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Bruno A, Vendetti F, Papalexis N, Russo M, Papadopoulos D, Mosconi C. Percutaneous balloon-assisted ultrasound-guided direct thrombin embolization of superficial femoral artery pseudoaneurysm: a case series and literature review. CVIR Endovasc 2024; 7:19. [PMID: 38363514 PMCID: PMC10873257 DOI: 10.1186/s42155-024-00428-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/18/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Superficial femoral artery (SFA) pseudoaneurysms, a rare but potentially life-threatening complication, that can arise after vascular interventions or trauma. This case series explores the efficacy and safety of a minimally invasive treatment modality, percutaneous ultrasound-guided thrombin injection (PUGTI) combined with balloon occlusion, in three patients with SFA pseudoaneurysms. CASE PRESENTATION Three patients (age: 71-82 years; 3 female) with SFA pseudoaneurysms underwent PUGTI with balloon occlusion. The procedure involved direct thrombin injection under ultrasound guidance while occluding the parent artery using a balloon catheter. Follow-up was conducted at 1 week and 1 month post-procedure to assess technical success, complications, and recurrence. CONCLUSION PUGTI combined with balloon occlusion appears to be a safe and effective treatment for SFA pseudoaneurysms, particularly for larger pseudoaneurysms. The procedure is associated with a high technical success rate. Balloon occlusion may offer a safer alternative to direct thrombin injection without occlusion, as it potentially minimizes the risk of complications such as distal thromboembolism.
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Affiliation(s)
- Antonio Bruno
- Alma Mater Studiorum, Università Di Bologna, Bologna, Italy
| | | | | | - Mattia Russo
- Alma Mater Studiorum, Università Di Bologna, Bologna, Italy.
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Juenger J, Mahlmann A, Udelnow A, Bauersachs R, Braun-Dullaeus RC, Herold J. The Role of Anticoagulants and Platelet Aggregation Inhibitors in the Treatment of Pseudoaneurysms and Risk of Venous Thrombosis. Angiology 2024; 75:156-165. [PMID: 36468771 DOI: 10.1177/00033197221143321] [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] [Indexed: 12/19/2023]
Abstract
Pseudoaneurysms (PSA) are one of the most common complications after arterial punctures. This retrospective study examined whether platelet aggregation inhibitors (APT) or anticoagulants (AC) lower the success rates of PSA treatment. A total of 468 patients with PSA were retrospectively analyzed between 2010 and 2018, and 238 were included in the study. Despite co-medication with APT or AC, thrombin injection (TI) was superior to compression bandage (CB) therapy in treating PSA (TIwAC 79 vs CBwAC 51%; P = .004 and TIwAPT 93 vs CBwAPT 54%; P = .001). There was no decrease in PSA-associated thrombosis in patients requiring anticoagulation after TI. The success rates of the TI and CB groups were compared in patients with and without AC therapy, and the latter was significantly lower. A reduced success rate was not observed in CB therapy patients requiring APT. In contrast, better results were seen in the TI group. Regarding PSA treatment, TI therapy is significantly superior to CB, including in patients requiring concomitant AC or APT therapy. PSA-associated thrombosis also occurs in patients requiring anticoagulation, and sonography should be performed. Concomitant medication use with APT does not significantly influence PSA therapy success or prevention of PSA-associated thrombosis.
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Affiliation(s)
- Jonas Juenger
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany
- Children's Hospital Prinzessin Margaret, Darmstadt, Germany
| | - Adrian Mahlmann
- Center for Vascular Medicine, Clinic of Angiology, St.-Josefs-Hospital, Katholisches Krankenhaus Hagen gem, GmbH, Germany
| | - Andrei Udelnow
- Department of Surgery, Dietrich Bonhoeffer Diakonie Hospital, Neubrandenburg, Germany
| | - Rupert Bauersachs
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany
| | | | - Joerg Herold
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany
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3
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Endovascular Management of a Deep Femoral Artery Perforating Branch Pseudoaneurysm after Total Hip Arthroplasty: A Case Study. Case Rep Med 2022; 2022:5925839. [DOI: 10.1155/2022/5925839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Pseudoaneurysm of the profundal femoris artery (PFA) following total hip arthroplasty (THA) is a rare and unusual complication. Awareness of this complication and a high level of suspicion allow early diagnosis and treatment, thereby reducing the morbidity of this condition. We present a case of a pseudoaneurysm of a perforating branch of the PFA after revision THA which was treated successfully by selective coil embolization.
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4
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Wu H, Zhang L, Zhang C, Xie B, Lou C, Liu Y, Bai H. Non-Surgical treatment Versus Surgery for Iatrogenic Femoral Artery Pseudoaneurysms: Systematic Review and Meta-Analysis. Front Surg 2022; 9:905701. [PMID: 36211300 PMCID: PMC9533642 DOI: 10.3389/fsurg.2022.905701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This study compared results of non-surgical treatment (compression and ultrasound guided thrombin injection (UGTI)) and surgery to treat iatrogenic femoral artery pseudoaneurysms. Methods PubMed and Embase databases were searched up to October 2021. Primary outcome measure was success rate, and other outcomes examined were complication rate, reintervention rate. Two authors independently reviewed and extracted data. Data were presented as the odds ratios (ORs) with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to appraise the quality of the body of evidence. Results Eight studies were included. A total of 623 patients with pseudoaneurysm undergoing treatment were included, of which 163 subjects underwent surgery, 397 subjects underwent compression, and 63 subjects underwent UGTI. The success rate was significantly lower in the non-surgery group (OR 0.24, 95% CI, 0.08–0.69, I2 = 0%). The complication rate was significantly lower in the non-surgery group (OR 0.10, 95% CI, 0.03 –0.29, I2 = 0%). Patients in the non-surgery group tended to have a lower, but statistically insignificant, reintervention rate (OR 0.11, 95% CI, 0.01–1.06, I2 = 35%). Further, the GRADE assessment showed that these results (success rate, complication rate, and reintervention rate) were of very low quality. Conclusions Available evidence shows that it is reasonable to regard non-surgical treatment as the primary treatment for iatrogenic femoral artery pseudoaneurysms, and surgery as a remedy after failure of non-surgical treatment in some cases.
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Affiliation(s)
- Haoliang Wu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, China
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, China
| | - Liwei Zhang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, China
| | - Cong Zhang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, China
| | - Boao Xie
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, China
| | - Chunyang Lou
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, China
| | - Yuanfeng Liu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, China
| | - Hualong Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, China
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, China
- Correspondence: Hualong Bai ;
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5
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Lindner JU, Markuske M, Szczanowicz L, Jobs A, Abdel-Wahab M, Desch S, Thiele H, Sulimov DS. Balloon-assisted injection of fibrin sealant for the treatment of postintervention access-site bleeding complications. Catheter Cardiovasc Interv 2022; 99:1327-1334. [PMID: 35019201 DOI: 10.1002/ccd.30068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/25/2021] [Indexed: 12/24/2022]
Abstract
This study sought to evaluate a new method that uses injection of fibrin sealant under simultaneous balloon occlusion for the treatment of postinterventional access site bleeding complications. With the rising complexity of interventional procedures, iatrogenic false aneurysms and active bleeding has become more common. In general, these complications are associated with increased morbidity and mortality, especially if surgical repair is required. Although high success rates are reported for ultrasound-guided compression and ultrasound-guided thrombin injection, these methods are not always feasible. All procedures of fibrin sealant injection under simultaneous balloon occlusion for the treatment of postinterventional access site bleeding complications or pseudoaneurysm were prospectively collected. Additional data were retrospectively obtained and analyzed for all patients treated by this new method. In total, 53 patients were included from 2018 to 2021. Most of the access site complications were related to transcatheter aortic valve replacement (40%) or percutaneous coronary intervention (21%), but also to a wide variety of other procedures. Of the 53 patients, 30 had to be treated for false aneurysms and 23 for active bleeding. A high primary success rate of 94% was achieved. Recurrences of false aneurysms occurred in six patients, of which only one needed open surgical repair. Regarding complications, two peripheral embolisms, thereof one requiring additional stent implantation occurred. Balloon-assisted thrombin injection seems to be feasible and safe. It provides a new alternative to prevent surgery for patients where common techniques are unavailable or have failed.
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Affiliation(s)
- Jakob U Lindner
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Markuske
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Lukasz Szczanowicz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alexander Jobs
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Dmitry S Sulimov
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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Herold J, Peters S, Juenger J, Udelnow A, Kropf S, Bauersachs R, Braun-Dullaeus R. High incidence of deep vein thrombosis during the treatment of pseudoaneurysms - a retrospective nonrandomized study. VASA 2021; 50:231-239. [PMID: 33435750 DOI: 10.1024/0301-1526/a000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Pseudoaneurysms (PSAs) are concerning complications after arterial invasive interventions. Therapeutic options include manual ultrasound-assisted compression, pressure dressings, surgical intervention and thrombin injection. Compression of neighboring veins is obvious. However, the incidence of deep vein thrombosis (DVT) in patients with PSA has not previously been investigated. Patients and methods: In this retrospective, nonrandomized study 238 patients with PSA were analyzed from 2013 to 2018. In 149 patients, all of the parameters were complete for participating. PSAs were treated according to the local standard therapy with either ultrasound-guided compression followed by compression bandage or thrombin injection. Treatment success was evaluated 24 hours later, and the venous system was examined for the presence of DVT. Results: Peripheral DVT was found in 25.4% patients after ultrasound-assisted compression and subsequent pressure bandages, but only 6.4% of patients had DVT after thrombin injection (p = 0.013). Lower leg veins, particularly veins of the crural muscles, were primarily affected. Significantly more PSAs were successfully treated without the occurrence of DVT in the thrombin injection group compared to the compression group (93.6 vs. 69.0%; p = 0.001). Conclusions: Our study revealed that the use of thrombin injections resulted in a significantly lower rate of postinterventional DVT and a higher total number of successfully treated PSAs compared to compression therapy.
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Affiliation(s)
- Joerg Herold
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany.,Department of Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Germany
| | - Sophie Peters
- Department of Surgery, Dietrich Bonhoeffer Diakonie Hospital, Neubrandenburg, Germany
| | - Jonas Juenger
- Children's Hospital Prinzessin Margaret, Darmstadt, Germany
| | - Andrej Udelnow
- Brandenburg Medical School "Theodor Fontane", Municipal Hospital of Brandenburg/Havel, Dpt. of Vascular and Endovascular Surgery, Brandenburg/Havel, Germany
| | - Siegfried Kropf
- Institute for Biometry and Medical Informatics, Otto-von-Guericke University Magdeburg, Germany
| | - Rupert Bauersachs
- Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Germany
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Minici R, Paone S, Talarico M, Zappia L, Abdalla K, Petullà M, Laganà D. Percutaneous treatment of vascular access-site complications: a ten years' experience in two centres. CVIR Endovasc 2020; 3:29. [PMID: 32507937 PMCID: PMC7276472 DOI: 10.1186/s42155-020-00120-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele. Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications. Results Ninety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%. Conclusions The percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.
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Affiliation(s)
- Roberto Minici
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy.
| | - Sara Paone
- IRC - FSH, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Marisa Talarico
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Lorenzo Zappia
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy
| | - Karim Abdalla
- Anaesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Catanzaro, Italy
| | - Maria Petullà
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy
| | - Domenico Laganà
- Radiology Division, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, Viale Europa, 88100, Catanzaro, CZ, Italy.,Radiology Division, University of Insubria, Varese, Italy
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8
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Schahab N, Kavsur R, Mahn T, Schaefer C, Kania A, Fimmers R, Nickenig G, Zimmer S. Endovascular management of femoral access-site and access-related vascular complications following percutaneous coronary interventions (PCI). PLoS One 2020; 15:e0230535. [PMID: 32191751 PMCID: PMC7082010 DOI: 10.1371/journal.pone.0230535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Major vascular complications (VCs) of ilio–femoral arterial access after percutaneous coronary interventions are infrequent, but are associated with increased mortality and morbidity. Routine endovascular repair of VCs is becoming the treatment of choice, especially for patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation. Here, we review the different types of vascular access site complications associated with percutaneous coronary interventions (PCIs) and assess the safety and efficacy of endovascular treatment. Methods Data were retrospectively analysed from patients who experienced VCs after transfemoral PCIs, from December 2014 to May 2018. During this period, out of 2833 patients who underwent femoral coronary interventions, 53 (1.9%) experienced major VCs. Results In total, 40/53 (75.5%) cases with major VCs led to unplanned endovascular repair and 13/53 (24.5%) cases required surgical repair. VCs included 17 (32.1%) retroperitoneal bleeding events (BARC-2, 3a,b), 20 (37.7%) intimal dissections, and 16 (30.2%) femoral pseudoaneurysms. Overall, 32 (60.4%) patients received a covered stent, two (3.8%) received a nitinol stent, five (9.4%) patients with dissections were treated with prolonged balloon angioplasty alone, and one patient with femoral pseudoaneurysm underwent thrombin injection with simultaneous balloon occlusion. The mean hospital stay for patients after endovascular treatment was 11.06 ± 5.2 days, while for patients after surgical repair it was 17 ± 8.2 days. Endovascularly treated patients were transfused with red blood cells (13/40 32.5% vs. 2/13 15.4%) significantly more often than patients treated surgically, although surgically treated patients received more red blood cell concentrates per unit than endovascularly treated patients (1 ± 0.47 vs. 2 ± 0.93). During the one-year follow-up, no intermittent claudication was reported, and no patient required secondary endovascular or surgical repair. Conclusions For patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation, endovascular management of VCs following PCIs seems to be a feasible and safe treatment option, and represents an alternative to surgical repair in life-threatening situations. Endovascular treatment was associated with significantly fewer red blood cell concentrates per patient and fewer days in hospital than surgical treatment.
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Affiliation(s)
- Nadjib Schahab
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Refik Kavsur
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Thorsten Mahn
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Christian Schaefer
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Alexander Kania
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II-Cardiology, Pulmonology and Angiology, University Hospital Bonn, Bonn, Germany
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Spazier M, Meyer F, Bauersachs R, Herold J. Das moderne befund- und patientenadaptierte Management von peripheren Pseudoaneurysmen nach arteriellem Zugang. Zentralbl Chir 2020; 145:438-444. [DOI: 10.1055/a-1096-1327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungPseudoaneurysmen (PSA) zählen zusammen mit den Hämatomen zu den häufigsten Komplikationen nach kathetergestützten Eingriffen.
Ziel und Methode Die narrative kompakte Kurzübersicht umreißt sowohl die Entstehung und Charakteristika von Pseudoaneurysmen sowie die Optionen der Diagnostik und Therapie als auch deren mögliche Komplikationen.
Ergebnisse Ätiopathogenese: Durch den nicht verschlossenen Stichkanal der Punktion kommt es zum kontinuierlichen Blutausstrom aus dem Gefäß, der im umliegenden Gewebe eine Pseudoaneurysmahöhle formt. Diese wird nicht wie beim wahren Aneurysma durch eine Gefäßwand begrenzt, sondern nur durch die umliegenden Gewebestrukturen eingedämmt. Dies ist aber meist nicht suffizient und es kommt zu einer raschen Ausbreitung und diffusen Einblutungen. Dadurch können umliegende Strukturen wie Nerven und Venen durch das expandierende Pseudoaneurysma komprimiert werden, woraus sich irreversible Schäden entwickeln können. Diagnostik: Die Duplexsonografie steht dominierend absolut im Vordergrund. Die CT-A, MR-A und DSA bleiben speziellen Fragestellungen oder klinischen Fallkonstellationen (z. B. Begleiterkrankungen etc.) vorbehalten – eine DSA ist stets mit Interventionsbereitschaft zu verbinden. Therapie: Mit der manuellen Kompression und der darauffolgenden Anlage eines
Druckverbandes, einer ultraschallgestützten Kompression, der Thrombininjektion und der operativen Sanierung stehen mehrere Verfahren zur Auswahl. Die ultraschallgestützte Kompression sollte dabei immer sofort eingesetzt werden, da sie höchst effizient und ubiquitär verfügbar ist. Additiv zur Kompression kann die Thrombininjektion bei PSA ohne Nerven-/Gewebeirritation mit eingesetzt werden und bietet noch bessere Verschlussraten, ist jedoch anspruchsvoller in der Anwendung. Die operative Ausschaltung ist die effektivste Methode, bietet aber neben dem größten Aufwand die meisten Begleitkomplikationen wie Wundheilungsstörung bei mazeriertem Gewebe und den längsten Krankenhausaufenthalt. Alternative Verfahren zu den genannten haben sich bisher nicht durchsetzen können.
Schlussfolgerung Das diagnostische und therapeutische Management von Pseudoaneurysmen stellt eine Herausforderung im interdisziplinären befund- und patientenadaptierten Vorgehen dar, das den erfahren Gefäßmediziner erfordert.
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Affiliation(s)
- Max Spazier
- Klinik für Gefäßmedizin – Angiologie und Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
| | - Frank Meyer
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Rupert Bauersachs
- Klinik für Gefäßmedizin – Angiologie und Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
| | - Joerg Herold
- Klinik für Gefäßmedizin – Angiologie und Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
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Tonogai I, Arase H, Kawabata Y, Sairyo K. Septic True Aneurysm of the Posterior Tibial Artery Diagnosed after Anterior Arthroscopic Debridement of a Septic Ankle following Infective Endocarditis: A Case Report. J Orthop Case Rep 2019; 8:68-73. [PMID: 30915299 PMCID: PMC6424318 DOI: 10.13107/jocr.2250-0685.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction There have been reports of true aneurysm of the posterior tibial artery, but only three reports have described true aneurysm of the posterior tibial artery at the ankle, and there has been only one report of tarsal tunnel syndrome caused by true aneurysm of this artery. In this case report, we describe a rare case of true septic aneurysm of the posterior tibial artery presenting as tarsal tunnel syndrome which was found after anterior arthroscopic debridement of a septic ankle in a 55-year-old man. Case Report 13 years earlier, this patient had undergone aortic valve replacement for severe aortic regurgitation caused by infective endocarditis with aortic valve vegetations. Since then, the patient had been treated with the oral anticoagulant warfarin. The aneurysm was successfully treated by a saphenous vein graft and administration of antibiotics. The patient likely developed septic ankle and aneurysm as a consequence of infective endocarditis. Conclusions Magnetic resonance imaging should be performed before arthroscopic surgery to rule outaneurysm, especially in a patient with a septic ankle and/ora history of infective endocarditis.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Hiroki Arase
- Department of Cardiovascular Surgery, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Yutaka Kawabata
- Department of Cardiovascular Medicine, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
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11
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Saydam O, Serefli D, Engin AY, Atay M, Kunt A. Percutaneous Treatment of Deep Femoral Artery Pseudoaneurysm Due to Penetrating Trauma. Ann Vasc Dis 2018; 11:569-571. [PMID: 30637019 PMCID: PMC6326050 DOI: 10.3400/avd.cr.18-00092] [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] [Indexed: 11/13/2022] Open
Abstract
Pseudoaneurysm of the deep femoral artery (FAP) due to penetrating trauma is less common and can be a challenging condition for surgeons. The conventional treatment strategy for FAP due to penetrating trauma is open surgical repair. With emerging technologies, less invasive techniques are being used in these patients. We report a 37-year-old male patient with delayed presentation of FAP secondary to a stab wound and treated successfully with ultrasound-guided thrombin injection.
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Affiliation(s)
- Onur Saydam
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Deniz Serefli
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - A Yaprak Engin
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Atay
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Aysegul Kunt
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
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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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Abstract
Pseudoaneurysms (PSAs) are commonly known as complications associated with invasive interventions. Because of the pulsatile in- and outflow of blood through the neck of PSAs, they tend to grow and, in the worse cases, can rupture. Therapeutic options are compression therapy, using a compression bandage and ultrasound-guided compression, and thrombin injection. Manual ultrasound-guided compression is widely performed and is successful in most cases. In general, it is combined with a subsequently applied compression bandage. Thrombin injection is a more difficult technique, but it has a higher success rate. This article gives an overview of the characteristics of PSAs, their diagnostic characteristics and the therapeutic methods used to treat them. Complications associated with compression or thrombin injection are also explained in detail.
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Affiliation(s)
- Sophie Peters
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Germany
| | | | - Joerg Herold
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Germany
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Theys T, Van Hoylandt A, Broeckx CE, Van Gerven L, Jonkergouw J, Quirynen M, van Loon J. Plasma-rich fibrin in neurosurgery: a feasibility study. Acta Neurochir (Wien) 2018; 160:1497-1503. [PMID: 29872915 DOI: 10.1007/s00701-018-3579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage represents an important and sometimes challenging complication in both cranial and spinal surgery. Current available options for dural closure pose inherent problems regarding safety, efficacy, immunogenicity, cost, and invasiveness. In this article, the use of leukocyte- and platelet-rich fibrin (L-PRF) derived from the patient's own blood is proposed to facilitate dural closure. We aim to describe the safety, feasibility, and applicability of L-PRF membranes and plugs in cranial and spinal neurosurgery. METHODS A retrospective study reviewing clinical and surgical characteristics was conducted in 47 patients in whom the use of L-PRF was attempted to reinforce dural closure at a single institution during 1 year. Procedures included skull base, posterior fossa, and spinal revision surgeries. RESULTS L-PRF membranes and/or plugs were used in 44 surgeries. The preparation of L-PRF failed in three cases. L-PRF membranes were used as onlay grafts to augment sealing or sutured into a defect. No short-term complications related to the use of L-PRF were recorded. Postoperative CSF leakage was present in two endoscopic transsphenoidal pituitary surgeries and in one spinal CSF leak repair. CONCLUSION L-PRF is safe, inexpensive, and completely autologous and can be rapidly and non-invasively harvested to aid in dural closure. Theoretical advantages include a regenerative bioactive potential, which could lead to improved wound healing and reduced infection rates. These findings warrant larger prospective studies to determine the potential role of L-PRF in neurosurgery.
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Laurito A, Kasemi H, Monti A, Maselli M, Manzo P, Tavolini V, Gaggiano A. Percutaneous Embolization of Delayed External Carotid Artery Pseudoaneurysm Eight Years after Partial Parathyroidectomy. Ann Vasc Surg 2017; 43:311.e1-311.e4. [PMID: 28385501 DOI: 10.1016/j.avsg.2016.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022]
Abstract
External carotid artery pseudoaneurysm (ECAP) is very rare. The usual mechanism is trauma or iatrogenic. We report a case of a patient with an asymptomatic, chronic ECAP secondary to partial parathyroidectomy. Percutaneous injection of the 2-component Fibrin Sealant (Tisseel; Baxter int, Deerfield, IL) with the 2 active ingredients (Sealer Protein Solution and Thrombin Solution) was carried out with successful occlusion of the pseudoaneurysmal sac. The 6-month follow-up computed tomographic scan confirmed the ECAP thrombosis. The ECAP endovascular approach is less invasive and reduces the complications of the open surgical intervention, especially in high-risk patients or presenting with hostile neck.
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Affiliation(s)
- Antonella Laurito
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Holta Kasemi
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy; Department "Paride Stefanini", Vascular Surgery Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Andrea Monti
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Mauro Maselli
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Paola Manzo
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Valeria Tavolini
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
| | - Andrea Gaggiano
- Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy
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Mafeld S, McNeill M, Haslam P. Percutaneous perirenal thrombin injection for the treatment of acute hemorrhage after renal biopsy. Diagn Interv Radiol 2017; 22:190-2. [PMID: 26809832 DOI: 10.5152/dir.2015.15241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Percutaneous renal biopsy is a valuable diagnostic approach. While commonly safe, it is not without risk and the most feared vascular complications include hemorrhage, pseudoaneurysm, and arteriovenous fistula formation. We report a case of acute hemorrhage after renal biopsy that was immediately identified by ultrasonography and successfully treated with percutaneous perirenal thrombin injection. This technique may prove a useful addition to the armamentarium of any operator performing renal biopsies.
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Tshomba Y, Papa M, Marone EM, Kahlberg A, Rizzo N, Chiesa R. A True Posterior Tibial Artery Aneurysm. Vasc Endovascular Surg 2016; 40:243-9. [PMID: 16703214 DOI: 10.1177/153857440604000311] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aneurysms of infrapopliteal arteries are rare. The etiology is usually traumatic, and most aneurysms are false. The English-language literature reports only 33 cases of infrapopliteal arterial true aneurysms, of which 8 involve the posterior tibial artery. The etiology of these lesions is unclear; a fibromuscular fibrodysplasia similar to ulnar aneurysm may be hypothesized, but traumatic, atherosclerotic, inflammatory, and other pathological processes are also probably involved. The natural history seems to be related to thrombosis and distal embolism more than to rupture. Surgical indications are debated. Aneurysm repair with a complete restoration of the blood flow through the affected artery is particularly challenging owing to the small size of the vessels, and ligation may be required. We report, to the best of our knowledge, the first case of an atherosclerotic posterior tibial artery true aneurysm successfully treated with aneurysmectomy and end-to-end direct reconstruction with a documented good long-term patency. Clinical features, imaging findings, and surgical management are described; indications and treatments (open or endovascular) are discussed.
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Affiliation(s)
- Yamume Tshomba
- Department of Vascular Surgery, Vita-Salute University, Scientific Institute H. San Raffaele, Milan, Italy.
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Mohan B, Mohan G, Tandon R, Kumbkarni S, Chhabra ST, Aslam N, Sood NK, Wander GS. A cost effective endovascular approach for management of post-catheterization profunda femoris artery pseudoaneurysm using thrombin. Indian Heart J 2014; 66:83-6. [PMID: 24581101 PMCID: PMC3946472 DOI: 10.1016/j.ihj.2013.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 08/07/2013] [Accepted: 12/04/2013] [Indexed: 12/03/2022] Open
Abstract
Post-catheterization PSA is one of the most commonly encountered vascular complications of cardiac and peripheral angiographic procedures. We report the case of patient who developed deep-seated profunda femoris artery pseudoaneurysm (PSA) following cardiac catheterization. Despite, repeated ultrasound guided compressions the PSA failed to close and instead produced local site pressure ulcers. The secondary infection followed which precluded use of percutaneous thrombin injection. The PSA was finally closed via a total endovascular technique combining intravascular thrombin injection and coil embolization, thus obviating the need for expensive measures like cover stents or invasive surgical repairs.
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Affiliation(s)
- Bishav Mohan
- Professor of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India.
| | - Gaurav Mohan
- DM Student, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Rohit Tandon
- Consultant, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Shalinder Kumbkarni
- Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Shibba Takkar Chhabra
- Assistant Professor of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Naved Aslam
- Associate Professor of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Naresh Kumar Sood
- Professor of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Gurpreet Singh Wander
- Professor & HOD of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
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Pinto DM, Bastianetto P. Percutaneous treatment of femoral pseudoaneurysms: comparison of fibrin sealant against thrombin. J Vasc Bras 2013. [DOI: 10.1590/jvb.2013.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Femoral pseudoaneurysms are a complication that occurs in connection with up to 8% of percutaneous procedures. Of the available treatments, ultrasound guided thrombin injection has a high success rate and is well-tolerated by patients. The combination of thrombin and fibrinogen known as fibrin sealant forms a stable clot and can be used to treat pseudoaneurysms, particularly those with complex anatomy and larger size. OBJECTIVE: To compare the results of treating femoral pseudoaneurysm in two ways: Group T was treated with thrombin alone and Group T+F was treated with fibrin sealant (thrombin+fibrinogen). METHODS: A retrospective analysis was conducted of femoral pseudoaneurysm cases treated between January 2005 and December 2012. RESULTS: Twenty-eight patients were treated, 21 with thrombin alone and seven with fibrin sealant. All patients in group T were treated successfully, but only four patients in group T+F were treated successfully (57.1% success rate in Group T+F, p<0.01). The three cases of failure in group T+F needed surgery and in one of these cases the complication was embolization to the femoral bifurcation. The pseudoaneurysms that were treated with fibrin sealant were larger (25 cm3 in Group T and 57.7 cm3 in Group T+F, p=0.02) and required larger volumes of thrombin (0.5 mL in Group T and 1.0 mL in Group T+F, p<0.01). There was one complication in Group T and two complications in Group T+F (p<0.01). CONCLUSIONS: Irrespective of the small number of cases reviewed, treatment with thrombin alone was superior to treating with fibrin sealant, since it caused few complications and was more effective at correcting pseudoaneurysms.
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Fustero Aznar J, Hermoso Cuenca V, Vélez Lomana A, Lara Guerrero I. Aneurisma de tronco tibioperoneo. A propósito de un caso. ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2013.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aburahma Z, Hass SM. Endovascular repair of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery: case report and review of literature. Vascular 2013; 21:102-4. [PMID: 23526110 DOI: 10.1177/1708538113477799] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery. Endovascular repair was successfully used as the treatment for this patient and studies have shown this to be a safe alternative to surgery.
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Affiliation(s)
- Zachary Aburahma
- West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA
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22
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Santos MB, Silva S, Bettencourt V, Teles RC, Almeida MS, Medeiros D, Silva JA. Ultrasound-guided thrombin-gelatin injection is effective for the treatment of iatrogenic femoral artery pseudoaneurysms: Initial results. Catheter Cardiovasc Interv 2012; 81:303-7. [DOI: 10.1002/ccd.24330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 01/07/2012] [Indexed: 11/09/2022]
Affiliation(s)
| | - Sergio Silva
- Department of Vascular Surgery; Egas Moniz Hospital; Lisbon; Portugal
| | - Vitor Bettencourt
- Department of Vascular Surgery; Egas Moniz Hospital; Lisbon; Portugal
| | | | | | - Duarte Medeiros
- Department of Vascular Surgery; Egas Moniz Hospital; Lisbon; Portugal
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Ferrero E, Ferri M, Viazzo A, Gaggiano A, Berardi G, Piazza S, Cumbo P, Castagno C, Pecchio A, Nessi F. Rupture of a True Giant Aneurysm of the Posterior Tibial Artery: A Huge Size of 6 cm on Diameter. Ann Vasc Surg 2010; 24:1134.e9-13. [DOI: 10.1016/j.avsg.2010.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 01/21/2010] [Accepted: 01/29/2010] [Indexed: 11/16/2022]
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25
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Preparation and characterization of injectable fibrillar type I collagen and evaluation for pseudoaneurysm treatment in a pig model. J Vasc Surg 2010; 52:1330-8. [DOI: 10.1016/j.jvs.2010.05.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 05/28/2010] [Accepted: 05/30/2010] [Indexed: 12/27/2022]
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Endovascular Treatment of Complications of Femoral Arterial Access. Cardiovasc Intervent Radiol 2010; 33:457-68. [PMID: 20162284 DOI: 10.1007/s00270-010-9820-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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Karkos CD, Karamanos DG, Papazoglou KO, Papadimitriou DN, Gerogiannis IN, Demiropoulos FP, Gerassimidis TS. Ruptured pseudoaneurysm of the profunda femoris artery due to pellet injury: endovascular treatment by coil embolization. Cardiovasc Intervent Radiol 2008; 32:837-9. [PMID: 19104897 DOI: 10.1007/s00270-008-9490-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 11/15/2008] [Accepted: 11/26/2008] [Indexed: 12/28/2022]
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Imaging appearances and endovascular management of uncommon pseudoaneurysms. Clin Radiol 2008; 63:1254-64. [PMID: 18929043 DOI: 10.1016/j.crad.2008.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 04/07/2008] [Accepted: 04/08/2008] [Indexed: 11/20/2022]
Abstract
Pseudoaneurysms are uncommon and their aetiology is varied. They occur in numerous anatomical locations and present with a multitude of clinical presentations sometimes life-threatening. This review describes the causes, sites, and presentations of uncommon pseudoaneurysms, as well as illustrating their diagnostic appearances and endovascular management.
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Finkelstein A, Bazan S, Halkin A, Herz I, George J, Miller HI, Keren G, Banai S. Treatment of post-catheterization femoral artery pseudo-aneurysm with para-aneurysmal saline injection. Am J Cardiol 2008; 101:1418-22. [PMID: 18471452 DOI: 10.1016/j.amjcard.2008.01.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Revised: 01/03/2008] [Accepted: 01/03/2008] [Indexed: 11/16/2022]
Abstract
Femoral artery pseudoaneurysm is a common complication associated with cardiac catheterization procedures. Ultrasound-based techniques (e.g., mechanical compression, thrombin injection) and open surgical intervention are frequently used in the management of pseudoaneurysm. The investigators report their prospective experience with a novel method for the treatment of pseudoaneurysm after cardiac catheterization using ultrasound-guided, para-aneurysmal injection of physiologic saline. Sixty-four consecutive patients with pseudoaneurysms after cardiac catheterization were treated using normal saline (0.9% sodium chloride 25 to 60 ml) injected into the tissue surrounding the tract connecting the pseudoaneurysm with the femoral artery, followed by manual pressure of short duration. In none of the patients was concomitant antithrombotic therapy (aspirin [n = 63], clopidogrel [n = 45], unfractionated or low-molecular-weight heparin [n = 23], and warfarin [n = 5]) discontinued during the closure attempt. Fifty-nine of the 64 pseudoaneurysms (92%) were successfully occluded using saline injection. In 5 patients in whom saline injection failed, the pseudoaneurysms were successfully treated with thrombin injection (n = 4) or ultrasound-guided compression (n = 1). In all 64 patients, pseudoaneurysm closure was confirmed by ultrasound at 24 hours. The procedure was very well tolerated by the patients, and no side effects or complications were noted. In conclusion, ultrasound-guided saline injection affords a simple, safe, and effective alternative treatment for the closure of postcatheterization pseudoaneurysms.
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Affiliation(s)
- Ariel Finkelstein
- Interventional Cardiology, Division of Cardiology, The Tel Aviv Medical Center, Tel Aviv, Israel
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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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Hofmann I, Wunderlich N, Robertson G, Kieback A, Haller C, Pfeil W, Störk T, Hoffmann G, Bischoff KO, Dorsel T, Görge G, Sievert H. Percutaneous injection of thrombin for the treatment of pseudoaneurysms: the German multicentre registry. EUROINTERVENTION 2007; 3:321-6. [DOI: 10.4244/eijv3i3a59] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mittleider D, Cicuto K, Dykes T. Percutaneous Thrombin Injection of a Femoral Artery Pseudoaneurysm with Simultaneous Venous Balloon Occlusion of a Communicating Arteriovenous Fistula. Cardiovasc Intervent Radiol 2007; 31 Suppl 2:S115-9. [DOI: 10.1007/s00270-007-9200-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 09/12/2007] [Accepted: 09/25/2007] [Indexed: 11/28/2022]
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Affiliation(s)
- Geoffrey W Webber
- Zena and Michael A. Wiener Cardiovascular Institute and the Marie-José and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, One Gustave L. Levy Pl, Box 1033, New York, NY 10029, USA
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Bhat R, Chakraverty S. Femoral artery thrombosis following percutaneous treatment with thrombin injection of a femoral artery pseudoaneurysm: a case report. Cardiovasc Intervent Radiol 2007; 30:789-92. [PMID: 17508246 DOI: 10.1007/s00270-007-9024-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rajesh Bhat
- Department of Radiology, Level 6, Ninewells Hospital & Medical School, Dundee, DD19SY, UK.
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Maleux G, Thijs M, Heye S, Vandekerkhof J. Cannulated screw for proximal tibial fracture complicated by iatrogenic popliteal pseudoaneurysm: definitive treatment by ultrasound-guided thrombin injection. ACTA ACUST UNITED AC 2006; 61:1261-3. [PMID: 17099540 DOI: 10.1097/01.ta.0000198553.65342.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Gasthuisberg, Leuven, Belgium.
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Abstract
True aneurysms of the femoral artery are uncommon. They are most often identified in elderly males and are frequently associated with aneurysms at other locations. Femoral artery aneurysms that are symptomatic or larger than 2.5 cm should be repaired in order to prevent limb-threatening complications, such as rupture, thrombosis, or embolization. Open repair is the standard method of treatment and should be preceded by evaluation for coexisting aortoiliac or popliteal aneurysms, assessment of superficial femoral artery patency, and determination of the point of origin of the deep femoral artery relative to the aneurysm sac. Femoral artery pseudoaneurysms are most often seen in the setting of previous femoral artery catheterization but may also be associated with trauma, anastomotic leakage, or infection. The majority of femoral pseudoaneurysms less than 3 cm in diameter will spontaneously thrombose and may be observed with serial duplex ultrasound exams in asymptomatic patients. Symptomatic pseudoaneurysms, pseudoaneurysms with a diameter greater than 3 cm, and those found in patients who are anticoagulated should usually be treated. Ultrasound-guided thrombin injection is our preferred method for treating femoral pseudoaneurysm because of its low risk, high success rate, and efficacy in the setting of anticoagulation. Ultrasound-guided compression is an alternative method that may be considered when thrombin products are contraindicated. Open pseudoaneurysm repair should be undertaken in the setting of infection, rapid expansion, or if less-invasive methods are not technically feasible.
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Affiliation(s)
- Matthew A Corriere
- Department of Surgery, Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Pinto DM, Dias Júnior JO, Fonseca BLC, Moreialvar RD, Bez LG, Lopes CDS. Experiência inicial com o uso de adesivo tissular contendo trombina para tratamento do pseudo-aneurisma femoral. J Vasc Bras 2006. [DOI: 10.1590/s1677-54492006000100006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O pseudo-aneurisma (PSA) após cateterização femoral tem sido diagnosticado com regularidade em serviços com grande movimento de intervenções percutâneas, com incidência variando de 0,05 a 6%. PSA femorais pequenos podem ser acompanhados até a resolução espontânea. As opções de tratamento são: compressão guiada por ultra-som, injeção de trombina para trombose do PSA e tratamento cirúrgico. A injeção percutânea de trombina tem a vantagem de ser um procedimento indolor e rápido. Podem ser utilizados trombina isolada ou preparados contendo trombina associada a fibrinogênio e fatores de coagulação. A experiência inicial dos autores de cinco casos tratados com injeção de adesivo tissular contendo trombina mostrou resultado satisfatório em quatro; um caso necessitou tratamento cirúrgico. Não houve sucesso com uso isolado de trombina humana, porém, ocorreu trombose imediata após injeção de preparado de trombina associada a fibrinogênio/fator XIII. Neste artigo, são discutidas as opções de tratamento dos PSA femorais e a técnica do uso de trombina percutânea.
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Krueger K, Zaehringer M, Strohe D, Stuetzer H, Boecker J, Lackner K. Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 2005; 236:1104-10. [PMID: 16055694 DOI: 10.1148/radiol.2363040736] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To prospectively evaluate ultrasonographically (US) guided percutaneous thrombin injection for treatment of femoral artery and brachial artery pseudoaneurysms. MATERIALS AND METHODS The university institutional review board approved the study. Informed consent was obtained from all patients. Two hundred forty patients with postcatheterization femoral artery (n = 132) or brachial artery (n = 8) pseudoaneurysms were treated with US-guided bovine thrombin (1.000 IU/mL) injection. At diagnosis, 107 (44.6%) patients received anticoagulation therapy; 159 (66.2%), antiplatelet therapy; and 76 (31.7%), both therapies. Pseudoaneurysm size, length and width of pseudoaneurysm neck, thrombin dose, therapy outcome, and complications were documented. The peak blood flow in peripheral arteries was determined before and after thrombin injection. Follow-up duplex US was performed 12-24 hours, 5-7 days, and 21-25 days after treatment. A nonpaired t test was used to compare differences in age between the male and female patients. Two-way analysis of covariance was performed to analyze the influences of factors that may have been related to the amount of thrombin used. RESULTS Mean pseudoaneurysm volume was 4.69 cm3 +/- 5.49 (standard deviation). Simple and complex pseudoaneurysms were treated in 165 and 75 patients, respectively. A total of 260 thrombin injections were performed: 1.04 injections per patient with a simple pseudoaneurysm and 1.17 injections per patient with a complex pseudoaneurysm. The mean injected thrombin dose was 425.31 IU +/- 341.75 for all pseudoaneurysms, 382.12 IU +/- 281.00 for simple pseudoaneurysms only, and 520.33 IU +/- 434.64 for complex pseudoaneurysms only. There was only a computational correlation between pseudoaneurysm size and thrombin dose (r2 = 0.07). The primary success rate was 93.8% overall, 95.8% for simple pseudoaneurysms, and 89% for complex pseudoaneurysms. The secondary success rate was 99.6% overall, 100% for simple pseudoaneurysms, and 99% for complex pseudoaneurysms. Early (at < or =24 hours) reperfusion occurred in one simple and five complex pseudoaneurysms. Four late reperfusions-two in simple and two in complex pseudoaneurysms-were detected at 1-week follow-up; no late reperfusions were detected at 3 weeks. Thromboembolic complications occurred in two patients and resolved spontaneously. One mild allergic reaction and no infections occurred. CONCLUSION US-guided percutaneous thrombin injection enables successful, safe management of postcatheterization pseudoaneurysms.
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Affiliation(s)
- Karsten Krueger
- Department of Radiology and Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Joseph-Stelzmann-Str, 50924 Cologne, Germany.
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Abstract
OBJECTIVE To discuss the management of a patient with unilateral lower extremity pain as a consequence of a popliteal aneurysm. CLINICAL FEATURES An 85-year-old male had difficulty in ambulating due to low back and lower extremity pain. Standard tests demonstrated and reproduced pain at the lower back while inspection, palpation, and auscultation revealed a pulsatile mass in the popliteal fossa of the right knee. INTERVENTION AND OUTCOME Specific joint manipulation for relief of low back pain was performed. Comanagement of the patient with a vascular surgeon and subsequent surgical intervention resulted in relief of lower extremity pain. CONCLUSION Resolution of pain and guarded gait was accomplished by a multidisciplinary approach combining conservative care and invasive techniques.
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Affiliation(s)
- Rod L Kaufman
- University Health Center, Glendale, Calif 91205, USA.
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Affiliation(s)
- Joseph A Franklin
- Department of Surgery, Section of Vascular Surgery, University of Health Systems of Eastern Carolina and Brody School of Medicine at East Carolina University, Pitt County Memorial Hospital, Greenville, NC 27858, USA
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Lenartova M, Tak T. Iatrogenic pseudoaneurysm of femoral artery: case report and literature review. Clin Med Res 2003; 1:243-7. [PMID: 15931315 PMCID: PMC1069051 DOI: 10.3121/cmr.1.3.243] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 06/11/2003] [Indexed: 11/18/2022]
Abstract
The case of a patient who developed a femoral artery pseudoaneurysm (FAP) following cardiac catheterization is described. It is one of the most troublesome complications after various invasive cardiovascular procedures related to the femoral arterial access site. Iatrogenic pseudoaneurysms (IPA) form when an arterial puncture site fails to seal, allowing arterial blood to ooze into the surrounding tissues and form a pulsatile hematoma. The FAP occurs in 0.8% to 2.2% after interventional procedures. This problem has become more significant due to the exponential growth of interventional cardiology. Doppler flow mapping has been the mainstay of diagnosis. Diagnostic criteria include: swirling color flow in a mass separate from the affected artery, and a typical "to-and-fro" Doppler waveform in the pseudoaneurysm neck. Ultrasound-guided compression repair has replaced the need for surgical repair of FAP. It has been shown to be a safe and cost-effective method for achieving pseudoaneurysm thrombosis. However, it carries considerable drawbacks including long procedure times, discomfort to patients, high recurrence rate in patients receiving anticoagulant therapy and an overall 3.6% complication rate. Recently, percutaneous thrombin injection in the FAP has gained popularity despite complications associated with the initial use of high dose thrombin (average dose of 1,100 IU). The technique was refined when low-dose thrombin injections were studied and proved to have the same efficacy and consistently high success rates (average dose used 192 IU). However, there is a theoretical risk of developing type I IgE-mediated allergic reaction to bovine thrombin. The indications, advantages, disadvantages, and complications of the various treatment modalities are discussed in this report and review of the literature. Other treatments with collagen injection are also discussed in detail.
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Affiliation(s)
- Martina Lenartova
- Department of Cardiology, Marshfield Clinic, Marshfield, Wisconsin 54449, USA
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Abstract
Pseudoaneurysms are a recognized complication of arterial catheterization. Until recently, the standard method of treatment has been surgical. The past decade has seen the introduction of several minimally invasive techniques that have largely replaced surgical treatment of pseudoaneurysms. The most commonly used methods are ultrasound-guided compression and percutaneous injection of thrombin into the pseudoaneurysm. This review article describes all the methods available for the treatment of postcatheterization pseudoaneurysms, presents results from the largest published series, and discusses the relative merits of each technique.
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Affiliation(s)
- Robert Morgan
- Department of Vascular Radiology, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom.
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Patel JV, Weston MJ, Kessel DO, Prasad R, Toogood GJ, Robertson I. Hepatic artery pseudoaneurysm after liver transplantation: treatment with percutaneous thrombin injection. Transplantation 2003; 75:1755-57. [PMID: 12777870 DOI: 10.1097/01.tp.0000063936.94587.10] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pseudoaneurysms of the hepatic artery are a rare complication of liver transplantation. Early diagnosis and treatment are essential to avoid life-threatening hemorrhage. Conventional treatment consists of surgical resection and vascular reconstruction or transarterial coil embolization. More recently, percutaneous thrombin injection has been successfully used in the treatment of femoral artery pseudoaneurysms. We describe a 70-year-old woman who had a hepatic artery pseudoaneurysm after orthotopic liver transplantation, which was successfully treated by percutaneous thrombin injection.
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Affiliation(s)
- Jai V Patel
- Department of Radiology, The Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Leeds, UK.
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Vaidhyanath R, Blanshard KS. Case report: insertion of a covered stent for treatment of a popliteal artery pseudoaneurysm following total knee arthroplasty. Br J Radiol 2003; 76:195-8. [PMID: 12684236 DOI: 10.1259/bjr/32510074] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report the use of a covered stent to successfully treat a pseudoaneurysm of the popliteal artery, which occurred following total knee arthroplasty. Percutaneous endovascular repair offers a safe alternative to surgical management of this condition.
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Affiliation(s)
- R Vaidhyanath
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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Krüger K, Zähringer M, Söhngen FD, Gossmann A, Schulte O, Feldmann C, Strohe D, Lackner K. Femoral pseudoaneurysms: management with percutaneous thrombin injections--success rates and effects on systemic coagulation. Radiology 2003; 226:452-8. [PMID: 12563139 DOI: 10.1148/radiol.2262012107] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine the success rate of percutaneous ultrasonographically (US) guided thrombin injection in the treatment of femoral pseudoaneurysms and to evaluate the effects of thrombin injection on systemic coagulation parameters. MATERIALS AND METHODS Fifty femoral pseudoaneurysms (37 simple pseudoaneurysms with one lobe and 13 complex pseudoaneurysms with two or three lobes) were treated with US-guided percutaneous thrombin injections. Pseudoaneurysm size, neck length and width, thrombin dose, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 12-24 hours and 5-7 and 21-25 days. In 25 patients, activated thromboplastin time, Quick test (prothrombin time), thrombin time, fibrinogen, D-dimer, antithrombin III, thrombin-antithrombin III complex, and prothrombin fragments 1 and 2 were determined before and at 2, 5, and 10 minutes after thrombin injection. Differences in results before and those after thrombin injection were evaluated by means of the one-sample t test. RESULTS Mean volume of pseudoaneurysms was 5.84 cm(3) +/- 4.89 (SD). Fifty-eight thrombin injections were performed. Mean thrombin dose was 357 IU +/- 291 in simple and 638 IU +/- 549 in complex pseudoaneurysms. Primary success rate was 36 of 37 (97%) for simple and eight of 13 (61%) for complex pseudoaneurysms. Reperfusion occurred in four complex pseudoaneurysms (none in simple ones). Secondary success rate was 100%. No thromboembolic, infectious, or allergic complications occurred. During follow-up, reperfusion was detected in one patient with a complex pseudoaneurysm. Levels of thrombin-antithrombin III complex increased significantly (P <.05) after thrombin injection, whereas changes in all other laboratory tests were not significant. CONCLUSION US-guided percutaneous injection of thrombin is successful and safe in the management of femoral pseudoaneurysms. The increase of thrombin-antithrombin III complex indicates the possibility of thrombin passage into the arterial circulation.
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Affiliation(s)
- Karsten Krüger
- Department of Radiology, University of Cologne, Joseph-Stelzmann-Strasse, D-50924 Cologne, Germany.
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Abstract
Percutaneous cardiac catheterization and endovascular procedures are associated with complications at the vascular access site. While surgery has been the traditional treatment for vascular access complications, the current state of the art permits percutaneous management of many access site complications. Surgical repair may be required only when percutaneous methods fail, are not available, or are unsuitable.
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Affiliation(s)
- Aditya K Samal
- Department of Cardiology, Ochsner Medical Institutions, New Orleans, Louisiana 70115, USA
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Lönn L, Olmarker A, Geterud K, Klingenstierna H, Delle M, Grip L, Risberg B. Treatment of femoral pseudoaneurysms. Percutaneous US-guided thrombin injection versus US-guided compression. Acta Radiol 2002. [PMID: 12225482 DOI: 10.1034/j.1600-0455.2002.430410.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Thrombin injection in femoral pseudoaneurysms has been suggested to be superior to traditional US-guided compression. Our aim was to evaluate results with compression therapy with special reference to use of thrombin in case of failure. We also studied 7 patients who underwent primary thrombin injection. MATERIAL AND METHODS We retrospectively reviewed all (n=44) femoral artery pseudoaneurysms diagnosed at our department during October 1998-May 1999. US-guided compression with the Femostop device or US-guided thrombin injection (100-1000 IU) was the first choice according to the physicians' preference, followed by the other regime if the first choice was non-successful. RESULTS Thirty-nine (89%) of the patients received anticoagulation treatment and/or concomitant antiplatelet drugs. Out of the 44 patients, 37 were treated with compression as the first choice. This regime was successful in 22 (59%). This group included 2 lesions that resolved spontaneously after initially failed compression and 1 deep venous thrombosis after treatment. The persistent 15 pseudoaneurysms after failed compression received thrombin injection, and it was also the primary therapy in 7 patients. Complete thrombosis within the pseudoaneurysm was immediately induced after treatment. One early recurrence required a second injection. No complication of thrombin was noted and no surgery was required. CONCLUSION US-guided thrombin injection is an effective treatment for embolisation of pseudoaneurysms. The technique is superior to compression therapy.
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Affiliation(s)
- L Lönn
- Departments of Diagnostic Radiology, Cardiology and Vascular Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
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Salamat M, Brown PR, Magee CA, Reyes DK, Peters DN, Venbrux AC. Experimental evaluation of a new transcatheter vascular embolization device in the swine model. J Vasc Interv Radiol 2002; 13:301-12. [PMID: 11875090 DOI: 10.1016/s1051-0443(07)61724-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate a new transcatheter device suitable for arterial embolization in an animal model. MATERIALS AND METHODS A new prototype self-expanding braided embolic device (Embolizor), consisting of nitinol wire strands fixed at either end with platinum-iridium bands and covered with a film of polyethylene, was deployed through 5-F diagnostic catheters into renal artery branches in five swine. Standard stainless-steel spring coils were deployed in other renal branches and served as controls. The animals underwent follow-up selective renal arteriography to determine presence or absence of vessel recanalization or device migration 15-23 days after device deployment. Histopathologic evaluation of target vessels and peripheral renal parenchyma was also performed. RESULTS Ten Embolizors and 10 stainless-steel coils were deployed in arteries ranging in size from 1.8 to 3.0 mm in diameter. The Embolizor was easily and precisely deployed. Angiographic evidence of vascular occlusion in the Embolizor group was noted within 30 seconds in eight device deployments and within 5 minutes in two. No early or delayed device migration was noted on follow-up arteriography. In the control group, seven of 10 previously occluded arteries were recanalized. No recanalization was noted in the Embolizor group. Light microscopy revealed evidence of infarction in all specimens examined. Whereas three specimens in the Embolizor group contained occasional giant cells, there were numerous multinucleated giant cells present within the interstices of all control spring coils. CONCLUSION The Embolizor was easily, precisely, and successfully deployed through standard selective diagnostic angiographic catheters. Short-term follow-up demonstrated no recanalization or migration of the device. The Embolizor was shown on histopathologic analysis to have no significant foreign body reaction.
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Affiliation(s)
- Mehrdad Salamat
- Division of Pediatric Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Affiliation(s)
- Steven S Kang
- Miami Cardiac and Vascular Institute, Florida 33176, USA.
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Holder R, Hilton D, Martin J, Harris PL, Rowlands PC, McWilliams RG. Percutaneous thrombin injection of carotid artery pseudoaneurysm. J Endovasc Ther 2002; 9:25-8. [PMID: 11958321 DOI: 10.1177/152660280200900105] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection. CASE REPORT A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications. CONCLUSIONS Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.
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Affiliation(s)
- Rebecca Holder
- Department of Radiology, Royal Liverpool University Hospital, England, UK
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