparin usage, sheath size, procedure time, and number of previous neurointervention procedures with the Mann-Whitney U test. RESULTS Most of the pseudoaneurysms were successfully occluded with 200 IU of thrombin (n=5). Only 1 pseudoaneurysm required a slightly higher thrombin concentration (250 IU, n=1). During the short-term follow-up, no residual sac was observed and no surgical repair was necessary. Pain in the groin region was alleviated. During the 1-month follow-up, no evidence of pseudoaneurysm recurrence nor subcutaneous hematoma was noted. Patient factors (sex, age, and BMI) and procedure factors (heparin usage, sheath size, procedure time, number of previous procedures) were not statistically different between the subcutaneous hematoma and pseudoaneurysm groups. CONCLUSION Ultrasound-guided percutaneous low-dose thrombin injection (200-250 IU) is safe, effective, and less invasive for treating iatrogenic femoral pseudoaneurysm in neurointervention.
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Affiliation(s)
- Jae Ho Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Jon Sheen
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongwhane Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewoo Chung
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ga Young Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunhee Jeong
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongsik Han
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Ho Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Koza Y, Kaya U. Retrospective Analysis of 120 Cases of Iatrogenic and Traumatic Peripheral Arterial Pseudoaneurysms. Eurasian J Med 2019; 52:180-184. [PMID: 32612428 DOI: 10.5152/eurasianjmed.2019.18422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/07/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The pseudoaneurysm formation is the most common complication of arterial catheterization. This study aimed to report our clinical experience with the treatment of iatrogenic and post-traumatic pseudoaneurysms of the peripheral arteries. Materials and Methods One hundred twenty patients, who were treated with the diagnosis of arterial pseudoaneurysm of the lower or upper extremity artery between January 2010 and October 2017, took part in this study. Patients with pseudoaneurysms originated from the anastomotic line of the previous vascular operations were excluded from the study. The diagnosis of pseudoaneurysms was made using ultrasonography and confirmed by magnetic resonance imaging (MRI) or computed tomography (CT) scan when deemed necessary. Results The most frequent symptom was a pulsatile mass. The mean diameter of pseudoaneurysms was 4.7±1.8 cm (2.3-8 cm). Among 120, 108 patients underwent surgery, and 10 patients required a blood transfusion during the operation. Wound infection was reported in 20 (15.5%) patients as an early postoperative complication. Arterial thrombosis developed in 6 (4.5%) patients, venous thrombosis in 2 (1.7%) patients, and lymphorrhea in 15 (12.5%) patients. A male patient died on the postoperative 25th day, while two patients died on postoperative 10th and 12th days (2.5%). Conclusion Although lesser invasive treatment modalities have been described with some advantages or disadvantages, open surgical repair is the standard method of treatment for iatrogenic and traumatic peripheral arterial pseudoaneurysms.
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Affiliation(s)
- Yavuzer Koza
- Department of Cardiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ugur Kaya
- Department of Cardiovascular Surgery, Ataturk University School of Medicine, Erzurum, Turkey
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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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Lewandowski P, Baran J, Maciejewski P, Budaj A. A novel technique for iatrogenic pseudoaneurysm obliteration with ultrasound-guided thrombin foam injection. VASA 2018; 48:181-184. [PMID: 30322345 DOI: 10.1024/0301-1526/a000751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Iatrogenic pseudoaneurysms (IPA) are treated with ultrasound-guided thrombin injections (UGTI). We describe a novel technique for IPA repair that applies UGTI with thrombin foam (UGTFI). METHODS AND RESULTS Successful obliteration of 6 IPAs (IPA without a neck, n = 5; with a neck, n = 1) in 6 patients (2 males, aged 68 ± 1 years, 4 females, aged 59 ± 11 years) was performed by using UGTFI. The dose of administered thrombin was 25-75 IU. No microembolization phenomenon and no serious clinical complications were observed. CONCLUSIONS Treatment of IPA with UGTFI may reduce the embolization rate, risk of IPA cavity thrombin leakage, required drug dose. Use of the thrombin foam could be the next step in the development of the UGTI, particularly in the treatment of IPA without a neck.
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Affiliation(s)
- Paweł Lewandowski
- 1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Jakub Baran
- 1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Paweł Maciejewski
- 1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Andrzej Budaj
- 1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
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Sardar MR, Goldsweig AM, Abbott JD, Sharaf BL, Gordon PC, Ehsan A, Aronow HD. Vascular complications associated with transcatheter aortic valve replacement. Vasc Med 2017; 22:234-244. [PMID: 28494713 DOI: 10.1177/1358863x17697832] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is now an accepted pathway for aortic valve replacement for patients who are at prohibitive, severe and intermediate risk for traditional aortic valve surgery. However, with this rising uptrend and adaptation of this new technology, vascular complications and their management remain an Achilles heel for percutaneous aortic valve replacement. The vascular complications are an independent predictor of mortality for patients undergoing TAVR. Early recognition of these complications and appropriate management is paramount. In this article, we review the most commonly encountered vascular complications associated with currently approved TAVR devices and their optimal percutaneous management techniques.
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Affiliation(s)
- M Rizwan Sardar
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA.,2 Aultman Hospital, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
| | - Andrew M Goldsweig
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Dawn Abbott
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Barry L Sharaf
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Paul C Gordon
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Afshin Ehsan
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Herbert D Aronow
- 1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Menon N, Drucker CB, Bhardwaj A, Kalsi R, Crawford RS, Sarkar R, Toursavadkohi S. Flow Reduction-Aided Thrombin Injection for Complex Femoral Pseudoaneurysms: Case Series and Review of the Literature. Ann Vasc Surg 2017. [PMID: 28647639 DOI: 10.1016/j.avsg.2017.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral pseudoaneurysms are a known complication of vascular access procedures. Complex lesions-those with short, wide necks or other complex arrangements-would conventionally require open repair, but we believe that even these lesions could be managed with an endovascular approach. METHODS Four patients with complex pseudoaneurysms were offered an open repair or thrombin injection with the use of flow-reducing balloons. RESULTS In our series of 4 patients with complex pseudoaneurysms, all were safely treated with percutaneous thrombin injection in conjunction with endovascular flow reduction. All patients recovered from their procedures without incident and are free from recurrence at follow-up. CONCLUSIONS Flow reduction-aided thrombin injection may have particular utility in complex femoral pseudoaneurysms, especially in a patient population that may not tolerate open repair. High-risk lesions may merit special consideration for this technique, and further study is warranted.
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Affiliation(s)
- Nandakumar Menon
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Charles B Drucker
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Abhishek Bhardwaj
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Richa Kalsi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Robert S Crawford
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Rajabrata Sarkar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
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A Retrospective Analysis of Surgical Femoral Artery Closure Techniques: Conventional versus Purse Suture Technique. Ann Vasc Surg 2017; 44:103-112. [PMID: 28483631 DOI: 10.1016/j.avsg.2017.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Different techniques have been reported for the exploration and repair of femoral artery (FA) in patients who undergo minimally invasive cardiac surgery (MICS) and endovascular aortic surgery. We used a modified approach alternative to the conventional technique (group CT) since May 2013, which specifies a shorter groin incision and diamond-shaped hemostatic purse sutures for arteriotomy closure without the requirement of cross-clamping (group PT [purse suture technique]) and evaluated early outcomes and the complication profiles of the 2 techniques for femoral access. METHODS In our clinic, between May 2011 and December 2015, 503 FA cannulations were performed on 345 patients who underwent MICS (n = 109, mean age 64.1 ± 17.6 years, female/male ratio 71/38), endovascular abdominal aneurysm repair (n = 158, mean age 71.3 ± 10.2 years, female/male ratio 63/95), thoracal endovascular aneurysm repair (n = 50, mean age 65.0 ± 15.3 years, female/male ratio 15/35), and transaortic valve implantation (n = 28, mean age 80.8 ± 5.9 years, female/male ratio 13/15). A total of 295 FAs were exposed via mini incision and were repaired with the PT. We compared the duration of femoral closure (FC), wound infection, and vascular complications including bleeding hematoma, thromboembolic and ischemic events, pseudoaneurysm, seroma, surgical reintervention rates, delayed hospital stay for groin complications, and existence of postoperative local luminal narrowing (LLN) at the intervention site over 25% for both groups. RESULTS FC time (CT 14.9 ± 3.16 min, PT 6.5 ± 1.12 min, P < 0.0001), bleeding hematoma frequency (CT 6.2%, PT 1.7%, P = 0.01), and prolonged hospital stay for groin complications (CT 14.9%, PT 3.4%, P < 0.0001) were significantly lower in the PT group. Rate of technical success (CT 80.3%, PT 87.4%, P = 0.03) and event-free patient (CT 66.1%, PT 77.5%, P = 0.03) were significantly better in the PT group. There were no differences between groups in terms of ischemic events, wound infection rates, development of pseudoaneurysm and seroma, surgical reintervention rates, and LLN of FA over 25% at 6-month duplex evaluation. CONCLUSIONS The comparison of the 2 approaches revealed the advantages of the PT in terms of bleeding hematoma and shortening in FC time and the length of hospital stay. We suggest performing a smaller skin incision for FA access and utilizing purse sutures, which allows completing the procedure without cross-clamping, thus providing a favorable approach and excellent comfort for the surgeon.
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Mishra A, Rao A, Pimpalwar Y. Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms. J Clin Diagn Res 2017; 11:TC04-TC06. [PMID: 28571227 DOI: 10.7860/jcdr/2017/25582.9512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/10/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Arterial pseudoaneurysms are well known iatrogenic complication of percutaneous angiographic or interventional vascular procedures. In the past, the definitive treatment option was open surgical repair which is a relatively invasive procedure. In the last few years, Ultrasound (US) guided percutaneous thrombin injection has been gaining popularity as definitive treatment of pseudoaneurysms. AIM To evaluate efficacy and safety of US guided percutaneous injection of thrombin for treatment of iatrogenic femoral pseudoanurysms at a tertiary care interventional radiological and cardiology centre. MATERIALS AND METHODS A retrospective analysis was conducted on 38 consecutive patients, diagnosed to have iatrogenic femoral artery pseudoaneurysms by Doppler study, in the period from Jan 2013 to Jun 2016. All these patients were treated by US guided percutaneous injection of thrombin solution inside the pseudoaneurysm sac till contents became echogenic and flow inside the pseudoaneurysm stopped completely. One month further follow up in all these patients was done. RESULTS The dose of thrombin injected varied from 200-1000 IU (mean 300 IU). Immediate thrombosis was seen in all the pseusdoaneurysms. Follow up at 24-48 hours showed complete thrombosis and regression of pseudoaneurysm in all the patients except one in whom a small residual sac was seen which thrombosed completely on second thrombin injection. Further follow up at one month showed regression of aneurysms in all the cases. No significant post procedural clinically significant complications were seen in any of the patients. CONCLUSION US guided percutaneous thrombin injection is a highly successful and safe procedure for the treatment of iatrogenic femoral pseudoaneurysms.
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Affiliation(s)
- Atul Mishra
- Interventional Radiologist, Department of Radiodiagnosis and Interventional Radiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Akhilesh Rao
- Radiologist, Department of Radiodiagnosis and Interventional Radiology, Command Hospital (CC), Lucknow, Uttar Pradesh, India
| | - Yayati Pimpalwar
- Radiologist, Department of Radiodiagnosis and Interventional Radiology, Command Hospital (CC), Lucknow, Uttar Pradesh, India
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Papadakis M, Zirngibl H, Floros N. Iatrogenic Femoral Pseudoaneurysm and Secondary Ipsilateral Deep Vein Thrombosis: An Indication for Early Surgical Exploration. Ann Vasc Surg 2016; 34:269.e13-5. [PMID: 27174354 DOI: 10.1016/j.avsg.2015.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/27/2015] [Accepted: 12/03/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Marios Papadakis
- Department of Vascular Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany.
| | - Hubert Zirngibl
- Department of Vascular Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany
| | - Nikolaos Floros
- Department of Vascular Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany
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Stone PA, Thompson SN, Hanson B, Masinter D. Management of Iatrogenic Pseudoaneurysms in Patients Undergoing Coronary Artery Bypass Grafting. Vasc Endovascular Surg 2016; 50:217-20. [DOI: 10.1177/1538574416637448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: A plethora of papers have been written regarding postcatheterization femoral pseudoaneurysms. However, literature is lacking on pseudoaneurysmal management in patients undergoing coronary artery bypass grafting (CABG). Thus, we examined if pseudoaneurysms with subsequent CABG can be managed with the same strategies as those not exposed to the intense anticoagulation accompanying CABGs. Methods: During a 14-year study period, we retrospectively examined femoral iatrogenic pseudoaneurysms (IPSAs) diagnosed postheart catheterization in patients having a subsequent CABG. Patient information was obtained from electronic medical records and included pseudoaneurysm characteristics, treatment, and resolution. Outcomes of interest included the occurrence of IPSA treatment failures and complications. Results: In the 66 patients (mean age, 66 ± 11 years, 46% male) meeting inclusion criteria, mean dose of heparin received during the CABG procedure was 34 000 ± 23 000 units. The IPSA size distribution was the following: 17% of IPSAs measured <1 cm, 55% between 1 and 3 cm, and 21% measured >3 cm. Pseudoaneurysms were managed with compression, duplex-guided thrombin injection, and surgical repair (1%, 27%, and 26% of cases, respectively). Thrombin injection and surgical repair were 100% effective at treating pseudoaneurysms, with 1 patient experiencing a surgical site infection postsurgical repair. Observation-only management was employed in 30 (45%) patients. Nine of 30 patients with no intervention beyond observation had duplex documented resolution/thrombosis during follow-up. One patient initially managed by observation required readmission and surgical repair of an enlarging pseudoaneurysm (6 cm growth) following CABG. Conclusion: Management of pseudoaneurysms in patients prior to CABG should be similar to those patients not undergoing intense anticoagulation. In appropriate cases, small aneurysms can be safely observed, while thrombin injections are effective and safe as well. Thus, routine open surgical repair is not routinely required in patients with femoral pseudoaneurysms at time of CABG.
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Affiliation(s)
- Patrick A. Stone
- Division of Vascular and Endovascular Surgery, Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Stephanie N. Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Brent Hanson
- Division of Vascular and Endovascular Surgery, Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - David Masinter
- Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
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Stone PA, Martinez M, Thompson SN, Masinter D, Campbell JE, Campbell Ii JR, AbuRahma AF. Ten-Year Experience of Vascular Surgeon Management of Iatrogenic Pseudoaneurysms: Do Anticoagulant and/or Antiplatelet Medications Matter? Ann Vasc Surg 2015; 30:45-51. [PMID: 26256702 DOI: 10.1016/j.avsg.2015.06.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/06/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previous studies examining the natural history of femoral pseudoaneurysms (PSAs) were performed before the current era of anticoagulant and/or antiplatelet therapy. The purpose of our study was to elucidate in a vascular surgeon directed approach to PSAs, the association between medication use and the failure of conservative, observation-only management. METHODS We retrospectively examined 308 femoral iatrogenic PSAs diagnosed via duplex imaging at our institution during a 10-year time period (2004-2013). Information on PSA characteristics, treatment, and antiplatelet and/or anticoagulant medication usage was obtained. We identified patients who failed observation-only conservation management, with failure defined as the need for delayed treatment because of PSAs triggered by either expansion (≥ 1 cm increase or size enlarging to ≥ 3 cm) and/or persistence (≥ 15 days). RESULTS Immediate and/or acute treatments of PSAs included 1 ultrasound-guided compression, 14 surgical repairs, and 126 thrombin injections. Of the 167 PSAs initially managed by observation only, 70 (42%) were found by ultrasound imaging to thrombosis spontaneously. An additional 70 (42%) patients had the diagnosis of PSA <3 cm and were managed conservatively with only clinical follow-up. Twenty-seven PSAs (16%) originally managed conservatively required additional treatment because of expansion and/or persistence. Patients receiving dual-antiplatelet therapy had higher rates of failed conservative management (44%) than patients not on dual therapy (9%, P < 0.01). The number of antiplatelet and/or anticoagulant medications used during observation was larger in patients failing conservative management (2.0 ± 0.7) versus patients not requiring additional intervention (1.5 ± 0.7, P < 0.01). CONCLUSIONS Most of the PSAs initially managed with observation-only did not require additional intervention. However, anticoagulant and/or antiplatelet agents use associated with PSAs required further intervention after failing observation-only management. When observation is the chosen strategy for PSA management, especially in the setting of aggressive antithrombotic and dual-antiplatelet therapy, surveillance is required to ensure proper resolution.
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Affiliation(s)
- Patrick A Stone
- Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV.
| | - Maria Martinez
- Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV
| | - Stephanie N Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, WV
| | - David Masinter
- Charleston Area Medical Center Health Education and Research Institute, Charleston, WV
| | - John E Campbell
- Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV
| | - James R Campbell Ii
- Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV
| | - Ali F AbuRahma
- Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV
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Grandhi R, Zhang X, Jadhav AP, Horowitz MB, Ducruet AF, Jankowitz BT, Jovin TG. Femoral arteriotomy closure using the Mynx vascular closure device: a profile of device efficacy and complications. Interv Cardiol 2014. [DOI: 10.2217/ica.14.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Abissegue Y, Lyazidi Y, Chtata HT, Taberkant M. Late Complication of a Femoral Monitoring Catheter: A Case of Femoral False Aneurysm Treated Surgically. Ann Vasc Surg 2014; 28:1032.e17-20. [DOI: 10.1016/j.avsg.2013.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 09/11/2013] [Accepted: 09/24/2013] [Indexed: 10/25/2022]
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Kleczynski P, Rakowski T, Dziewierz A, Jakala J, Dudek D. Ultrasound-guided thrombin injection in the treatment of iatrogenic arterial pseudoaneurysms: single-center experience. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:24-26. [PMID: 24151057 DOI: 10.1002/jcu.22106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 04/04/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to assess the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of postcatheterization arterial pseudoaneurysms. We evaluated retrospectively 82 consecutive subjects treated with percutaneous ultrasound-guided thrombin injection of postcatheterization femoral (n = 79), brachial (n = 2), and radial (n = 1) pseudoaneurysms from January 2006 to April 2012. Pseudoaneurysm size, thrombin dose, and therapy outcome were documented. All pseudoaneurysm sacs were thrombosed with a single injection. The overall primary success rate (complete sac thrombosis) was 92.7%. A 30-day Doppler ultrasound follow-up showed a 100% procedural success. There were no complications.
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Affiliation(s)
- Paweł Kleczynski
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Park SH, Rha SW, Byon JS. A Case of Successful Treatment of Huge Pseudoaneurysm Complicated withEndovascular Intervention Using Thrombin Injection. Vasc Specialist Int 2013. [DOI: 10.5758/kjves.2013.29.3.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sang-Ho Park
- Department of Cardiology, Soonchunhang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seung-Woon Rha
- Department of Cardiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Soo Byon
- Department of Cardiology, Soonchunhang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Management of Vascular Access in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2013; 6:767-76. [PMID: 23866177 DOI: 10.1016/j.jcin.2013.05.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/18/2013] [Accepted: 05/09/2013] [Indexed: 11/22/2022]
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22
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Grandhi R, Kanaan H, Shah A, Harrison G, Bonfield C, Jovin T, Jankowitz B, Horowitz M. Safety and efficacy of percutaneous femoral artery access followed by Mynx closure in cerebral neurovascular procedures: a single center analysis. J Neurointerv Surg 2013; 6:445-50. [DOI: 10.1136/neurintsurg-2013-010749] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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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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Abstract
PURPOSE A femoral artery pseudoaneurysm - is the most common complication associated with invasive coronary interventions. The aim of the study was to analyze the effectiveness of various methods used for femoral pseudoaneurysm treatment and to assess how routine use of radial approach leads to reduction of these site complications. METHODS The study comprised 1854 consecutive patients who were hospitalized in years 2005-2008 and underwent coronary angiography (with or without angioplasty) via femoral artery access. Since 2009 routine radial approach has been introduced for both coronary angiography and angioplasty. In patients with symptoms suggesting entry site complications Doppler ultrasound was performed. RESULTS Femoral access site complications requiring additional procedures were observed in 63 patients (3.4%): in 56 femoral pseudoaneurysms (88.8%) and in 7 arteriovenous fistulas (11.1%) were diagnosed (all appeared after coronary angioplasty). The patients were treated in following ways: standard compression with an elastic bandage prolonged to 12 hours - in 14 cases (25%), ultrasound guided compression - in 13 patients (23.2%), finger compression followed by standard compression with an elastic bandage prolonged to 12 hours or ice compress - in 10 patients (17.8%), surgical treatment - in 3 patients (5.3%). Only 2 patients required thrombin injection (3.6%). Since the time routine radial approach was introduced extreme reduction in the rate of local complications was registered. CONCLUSION Although iatrogenic femoral pseudoaneurysms following invasive percutaneous coronary interventions are still important complications, most of them can be treated conservatively. It seems that radial access completely eliminates the risk of this complication.
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Bhatty S, Cooke R, Shetty R, Jovin IS. Femoral vascular access-site complications in the cardiac catheterization laboratory: diagnosis and management. Interv Cardiol 2011. [DOI: 10.2217/ica.11.49] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Drew M, Yu JC, Michaels LA. Arterial pseudoaneurysms in haemophilia: conservative treatment with observation and factor replacement. Haemophilia 2010; 17:550-2. [PMID: 21118336 DOI: 10.1111/j.1365-2516.2010.02434.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Other emergencies. Emerg Radiol 2009. [DOI: 10.1017/cbo9780511691935.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Meis A, Osada N, Schlegel PM, Fischbach R, Heindel W, Kloska SP. Sonographic follow-up of the access site after arterial angiography: Impact on the detected complication rate. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1151-1157. [PMID: 19710212 DOI: 10.7863/jum.2009.28.9.1151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study prospectively evaluated the impact of sonographic follow-up on the detection rate of access site complications in arterial angiography and determined parameters associated with major complications of the access site after arterial angiography. METHODS Sonographic follow-up (mean +/- SD, 1.46 +/- 1.11 days after) of the access site (transfemoral, n = 896; and transbrachial, n = 44) was obtained prospectively in 940 arterial angiographies and included evaluations for hematoma, pseudoaneurysm, arteriovenous fistula, arterial dissection, and venous/arterial thrombosis. Clotting parameters, anticoagulation therapy, and several patient and procedure characteristics were recorded. Univariate and multivariate logistic regression analyses were performed. RESULTS Sonography depicted major access site complications in 39 of 940 angiographies (4.2%). Major access site complications (major local hematoma, n = 13; retroperitoneal hematoma, n = 1; pseudoaneurysm, n = 18; arterial dissection, n = 1; arteriovenous fistula, n = 1; arterial thrombosis, n = 2; and venous thrombosis, n = 3) required conservative (n = 32 [3.4%]) or surgical (n = 7 [0.7%]) treatment. Independent factors significantly associated with major access site complications were age older than 60.33 years and sheath size greater than 5F (P < .05). CONCLUSIONS Major access site complications were detected in 4.2% of cases and were significantly associated with age and sheath size.
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Affiliation(s)
- Alexandra Meis
- Department of Clinical Radiology, University of Muenster, Germany
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Abstract
Vascular embolizations are complex and sophisticated procedures and can be a powerful alternative or useful adjunct to surgery in many clinical situations. Hemorrhage, vascular malformations, and tumors are the main indications for embolization procedures. Establishing the correct indication for intervention as well as the proper embolic agent and the most suitable catheterization technique requires advanced knowledge in interventional radiology, and an interdisciplinary approach is a prerequisite. A broad spectrum of microcatheters and embolization materials is available for these therapies. The desired level of occlusion and the individual vascular territory determine the choice of mechanical devices, particles, or liquid substances. Sclerosing agents and thrombin are used in special situations such as varicoceles and pseudoaneurysms.
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Secko MA, Stone MB. Bilateral femoral artery aneurysms and bilateral common femoral vein thromboses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:223-225. [PMID: 19065631 DOI: 10.1002/jcu.20543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report the sonographic findings of a patient with bilateral femoral artery aneurysms with concomitant bilateral deep venous thrombosis of the common femoral veins. Femoral arterial aneurysms may be associated with additional arterial aneurysms, and rarely with associated venous thrombosis. Patients presenting with femoral artery aneurysms should undergo a thorough vascular sonographic examination that includes the abdominal aorta, the iliac vessels and the deep venous system of the lower extremity.
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Affiliation(s)
- Michael A Secko
- Department of Emergency Medicine, SUNY Downstate/Kings County Hospital Center, Brooklyn, NY 11203, USA
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31
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Sharma M, Yong C, Majure D, Zellner C, Roberts JP, Bass NM, Ports TA, Yeghiazarians Y, Gregoratos G, Boyle AJ. Safety of cardiac catheterization in patients with end-stage liver disease awaiting liver transplantation. Am J Cardiol 2009; 103:742-6. [PMID: 19231345 DOI: 10.1016/j.amjcard.2008.10.037] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 10/31/2008] [Accepted: 10/31/2008] [Indexed: 12/13/2022]
Abstract
Patients with end-stage liver disease (ESLD) are predisposed to bleeding complications due to thrombocytopenia, reduced synthesis of coagulation factors, and increased fibrinolytic activity. The exact incidence of vascular access site and bleeding complications related to cardiac catheterization in this group remains unknown. Eighty-eight consecutive patients with ESLD who underwent left-sided cardiac catheterization from August 2004 to February 2007 were identified. Eighty-one patients without known liver disease matched for age, gender, and body mass index who underwent left-sided cardiac catheterization during the same period were chosen as the control group. Vascular complications were defined as hematoma >5 cm, pseudoaneurysm, arteriovenous fistula, or retroperitoneal bleeding. Patients with ESLD had lower baseline mean hematocrit (32.3 +/- 6.0% vs 39.2 +/- 6.2%, p <0.001) and mean platelet count (90.1 +/- 66.3 vs 236.1 +/- 77.1 x 10(9)/L, p <0.001) compared with controls. They also had higher mean serum creatinine (1.9 +/- 1.7 vs 1.2 +/- 0.8 mg/dl, p = 0.002) and mean international normalized ratio (1.6 +/- 0.7 vs 1.1 +/- 0.2, p <0.001). There were more complicated pseudoaneurysms in the patients with liver failure (5.7% [5 of 88]), compared with 0% in controls (p = 0.029). Patients with ESLD had lower starting hemoglobin levels and greater reductions in hemoglobin after cardiac catheterization, resulting in greater need for packed red blood cell transfusion (16% vs 4%, p = 0.008), fresh frozen plasma (51.7% vs 1.2%, p <0.001), and platelet transfusions (48.3% vs 1.2%, p <0.001). Major bleeding was higher in the ESLD group (14.8% vs 3.7%, p = 0.014), driven mainly by the need for blood transfusion. In conclusion, despite severe coagulopathy, left-sided cardiac catheterization may be performed safely in this patient population, with correction of coagulopathy and meticulous attention to procedural technique.
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Affiliation(s)
- Madan Sharma
- Division of Cardiology, University of California, San Francisco, San Francisco, California, USA [corrected]
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Kalapatapu VR, Shelton KR, Ali AT, Moursi MM, Eidt JF. Pseudoaneurysm: A review. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2008; 10:173-83. [DOI: 10.1007/s11936-008-0019-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Postcatheterization femoral artery pseudoaneurysms: therapeutic options. A case-controlled study. Int J Surg 2008; 6:214-9. [PMID: 18455971 DOI: 10.1016/j.ijsu.2008.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 02/29/2008] [Accepted: 03/12/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Postcatheterization femoral artery pseudoaneurysm is a troublesome complication following percutaneous canulations of the femoral artery. Both diagnostic and therapeutic options in the management of these pseudoaneurysms have changed dramatically, with surgery being required only rarely. We aimed to perform a comprehensive review of our experience, techniques and results in treating postcatheterization femoral artery pseudoaneurysms. METHODS A retrospective study of all patients presenting with local complications following invasive percutaneous femoral artery canulations over a five-year period was performed. Physical examination with color Doppler ultrasound analysis identified 29 femoral artery pseudoaneurysms. Surgery, duplex-guided compression, and thrombin injection were the main therapeutic options. RESULTS Fourteen cases of femoral artery pseudoaneurysms were treated by duplex-guided compression obliteration with a 78.5% success rate. Four patients had spontaneous thrombosis of their pseudoaneurysms. Five patients underwent percutaneous thrombin injection. Six patients had conventional surgery. Three cases failed duplex-guided compression: one closed with thrombin injection, and two were repaired surgically. Follow-up US showed no recurrent pseudoaneurysms for patients who underwent successful duplex-guided compression. CONCLUSION Despite the voluminous data in the literature of treating postcatheterization femoral artery pseudoaneurysms by thrombin guided injection, as a quick and effective method of therapy, with infrequent failures and complications, our study confirms the clinical usefulness of duplex-guided compression in the management of these pseudoaneurysms. The possibility of spontaneous thrombosis of small pseudoaneurysms is emphasized.
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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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Oh SN, Jung SE, Rha SE, Lim GY, Ku YM, Byun JY, Lee JM. Sonography of various cystic masses of the female groin. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1735-1742. [PMID: 18029925 DOI: 10.7863/jum.2007.26.12.1735] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this presentation is to review the pathologic spectrum of cystic masses that may involve the female groin region, with a correlation of the lesions with their sonographic appearance. METHODS We reviewed the sonographic findings of palpable groin masses showing a cystic pattern in female patients. The groin region is best depicted with a high-frequency (7.5- to 12-MHz) linear array transducer. Color Doppler sonography and an extended field of view are helpful in the differential diagnosis of variable groin masses. RESULTS There are various cystic masses involving the female groin, such as round ligament cysts, varicosities of the round ligament, inguinal herniation of the ovary, cystic lymphangiomas, epidermal inclusion cysts, abscesses, and pseudoaneurysms. CONCLUSIONS Sonography with color Doppler imaging is helpful for the differential diagnosis of the pathologic spectrum of cystic masses involving the female groin.
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Affiliation(s)
- Soon Nam Oh
- Department of Radiology, Kangnam St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
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Abstract
Physicians spend a considerable amount of time and effort inserting catheters and needles into patients. Central venous catheters are the mainstay of measuring hemodynamic variables that cannot be assessed by noninvasive procedures. These catheters also allow hemodialysis, parenteral nutritional support, delivery of medications, and catecholamine administration. Arterial pressure catheters are frequently used for hemodynamic monitoring and for obtaining arterial blood gases in critically ill patients. Such use of arterial and central venous catheters, however, is potentially associated with severe complications that can be injurious to patients and expensive to treat. Techniques involving the use of anatomic landmarks have been the traditional mainstay of accessing the central venous system for decades. With the development and refinement of portable and affordable high-resolution ultrasound devices, imaging vascular access has changed the role of the traditional landmark techniques. In this article, we explain the use of ultrasound for vascular access to reduce complications associated with cannulation of veins and arteries. We will also provide a brief overview of the current literature regarding ultrasound-guided vascular access.
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Affiliation(s)
- Tim Maecken
- BG University Hospital Bergmannsheil, Clinic of Anaesthesiology, Intensive Care, Palliative Care and Pain Therapy, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, Bochum, Germany.
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