Immediate transcatheter embolization of Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm

CT angiography of non-aortic thoracic arterial trauma

While aortic injury is the most commonly cited thoracic arterial injury, non-aortic arterial injuries represent an uncommon but significant source of morbidity and mortality in blunt and penetrating thoracic trauma patients. Knowledge of the spectrum of vascular injury and anatomic considerations that dictate patterns of associated thoracic hemorrhage will assist the radiologist in the accurate and efficient diagnosis of these injuries. This article provides a review of anatomy, pertinent clinical exam and CT angiography findings, as well as therapeutic options for non-aortic thoracic arterial trauma.

Successful percutaneous embolization of an intraoperative swan ganz catheter-related pulmonary artery injury

Intraoperative pulmonary artery injury due to Swan Ganz catheterization is a rare but potentially life-threatening injury which demands rapid recognition and treatment. Subsequent pseudoaneurysm formation can occur if not immediately recognized, and percutaneous embolization is a viable option for treatment in most settings. We report a case of a 59-year-old female who underwent coronary artery bypass surgery and suffered an intraoperative Swan Ganz catheter-related injury which led to life threatening hemorrhage with subsequent pulmonary artery pseudoaneurysm formation that was successfully embolized. This case report is pathognomonic for this injury and discusses risk factors, presentation, and treatment options of this rare but serious injury.

Evaluation and Treatment of Massive Hemoptysis

Massive hemoptysis is appropriately defined as life-threatening hemoptysis that causes airway obstruction, respiratory failure, and/or hypotension. Patients with this condition die from asphyxiation, not hemorrhagic shock. Any patient who presents with life-threatening hemoptysis requires immediate treatment to secure the airway and stabilize hemodynamics. Early activation and coordinated response from a multidisciplinary team is critical. Once the airway is secure and appropriate resuscitation is initiated, priorities are to localize the source of the bleeding and gain hemorrhage control. Nonsurgical control of hemorrhage is superior to surgery in the acute situation.

Traumatic Right Pulmonary Artery Rupture after Accidentally Being Stepped on the Chest

Traumatic pulmonary artery rupture is a rare, life-threatening injury. Currently, no strict guidelines for its management exist. Herein, we report a successful surgical repair of a right pulmonary artery rupture caused by being stepped on.

Molecular aspects of development and regulation of endometriosis

Endometriosis is a common and painful condition affecting women of reproductive age. While the underlying pathophysiology is still largely unknown, much advancement has been made in understanding the progression of the disease. In recent years, a great deal of research has focused on non-invasive diagnostic tools, such as biomarkers, as well as identification of potential therapeutic targets. In this article, we will review the etiology and cellular mechanisms associated with endometriosis as well as the current diagnostic tools and therapies. We will then discuss the more recent genomic and proteomic studies and how these data may guide development of novel diagnostics and therapeutics. The current diagnostic tools are invasive and current therapies primarily treat the symptoms of endometriosis. Optimally, the advancement of "-omic" data will facilitate the development of non-invasive diagnostic biomarkers as well as therapeutics that target the pathophysiology of the disease and halt, or even reverse, progression. However, the amount of data generated by these types of studies is vast and bioinformatics analysis, such as we present here, will be critical to identification of appropriate targets for further study.

Endovascular treatment of PA pseudoaneurysm caused by Swan-Ganz catheter

The following case report describes a complication of Swan-Ganz catheterization and its endovascular treatment with a single coil. Application of this particular catheter in the pulmonary artery during cardiac surgery may lead to mechanical perforation and creation of an extravascular sac, which is called a pseudoaneurysm. There are different methods that lead to tamponade or closure of the leakage. Interventional cardiology procedures are nowadays the most appropriate way of treatment of Swan-Ganz catheter induced vascular complications.

Pulmonary artery pseudoaneurysm after Swan-Ganz catheterization: a case presentation and review of literature

INTRODUCTION

The Swan-Ganz catheter for pulmonary artery (PA) cannulation was introduced in 1970 and has been utilized in the management of critically ill and cardiac patients. Although the routine use of this catheter has not been associated with better patient outcomes in prospective randomized trials, their ability to provide crucial hemodynamic measurements and the ease of bedside insertion makes them valuable in certain complex clinical scenarios. However, Swan-Ganz catheter insertion is not without complications. PA injury is the most serious complication suspected by the occurrence of hemoptysis after the procedure. We present a case of PA injury with pseudoaneurysm formation after Swan-Ganz catheterization along with a comprehensive review of literature.

METHODS

We reviewed all PubMed/Medline indexed articles published between 1993-2013, reporting the development of PA pseudoaneurysm after Swan-Ganz catheter use. Cases were analyzed with specific reference to patient demographics, indication for Swan-Ganz insertion, initial presenting symptom, duration between insertion and first evidence of PA injury, inciting event, site of pseudoaneurysm, treatment and outcome.

RESULTS

Forty-one patients were identified from 27 papers. In the reviewed population, 87.8% were older than 60 years of age and 82.9% were females. Fifty-one percent of the patients had an episode of hemoptysis on the day of Swan-Ganz catheter insertion. Ninety-seven percent of the patients had PA pseudoaneurysm in the right pulmonary circulation. The admission-to-discharge mortality rate in the reviewed cohort was 15%. Cause of death in 22% of the cases was hemoptysis, while non-catheter related complications were responsible for the remaining deaths.

CONCLUSION

PA injury is a feared complication after Swan-Ganz catheterization and can be fatal. In patients who develop massive or recurrent hemoptysis after Swan-Ganz catheter use, PA injury must be considered and airway protection should be employed along with appropriate catheter based or surgical interventions.

Percutaneous transcatheter embolization of pulmonary artery pseudoaneurysms causing massive hemoptysis: two different case scenarios

Systemic bronchial arterial circulation is the most common source for massive hemoptysis. Rarely, the source of bleeding can be the pulmonary artery. We report 2 different case scenarios of massive hemoptysis due to different etiologies, in which the source of bleeding was the pulmonary artery. Both the patients were treated with percutaneous transcatheter embolotherapy using coils. The 2 cases highlight the importance of considering pulmonary arterial etiology as the cause of hemoptysis while reporting diagnostic computed tomography studies and tailoring the interventional technique toward performing pulmonary angiography instead of searching for a systemic arterial source for hemoptysis.

Rupture de l'artère pulmonaire par cathéter de Swan-Ganz au cours de la chirurgie cardiaque : conduite à tenir et stratégie

Pulmonary artery catheterization is almost uniformly used nowadays in cardiac surgery. Although rare, rupture of the pulmonary artery following catheterization is highly lethal. This review examines ways of avoiding its occurrence and means of improving outcomes in case of rupture.

Ultrasonographically Guided Percutaneous Embolization of a Pulmonary Pseudoaneurysm

Pulmonary pseudoaneurysms have been described as an unusual complication of Swan-Ganz catheter placement, tuberculosis, bronchiectasis, aspergillomas, and pulmonary hypertension. Untreated, they may lead to life-threatening hemorrhage. Coil embolization to occlude the pseudoaneurysms is the treatment of choice. This report describes a case in which a pulmonary pseudoaneurysm that likely resulted from the previous use of a Swan-Ganz catheter was identified but in which angiography failed to demonstrate a feeding vessel. The pseudoaneurysm was visible by transthoracic ultrasonography because it was surrounded by consolidated lung, possibly related to hemorrhage. Ultrasonography was used to guide puncture of the pseudoaneurysm, and percutaneous coil embolization was performed subsequently. Subsequent angiography and computed tomography demonstrated successful occlusion of the aneurysm. This case illustrates the utility of percutaneous management of pulmonary pseudoaneurysms in certain cases.

Pulmonary Artery Interventions: An Overview

Interventional radiologists should be familiar with minimally invasive procedures used to treat various abnormalities of the pulmonary arteries. These well-established techniques, which obviate open surgery, are safe and effective when performed by an experienced interventionalist. Catheter-based thrombolysis with intrapulmonary arterial infusion of thrombolytic drugs, percutaneous thrombectomy, or embolus fragmentation can be performed in patients with life-threatening pulmonary embolism. Pulmonary artery stenoses, mainly encountered in patients with pulmonary vasculitis (as in Behçet disease or Takayasu arteritis), may be treated with balloon angioplasty and stent placement. Transcatheter embolization of pulmonary arteriovenous malformation is the standard treatment for hereditary hemorrhagic telangiectasia and is a very effective alternative to surgery to correct an aneurysm or pseudoaneurysm. In cases of hemoptysis that originates in the pulmonary artery, early diagnosis is mandatory for treatment with embolization. Percutaneous retrieval of foreign bodies from the heart or the pulmonary arteries and endovascular biopsy should also be part of the armamentarium of interventional radiologists.

Pulmonary artery rupture induced by a pulmonary artery catheter: a case report and review of the literature

Placement and use of pulmonary artery catheters (PACs) carry potential risks. The authors describe a case of a patient who developed massive hemoptysis after placement of a PAC that caused a rupture of the pulmonary artery with pseudoaneurysm formation. Treatment was successfully achieved with transcatheter coil embolization. Pulmonary artery rupture and pseudoaneurysm formation are among the most serious complications of PAC use because of the associated risk of mortality. Patients with this complication may be asymptomatic or may present with variable amounts of hemoptysis immediately or days after using a PAC. The gold standard diagnostic test is pulmonary angiography, and the treatment of choice for most patients is transcatheter embolization. Physicians and other health care personnel handling these catheters should be familiar with the specific PAC balloon's inflation limits to avoid complications that may injure the patient.

Value of Multislice CT in the Diagnosis of Pulmonary Artery Pseudoaneurysm from Swan-Ganz Catheter Placement

Perforation of a pulmonary artery after placement of a Swan-Ganz catheter is a serious complication that requires immediate management. Exact description of size and anatomic localization of a pulmonary pseudoaneurysm is crucial for planning further therapy. This report describes a patient who experienced such a complication, but in whom primary pulmonary angiography failed to demonstrate bleeding. However, multislice computed tomography not only correctly demonstrated the anatomic location of the pseudoaneurysm but was also able to directly visualize the feeder vessel and its connection to the aneurysm. This information was essential for subsequent superselective angiographic visualization of the feeder vessel and for successful embolization as the least invasive method of choice.

Transcatheter coil embolization of large pulmonary artery pseudoaneurysms in a child

The authors report a case of a 5-year-old boy who initially presented with mastoiditis, underwent successful surgical treatment, and during the immediate postoperative period developed multiple, bilateral pulmonary artery pseudoaneurysms. The large size and multiplicity of the pseudoaneurysms precluded the patient from undergoing thoracic surgery. Successful endovascular coil and wire embolization was performed in a staged set of procedures with use of more than 30 m of wire and coils.

Pseudoaneurysm of the subclavian-vertebral artery junction--case report and review of the literature

Pseudoaneurysm of the subclavian-vertebral artery junction (SVJ) is a rare complication of internal jugular vein catheter placement. Because of its retroclavicular location, arterial injury at the SVJ poses a significant therapeutic challenge. A case report and review of the literature are presented.

[Threatening hemoptysis. Results of treatment with arterial embolization]

OBJECTIVE

Retrospective analysis the immediate and long-term efficacy of embolization of bronchial and systemic arteries in the treatment of threatening or relapsing hemoptysis.

MATERIALS AND METHODS

During the study period 122 arterial embolizations were performed in patients with hemoptysis over 100 ml in 24 hours, relapsing hemoptysis and/or presence of vital risk factors. Embolization was performed with polyvinyl alcohol particles, spongostan and metallic spirals. Seventy patients were included in the study and 47 were excluded as they came from other institutions.

RESULTS

Angiographic changes were observed in 100% of patients. The immediate clinical success, defined as hemoptysis control, was obtained in the 70 patients. The mean follow-up time was 21.2 +/- 16.3 months. Relapsing hemoptysis occurred in 17.1% of patients (12 patients), of which 5.7% (4 cases) occurred in the first seven days and in 11.4% (8 patients) after 6 months. In five patients (7.1%) a new embolization was performed and 6 were operated after embolization (5 of them with bronchiectasis). The remarkable complications derived from the procedure included self-limited paraparesis of the lower limbs and severe chest pain.

CONCLUSIONS

The embolization of bronchial arteries is an efficient technique for the treatment of threatening hemoptysis and relapses, is associated with a low morbidity rate, and the late relapse is relatively common among patiets with bronchiectasis.