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McCarthy CJ, Weinstein JL, Bulman JC, Schroeppel DeBacker SE, Berkowitz SJ, Dowlatshahi AS, Ahmed M, Faintuch S. Ultrasound-guided percutaneous thrombin injection for the management of upper extremity pseudoaneurysms: 20 years of tertiary care center experience. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39291585 DOI: 10.1002/jcu.23829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/10/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of upper extremity pseudoaneurysms. METHODS An institutional database containing 8,316,467 radiology reports was searched for suitable cases over a 241-month period. Fourteen female and 10 male patients, average age of 69.7 years (range 29-93) underwent a total of 26 procedures for the management of upper extremity pseudoaneurysms, involving the radial (n = 9), brachial (n = 9) or other upper extremity arteries (n = 6). Baseline demographic and pseudoaneurysm characteristics were documented, together with primary and secondary success, failures, and complications. All procedures were performed with real-time ultrasound guidance. RESULTS The mean pseudoaneurysm volume was 9.93 cm3 (range 0.06-111.62 cm3). Twelve cases were related to central line placement or arterial access. Primary success was obtained in 50% (n = 12) after a single ultrasound-guided thrombin injection, and secondary success was achieved in an additional six (for a total success of 75%). Success was highest for the treatment of brachial artery pseudoaneurysms (87.5%), and in those who were diagnosed within 7 days of the inciting event, findings that were statistically significant (p-value 0.046 and 0.002, respectively). CONCLUSIONS Ultrasound-guided percutaneous thrombin injection is safe and effective for managing upper extremity pseudoaneurysms.
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Affiliation(s)
- Colin J McCarthy
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey L Weinstein
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie C Bulman
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E Schroeppel DeBacker
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth J Berkowitz
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Arriyan S Dowlatshahi
- Department of Hand and Upper Extremity Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Muneeb Ahmed
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Salomao Faintuch
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Farrell A, Biswal R. Ultrasound-guided percutaneous coil and thrombin embolization of a left gastric artery pseudoaneurysm. Radiol Case Rep 2023; 18:4281-4286. [PMID: 37771379 PMCID: PMC10522854 DOI: 10.1016/j.radcr.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
Pseudoaneurysms are a commonly encountered pathology, though pseudoaneurysms of the visceral arteries are a less frequent, but potentially deadly entity. Transarterial embolization is the typical treatment of visceral pseudoaneurysms, but success is dependent on anatomy that is conducive to selecting the supplying vessel. Abdominal ultrasound is a viable method to effectively treat visceral pseudoaneurysms when transarterial embolization is not possible. It is also an excellent example of the growing utilization of ultrasound guidance in various interventional radiologic procedures. The usefulness of ultrasound is demonstrated in this case report, where a left gastric artery pseudoaneurysm was embolized through ultrasound guidance.
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Affiliation(s)
- Aidan Farrell
- Hackensack Meridian School of Medicine, 123 Metro Blvd, Nutley, NJ 07110, USA
| | - Rajiv Biswal
- Jersey Shore University Medical Center, 1945 NJ-33, Neptune, NJ 07753, USA
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Pseudoaneurysm of the posterior circumflex humeral artery after arthroscopic rotator cuff repair: a case report. J Shoulder Elbow Surg 2022; 31:e308-e313. [PMID: 35248704 DOI: 10.1016/j.jse.2022.01.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 02/01/2023]
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Chae SY, Park C, Kim JK, Kim HO, Lee BC. Ultrasound-Guided Percutaneous Thrombin Injection of Femoral Artery Pseudoaneurysms Caused by Vascular Access. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:589-599. [PMID: 36238797 PMCID: PMC9432433 DOI: 10.3348/jksr.2020.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 11/17/2022]
Abstract
Purpose To analyze the success and complication rates and factors associated with technical failure of the ultrasound (US)-guided percutaneous thrombin injection of femoral artery pseudoaneurysms caused by vascular access. Materials and Methods Records of 30 patients with post-catheterization femoral artery pseudoaneurysms who had been treated with US-guided percutaneous thrombin injections in the department of radiology between March 2009 and June 2019 were retrospectively analyzed. The lesion was diagnosed based on US or contrast-enhanced CT. The characteristics of the patients and their lesions were analyzed. Results The mean patient age was 67.8 years. The mean diameter of the pseudoaneurysmal sac was 20.88 mm (5-40 mm). Twenty patients (66.6%) obtained complete thrombosis after the primary injection, while 10 patients (33.3%) obtained partial thrombosis. The number of patients with a low platelet count (< 130 k/µL) was significantly higher in the partial thrombosis group than in the complete thrombosis group (p = 0.02). No substantial procedure-related complications were found in any patient. Conclusion The US-guided percutaneous thrombin injection is considered an initial treatment option for pseudoaneurysms caused by vascular access because of its safety and efficacy.
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Albarrán-Tamayo F, Murillo-Ortiz B, González Amaro R, López Briones S. Both in vitro T cell proliferation and telomere length are decreased, but CD25 expression and IL-2 production are not affected in aged men. Arch Med Sci 2021; 17:775-784. [PMID: 34025848 PMCID: PMC8130486 DOI: 10.5114/aoms.2019.87593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/03/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Aging is a natural process involving dysfunction of multiple organs and is characterized by increased susceptibility to infections, cancer and autoimmune diseases. The functionality of the immune system depends on the capacity of lymphocytes to proliferate in response to antigenic challenges, and telomere length has an important role regulating the number of cell divisions. The aim of this study was to determine the possible relationship between telomere length, interleukin 2 (IL-2) production, CD25 expression and proliferation of peripheral blood mononuclear cells (PBMCs) in aged men. MATERIAL AND METHODS Telomere length was measured by RT-PCR in PBMCs from young and aged men. IL-2 production and CD25 expression were determined by ELISA and flow cytometry, respectively. Cell proliferation was measured by CFSE dilution assays upon in vitro stimulation with concanavalin A (Con A). RESULTS PBMCs from aged men showed a shorter telomere length and a reduced capacity to proliferate in vitro, compared to young men. In contrast, no significant differences in the level of CD25 expression on T lymphocytes, and in vitro production of IL-2 were detected in both groups. In addition, no significant correlation was detected between levels of CD25 expression, IL-2 production, cell proliferation, and telomere length in aged men. CONCLUSIONS In aged men the telomere length shortening and the reduced T cell proliferation are not related to the capacity of IL-2 production and CD25 expression on T lymphocytes.
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Affiliation(s)
| | - Blanca Murillo-Ortiz
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad (UMAE) No. 1 Bajío, Instituto Mexicano del Seguro Social (IMSS), León, Guanajuato, México
| | - Roberto González Amaro
- Departamento de Inmunología, Escuela de Medicina, Universidad Autónoma de San Luís Potosí, San Luís Potosí, México
| | - Sergio López Briones
- Departamento de Medicina y Nutrición, División de Ciencias de la Salud, Campus León, Universidad de Guanajuato, León, Guanajuato, México
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Ueda T, Murata S, Saito H, Miki I, Yasui D, Sugihara F, Shimizu W, Kumita SI. Balloon-assisted Transcatheter arterial embolization using N-butyl cyanoacrylate for iatrogenic arterial bleeding by groin puncture: a new technology. CVIR Endovasc 2020; 3:42. [PMID: 32830301 PMCID: PMC7443418 DOI: 10.1186/s42155-020-00132-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background Balloon-assisted transcatheter arterial embolization (TAE) using n-butyl cyanoacrylate (NBCA) and lipiodol (Lp) mixture is a new endovascular treatment technique for iatrogenic arterial bleeding by groin puncture. It is less invasive compared to surgical repair, and NBCA migration into the circulation can be prevented by temporary balloon occlusion of the parent artery without ultrasound-guidance. This study aimed to report on the technical aspects and evaluate the efficacy and safety of fluoroscopically guided balloon-assisted transcatheter arterial embolization using NBCA for iatrogenic arterial bleeding by groin puncture. Materials and methods The study included five patients (mean age 54.6 years; 3 male and 2 female) with iatrogenic arterial bleeding by groin puncture. We performed transcatheter arterial embolization using NBCA while occluding the responsible artery with a balloon catheter during the embolization to prevent NBCA migration. Two sheaths were inserted into the common femoral artery. A microcatheter was advanced into the pseudoaneurysm or extravasation via the contralateral sheath. A balloon catheter was advanced into the responsible artery until the balloon portion covered the leakage site via another sheath. After balloon inflation, the NBCA and Lip mixture was slowly injected until the pseudoaneurysm, or the extravasation was filled without touching the balloon. The microcatheter was removed immediately after the filling. We assessed technical success, overall success, and complications. Results The injured arteries were the external iliac artery (n = 1), the common femoral artery (n = 2), and the proximal portion of the superficial femoral artery (n = 2). NBCA was injected once in four cases and twice in one case where complete hemostasis could not be achieved with one injection. The technical and overall success rate was 100% with no complications, including distal embolization of NBCA. Conclusions Balloon-assisted TAE using NBCA is a feasible, effective, and safe treatment for iatrogenic arterial bleeding by groin puncture. It may also be applicable in other arterial bleeding situations where the potential risk of distal embolization can be decreased by applying the balloon-assisted technique.
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Affiliation(s)
- Tatsuo Ueda
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Satoru Murata
- Center for Interventional Radiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-City, Chiba, 299-0011, Japan
| | - Hidemasa Saito
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Izumi Miki
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Daisuke Yasui
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Fumie Sugihara
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Pino R, Casati R, Lo Giudice F, Penco M. Iatrogenic arterial pseudoaneurysms: treatment or prevention? Minerva Cardioangiol 2020; 68:268-270. [PMID: 32319270 DOI: 10.23736/s0026-4725.20.05264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rodolfo Pino
- Unit of Cardiologic Intensive Care (UTIC), Partinico Civic Hospital, ASP Palermo, Partinico, Palermo, Italy -
| | - Rebecca Casati
- Faculty of Medicine and Surgery, University of L'Aquila, L'Aquila, Italy
| | | | - Maria Penco
- Faculty of Medicine and Surgery, University of L'Aquila, L'Aquila, Italy
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Kurzawski J, Janion-Sadowska A, Zandecki L, Sadowski M. Comparison of the Efficacy and Safety of Two Dosing Protocols for Ultrasound Guided Thrombin Injection in Patients with Iatrogenic Femoral Pseudoaneurysms. Eur J Vasc Endovasc Surg 2020; 59:1019-1025. [PMID: 32014339 DOI: 10.1016/j.ejvs.2020.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 12/04/2019] [Accepted: 01/09/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Ultrasound guided thrombin injection (UGTI) is a minimally invasive method of treatment for iatrogenic post-catheterisation femoral pseudoaneurysms (psAs). The optimal dosing protocol for UGTI has not been established. The aim of the study was to compare the success and complication rates between two different dosing protocols (the most commonly used "standard dose protocol" and the "low dose protocol," which is the fractionated administration of smaller thrombin doses of up to 40 IU every 15 s) in patients with a psA with sac volume of ≥1 mL. METHODS This was a retrospective cohort study, and the analysis was performed using a case matching approach based on propensity score. From June 2004 to August 2018, 384 patients who underwent femoral puncture for transcatheter procedures were diagnosed with femoral psA with a sac volume of ≥1 mL and qualified for UGTI. The patients' mean age was 68 (±10.6) years and there were 217 (56.5%) women. To compare protocols, 124 patients treated according to the low dose protocol were nearest neighbour matched according to their propensity score to 124 patients treated according to the standard dose protocol. RESULTS The overall success rate (99.2% vs. 98.4%; p = 1) and success rate of the first UGTI attempt (87.1% vs. 86.3%; p = .85) did not differ between the low dose and standard dose groups. Complications were less common in the low dose group (7.3% vs. 16.1%; p = .03) and the median total amount of thrombin used for procedures was smaller in the low dose group (120 IU vs. 195 IU; p = .01). CONCLUSIONS In patients with femoral psA with sac volume of ≥1 mL, the use of the low dose protocol seemed to be equally effective as the standard dose protocol and was associated with a lower complication rate and reduced thrombin dose.
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Affiliation(s)
| | | | - Lukasz Zandecki
- Jan Kochanowski University, The Faculty of Medicine and Health Sciences, Kielce, Poland.
| | - Marcin Sadowski
- Jan Kochanowski University, The Faculty of Medicine and Health Sciences, Kielce, Poland
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Shin JH, Song Y, Sheen JJ, Lee D, Chung J, Lee GY, Jeong H, Han S, Choi JH, Hwang SM, Lee DH. Safety and Effectiveness of Percutaneous Low-Dose Thrombin Injection for Femoral Puncture Site Pseudoaneurysms in Neurointervention: Single-Center Experience. Neurointervention 2020; 15:25-30. [PMID: 31893630 PMCID: PMC7105095 DOI: 10.5469/neuroint.2019.00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We present ultrasound-guided percutaneous low-dose thrombin (200-250 IU) injection for the treatment of iatrogenic femoral pseudoaneurysms. Second, we compared patient and procedure factors between subcutaneous hematoma and pseudoaneurysm groups. MATERIALS AND METHODS From April 2012 to May 2018, 8425 patients underwent neurointervention. Among these patients, 18 had small subcutaneous hematomas and 6 had pseudoaneurysms. Pseudoaneurysms in the neck and entire sac were visualized, and low-dose thrombins were injected while visualizing a "whirlpool" hyperechoic core in the pseudoaneurysm sac. Subcutaneous hematomas were treated with simple compression. We compared the following parameters between the subcutaneous hematoma group and pseudoaneurysm group: sex, age, body mass index (BMI), type of procedure, heparin usage, sheath size, procedure time, and number of previous neurointervention procedures with the Mann-Whitney U test. RESULTS Most of the pseudoaneurysms were successfully occluded with 200 IU of thrombin (n=5). Only 1 pseudoaneurysm required a slightly higher thrombin concentration (250 IU, n=1). During the short-term follow-up, no residual sac was observed and no surgical repair was necessary. Pain in the groin region was alleviated. During the 1-month follow-up, no evidence of pseudoaneurysm recurrence nor subcutaneous hematoma was noted. Patient factors (sex, age, and BMI) and procedure factors (heparin usage, sheath size, procedure time, number of previous procedures) were not statistically different between the subcutaneous hematoma and pseudoaneurysm groups. CONCLUSION Ultrasound-guided percutaneous low-dose thrombin injection (200-250 IU) is safe, effective, and less invasive for treating iatrogenic femoral pseudoaneurysm in neurointervention.
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Affiliation(s)
- Jae Ho Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Jon Sheen
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongwhane Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewoo Chung
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ga Young Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunhee Jeong
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongsik Han
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Ho Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Interventional treatment options in pseudoaneurysms: different techniques in different localizations. Pol J Radiol 2019; 84:e319-e327. [PMID: 31636766 PMCID: PMC6798774 DOI: 10.5114/pjr.2019.88021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 01/17/2023] Open
Abstract
Pseudoaneurysms are commonly experienced vascular abnormalities. The increase in the number of surgical and arteriographic procedures has caused a higher prevalence of pseudoaneurysms. Conventional angiography is still the gold standard method for diagnosis, but other imaging modalities such as duplex Doppler ultrasonography, magnetic resonance angiography and computed tomographic angiography are useful in noninvasive detection. Over the past few years, interventional radiological treatment has evolved and taken the place of surgery in management. There are different kinds of percutaneous and endovascular treatment methods in pseudoaneurysm management. Treatment options depend on certain conditions. We used a case-based approach to discuss pseudoaneurysms and their appropriate treatment by interventional radiological methods in this article.
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de Oliveira Leite TF, Bortolini E, Linard B, Boueri BA, Carnevale FC, Nomura CH, da Motta Leal Filho JM. Evaluation of Morphological and Clinical Factors Related to Failure of Percutaneous Treatment with Thrombin Injection of Femoral Pseudoaneurysms from Cardiac Catheterization. Ann Vasc Surg 2019; 59:173-183. [DOI: 10.1016/j.avsg.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/12/2019] [Accepted: 01/26/2019] [Indexed: 11/25/2022]
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Cantwell CP, Murray OM, Murray JG. Scintigraphic assessment of arterial embolism at mixed thrombin and technetium 99m injection therapy for femoral pseudoaneurysms. Ir J Med Sci 2019; 189:133-137. [PMID: 31165346 DOI: 10.1007/s11845-019-02037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinically evident arterial thrombosis is rare following thrombin injection therapy for femoral pseudoaneurysm. However, it is unclear to what extent injected thrombin may pass to the ipsilateral lower limb arteries. AIMS To assess if technetium 99m injected at the time of thrombin injection for femoral artery pseudoaneurysm therapy passes into the adjacent lower limb arteries. METHODS This was a prospective trial with institutional review board approval. Four consecutive patients with common femoral pseudoaneurysms and failed manual compression were enrolled. Under real-time colour flow doppler ultrasound, a mixture of 1000 IU thrombin and approximately 200 MBq technetium 99m was injected in 0.1-mL doses into the pseudoaneurysm until thrombosis occurred. Gamma camera imaging of the syringe before injection, the injected groin after thrombosis and the syringe after injection were performed. Analysis of the gamma camera information was performed to determine the amount of technetium 99m deposited in the arterial tree. RESULTS All the procedures were technically successful. A mean of 33% (range 3-50%; SD 21) of the administered technetium 99m dose was deposited in the arterial circulation during pseudoaneurysm therapy. No clinically evident arterial thrombosis was identified. CONCLUSION Technetium 99m is routinely deposited in the arterial circulation following injection of a mixture of thrombin and technetium for therapy of common femoral artery pseudoaneurysms. This suggests that arterial passage of thrombin is more common than clinically evident.
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Affiliation(s)
- Colin P Cantwell
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Department of Radiology, St Vincent's University Hospital, Donnybrook, Dublin 4, Ireland
| | - Orla M Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - John G Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland.
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Ehieli WL, Bozdogan E, Janas G, Jaffe TA, Miller CM, Bashir MR, Allen BC. Imaging-guided percutaneous thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms. Abdom Radiol (NY) 2019; 44:1120-1126. [PMID: 30739134 DOI: 10.1007/s00261-019-01923-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate factors that may affect successful ultrasound-guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms (PSA). MATERIALS AND METHODS This was an IRB-approved, HIPAA-compliant retrospective study of 326 consecutive subjects (138 males, 188 females; mean age 68 years, range 18-95) who underwent thrombin injection for treatment of femoral PSA; follow-up ultrasound was available in 145 subjects. The number of PSA lobes and dimensions, pre-procedure laboratory values (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count), and concomitant anticoagulation therapy were recorded. RESULTS Technical success was achieved in 98.2% (320/326) of subjects. Primary effectiveness (complete thrombosis at 24 h) was achieved in 74.5% (108/145). Twenty-five subjects underwent repeat thrombin injection, successful in 21 subjects, for a total effectiveness rate of 97.0% (129/133). No imaging factor was associated with technique failure, including number of lobes (p = 0.898), largest dimension (p = 0.344), or volume (p = 0.697). No statistically significant difference in pre-procedure INR, aPTT, or platelet count was found between subjects with CT and those with IT (p > 0.138). Anticoagulation therapy was associated with incomplete thrombosis (35.5% [38/107] for CT vs. 63.9% [23/26] for IT; p = 0.002). CONCLUSION Imaging-guided percutaneous thrombin injection has high technical success and effectiveness rates for the treatment of iatrogenic femoral artery PSA. Anticoagulation therapy was the only factor associated with incomplete thrombosis.
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Affiliation(s)
- Wendy L Ehieli
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA.
| | - Erol Bozdogan
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA
| | - Gemini Janas
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA
| | - Tracy A Jaffe
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA
| | - Chad M Miller
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA
| | - Brian C Allen
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA
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Kaifi R, Price L, Chen A, Sarani B, Zderic V. Intra- and Interobserver Reliability and Variability of Femoral Artery Pseudoaneurysm Measurements Between Pre- and Postprocessed B-mode Sonographic Images. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318819993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective was to enhance the contrast and segment the femoral artery pseudoaneurysm (FAP) area from patients’ ultrasonography (US) images. In addition, this study compared the intra- and interobserver reliability and variability of the FAP measurements from the original, contrast-enhanced, and segmented US. Retrospectively, 25 FAP sonograms were evaluated by four observers (two trained and two novice). They twice measured the FAP body width, neck width, and length from original, enhanced, and segmented US. The intra- and interobserver reliability for measuring FAP body width, neck width, and neck length improved by 10% after enhancing the original 2D US contrast and segmenting the region of interest across all observers. Also, the intra- and interobserver variability among measurements across all observers decreased by 44%. Using US processing was more profound for novice observers (intraclass correlation coefficient [ICC], 0.76–0.93) compared to trained observers (ICC, 0.94–0.99). US postprocessing resulted in a decrease in variability for FAP measurements.
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Affiliation(s)
- Reham Kaifi
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Lauren Price
- Department of Surgery, The George Washington University Medical School, Washington, DC, USA
| | - Andrew Chen
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Babak Sarani
- Department of Surgery, The George Washington University Medical School, Washington, DC, USA
| | - Vesna Zderic
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
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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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16
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Jefferson J, Nuffer Z, Butani D. Thrombin Injection to Treat an Iatrogenic Internal Mammary Artery Pseudoaneurysm. J Med Ultrasound 2018; 25:177-179. [PMID: 30065485 PMCID: PMC6029302 DOI: 10.1016/j.jmu.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 08/04/2017] [Indexed: 11/16/2022] Open
Abstract
A 71-year-old female presented to the emergency room eight weeks status post open heart surgery for aortic valve replacement with right-sided chest wall pain and swelling. Computed tomographic (CT) angiography demonstrated a hyperattenuating structure arising from the right internal mammary artery surrounded by a heterogeneously-attenuating fluid collection in the anterior right chest wall, compatible with a right internal mammary artery pseudoaneurysm with surrounding chest wall hematoma. Follow up color Doppler ultrasound confirmed the diagnosis. Under direct ultrasound visualization, we injected four hundred units of thrombin into the neck of the pseudoaneurysm using a 25-gauge spinal needle. Post-injection imaging demonstrated a successful cessation of flow within the pseudoaneurysm sac.
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Affiliation(s)
- Jamal Jefferson
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 648, Rochester, NY 14642, United States
| | - Zachary Nuffer
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642, United States
| | - Devang Butani
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642, United States
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17
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Abstract
Abstract. In addition to haematoma and arteriovenous fistula, the iatrogenic pseudoaneurysm is a common complication of vascular access that is caused by a perforation in the arterial wall. Iatrogenic pseudoaneurysms can progress in size and lead to rupture and active bleeding. Over the previous few decades, therapeutic methods have evolved from surgical repair to less invasive options, such as ultrasound-guided compression therapy (UGCT) and ultrasound-guided thrombin injection (UGTI). This paper presents an overview of the diagnostic and treatment modalities used in femoral pseudoaneurysms as well as a comprehensive summary of previous studies that analysed the success and complication rates of UGCT and UGTI.
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Affiliation(s)
- Maria Stolt
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Germany
| | | | - Joerg Herold
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Germany
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18
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Dahapute AA, Gala RB, Dhar SB, Viranii S, Vaishnav A. Radial Artery Pseudoaneurysm in a Post-operative Case of Midshaft Radius Fracture. J Orthop Case Rep 2018; 7:3-5. [PMID: 29600199 PMCID: PMC5868879 DOI: 10.13107/jocr.2250-0685.922] [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: Pseudoaneurysms of arteries are not uncommon complications of vessel handling during surgery. Early identification and management is important to prevent disastrous complications such as rupture and thrombosis. Case Report: We describe a case of a 28-year-old male who developed a pseudoaneurysm of the radial artery after being operated by plating for a mid-shaft radius fracture. He presented 2 weeks after surgery with swelling over the forearm which was confirmed to be a pseudoaneurysm after computed tomography angiography. It was treated with surgical excision and end-to-end anastomosis. Conclusion: A high index of suspicion must be maintained about the occurrence of this complication secondary to both trauma and surgery
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Affiliation(s)
- Aditya Anand Dahapute
- Department of Orthopaedics, Seth GordhandasSunderdas Medical College, Mumbai, Maharashtra, India
| | - Rohan Bharat Gala
- Department of Orthopaedics, Seth GordhandasSunderdas Medical College, Mumbai, Maharashtra, India
| | - Sanjay B Dhar
- Department of Orthopaedics, D.Y. Patil Medical College, Mumbai, Maharashtra, India
| | - Siddharth Viranii
- Department of Orthopaedics, Seth GordhandasSunderdas Medical College, Mumbai, Maharashtra, India
| | - AvaniSudhir Vaishnav
- Department of Orthopaedics, D.Y. Patil Medical College, Mumbai, Maharashtra, India
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Giant iatrogenic pseudoaneurysm of the brachial artery: A case report. Int J Surg Case Rep 2017; 37:193-195. [PMID: 28704745 PMCID: PMC5508487 DOI: 10.1016/j.ijscr.2017.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/17/2017] [Accepted: 06/18/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Pseudoaneurysms are a pulsatile hematoma caused by hemorrhage on soft tissues. It is an uncommon condition with many different etiologies. We report a case of a giant pseudoaneurysm caused by iatrogenic injury on the brachial artery. PRESENTATION OF CASE A 42 year-old male was submitted to our Vascular Surgery service with an enlargement of the right upper limb and a history of myocardial infarction. 60days before the patient reached our service, he was submitted to a cardiac catheterization performed by another medical team, since the catheter was placed on the right brachial artery near the cubital fossa, we suspected an iatrogenic pseudoaneurysm, which was confirmed by his clinical history and physical exam. It was opted to treat the pseudoaneurysm with an implant of polytetrafluoroethylene prosthesis. There were no complications whatsoever and the patient was discharged. DISCUSSION Pseudoaneurysms are more common after interventional procedures than diagnostic procedures, although brachial artery pseudoaneurysms are rare. Complications of pseudoaneurysms can cause serious threat to the afflicted limb and the patient's life. The management of any pseudoaneurysm is dependent on its size, location and pathogenesis. CONCLUSION Pseudoaneurysms develop slowly and should be diagnosed as early as possible in order to avoid complications and a better outcome. Due to an increase in recent endovascular procedures and the fact that brachial artery puncture is being performed more routinely, incidence of brachial artery pseudoaneurysms among overall population may rise.
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Luedde M, Krumsdorf U, Zehelein J, Ivandic B, Dengler T, Katus HA, Tiefenbacher C. Treatment of Iatrogenic Femoral Pseudoaneurysm by Ultrasound-Guided Compression Therapy and Thrombin Injection. Angiology 2016; 58:435-9. [PMID: 17875956 DOI: 10.1177/0003319706294608] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Development of an arterial pseudoaneurysm is a common complication following cardiac catheterization. We analyzed data from 6300 patients who received left heart catheterization at our institution. One day after the procedure, approximately 10% of the patients were examined with duplex sonography. In 204 patients (3.0%), a pseudoaneurysm of the femoral artery was diagnosed. All patients underwent compression therapy. Thereby, 159 of the pseudoaneurysms could be treated successfully. The remaining 45 pseudoaneurysms had a maximal diameter of more than 1.5 cm. Forty-two patients underwent ultrasound and biopsy-line—guided thrombin injection without complications. This strategy resulted in a successful occlusion in 41 cases. Pseudoaneurysms smaller than 2 cm can be treated with compression therapy. Larger pseudoaneurysms can be occluded by thrombin injection using ultrasound guidance. Patients with a pseudoaneurysm with a wide “neck” should be treated surgically, because the risk of an arterial occlusion following thrombin injection cannot be excluded.
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Affiliation(s)
- Mark Luedde
- Department of Cardiology, University of Heidelberg, Germany. -heidelberg.de
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21
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Giurgea GA, Mlekusch I, Hoke M, Carls A, Sabeti-Sandor S, Minar E, Mlekusch W. Percutaneous instillation of physiological saline solution for the treatment of femoral pseudoaneuryms. Wien Klin Wochenschr 2016; 128:421-5. [PMID: 26980216 DOI: 10.1007/s00508-016-0979-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 02/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the efficacy of para-aneurysmal saline injection for closure of postcatheterization pseudo-aneurysm (PA) at the vascular access site. METHODS Fifty-one consecutive patients with postcatheterization PA at the vascular access site were included to undergo percutaneous para-aneurysmal saline injection. In case of technical failure the day after, PA were treated by bovine thrombin injection. Anatomical properties of the PA were recorded as were details to injection. RESULTS Initially all patients exhibited success which was reduced to 43 % at day one. A saline volume of median 7 ml (interquartile range 6-8 ml) has been injected. The amount of injected saline was not different in patients with and without treatment success at day one (P = 0.6). Several anatomical properties of the PA exhibited marked differences in patients with or without success. The length (10.3 mm (7.8-12.0) vs. 12.5 mm (10.3-15.0); P = 0.009) and the angulation (110° (100-118) vs. 140° (129-146); P < 0.001) of the fistula/vessel axis was statistically different between groups. The peak systolic velocity failed to show significance with a tendency to higher values in the ineffective study group (P = 0.07). No peripheral complications occurred. CONCLUSION Para-aneurysmal saline injection may be a therapeutic alternative to percutaneous thrombin injection in patients exhibiting favorable anatomical properties.
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Affiliation(s)
- Georgiana-Aura Giurgea
- Department of Internal Medicine II, Division of Angiology, Vienna General Hospital-Medical School, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Irene Mlekusch
- Department of Vascular Surgery, Wilhelminenspital Vienna, Vienna, Austria
| | - Matthias Hoke
- Department of Internal Medicine II, Division of Angiology, Vienna General Hospital-Medical School, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Alexandra Carls
- Clinical Pharmacology and Pharmacoepidemiology, University Heidelberg, Heidelberg, Germany
| | - Schila Sabeti-Sandor
- Department of Internal Medicine II, Division of Angiology, Vienna General Hospital-Medical School, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Erich Minar
- Department of Internal Medicine II, Division of Angiology, Vienna General Hospital-Medical School, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Mlekusch
- Department of Internal Medicine II, Division of Angiology, Vienna General Hospital-Medical School, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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22
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Kurzawski J, Sadowski M, Janion-Sadowska A. Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:188-195. [PMID: 26179719 DOI: 10.1002/jcu.22274] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To study the complications of ultrasound-guided thrombin injection of pseudo-aneurysms occurring after interventional cardiovascular procedures. METHOD We prospectively studied 353 patients who developed post-catheterization femoral artery pseudo-aneurysms and were treated with ultrasound-guided thrombin injection. RESULTS Arterial micro-embolization occurred in 53 patients (15%) and pulmonary embolism in 1 patient (0.3%). None of the patients developed significant peripheral arterial embolism. The length of the communicating channel between the arterial lumen and the pseudo-aneurysm was inversely correlated with the risk of embolization (p < 0.0001). A 4.6 mm increase in channel length decreased the odds of embolization by 14%, and patients with a channel less than 2 mm long were at greater risk. Repeated thrombin injection also increased the risk of embolization (p = 0.02). CONCLUSION Thrombin injection for the treatment of post-catheterization femoral pseudo-aneurysm is feasible and safe, but it must be performed with caution, especially when the sac is directly communicating with the artery, or when success cannot be achieved with a single injection.
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Affiliation(s)
- Jacek Kurzawski
- Świȩtokrzyskie Cardiology Center, Grunwaldzka 45, 25-736 Kielce, Poland
| | - Marcin Sadowski
- Świȩtokrzyskie Cardiology Center, Grunwaldzka 45, 25-736 Kielce, Poland
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23
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Jalaeian H, Misselt A. Anaphylactic reaction to bovine thrombin in ultrasound-guided treatment of femoral pseudoaneurysm. J Vasc Interv Radiol 2016; 26:915-6. [PMID: 26003458 DOI: 10.1016/j.jvir.2015.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/21/2015] [Accepted: 02/21/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hamed Jalaeian
- Department of Interventional Radiology, University of Minnesota, 420 Delaware Street SE, MMC 292 B-212 Mayo, Minneapolis, MN 55455
| | - Andrew Misselt
- Department of Interventional Radiology, University of Minnesota, 420 Delaware Street SE, MMC 292 B-212 Mayo, Minneapolis, MN 55455
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24
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Tikekar A, Milner HR. Diagnosis and treatment of a suspected pseudoaneurysm of the femoral artery in a working police dog. N Z Vet J 2014; 63:121-4. [PMID: 25204329 DOI: 10.1080/00480169.2014.961991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Tikekar
- a Vetspecs 90 Disraeli Street Addington Christchurch 8024 New Zealand
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25
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Chen DH, Sammel AM, Jain P, Jepson NS. Cardiologist operated ultrasound guided thrombin injection as a safe and efficacious first line treatment for iatrogenic femoral artery pseudoaneurysms. Heart Lung Circ 2014; 24:165-72. [PMID: 25201028 DOI: 10.1016/j.hlc.2014.07.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/19/2014] [Accepted: 07/21/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of ultrasound guided thrombin injection (UGTI) as a first line treatment for post arterial cannulation iatrogenic femoral artery pseudoaneurysms (IFAP). BACKGROUND IFAPs complicate up to 1% of diagnostic and 8% of interventional cardiac catheterisation procedures. UGTI remains a second line or non-attempted treatment after ultrasound guided manual compression (UGMC) and surgical repair in many centres. METHODS A retrospective review was undertaken of 121 consecutive patients who received UGTI as a first line treatment for IFAPs following cardiac diagnostic, interventional or catheter ablation procedures between 1999 and 2011 at our centre. The mean patient age was 70.7 years and 63% were male. At the time of injection, 89% were on at least one antiplatelet or anticoagulant. Pseudoaneurysms had a mean maximum dimension of 26.7mm (range 10-122mm) and 25% were multilobed. UGTI was performed by an interventional cardiologist with a mean bovine thrombin dose of 648 IU (range 50-5000 IU). RESULTS Primary success, defined as immediate IFAP thrombosis with UGTI, was achieved in 111 (92%) patients. Recurrence occurred in seven patients, three of whom required surgical repair. Multilobed IFAPs had significantly lower primary success rates than unilobed IFAPs (80% vs. 96%, p=0.016). Antiplatelet and anticoagulant use and IFAP size did not significantly affect outcomes. UGTI was not associated with any serious complications (such as thromboembolism, aneurysm rupture, venous thrombosis or abscess formation). CONCLUSION Interventional cardiologist operated UGTI should be considered as a first line therapy for uncomplicated IFAPs following interventional and diagnostic cardiac procedures. Despite high rates of concomitant antiplatelet and antithrombotic therapy, initial thrombosis rates exceeded 90% and we did not experience serious complications.
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Affiliation(s)
- Daniel H Chen
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia.
| | - Anthony M Sammel
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
| | | | - Nigel S Jepson
- Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
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26
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Traumatic Pseudoaneurysm and Arteriovenous Fistula Detected by Bedside Ultrasound. J Emerg Med 2014; 46:667-9. [DOI: 10.1016/j.jemermed.2013.08.136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 07/24/2013] [Accepted: 08/17/2013] [Indexed: 11/16/2022]
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27
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Vascular complications and special problems in vascular trauma. Eur J Trauma Emerg Surg 2013; 39:569-89. [DOI: 10.1007/s00068-013-0336-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/30/2013] [Indexed: 12/17/2022]
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28
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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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Lee JKT, Tsui KL, Chan KK, Li SK. Intra-pericardial thrombin injection for post-infarction left ventricular free wall rupture. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:337-40. [PMID: 24062924 DOI: 10.1177/2048872612460966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 08/21/2012] [Indexed: 11/15/2022]
Abstract
Left ventricular free wall rupture (LVFWR) is a fatal complication of acute myocardial infarction. Different modalities of treatment were previously described, including surgical intervention and medical treatment. We report a case treated with intra-pericardial thrombin injection that gave a favourable outcome for a patient who presented with LVFWR and cardiac tamponade, following acute myocardial infarction.
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Affiliation(s)
- Joe-Kin-Tong Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, China
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30
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Gupta PN, Salam Basheer A, Sukumaran GG, Padmajan S, Praveen S, Velappan P, Nair BU, Nair SG, Kunjuraman UK, Madthipat U, R J. Femoral artery pseudoaneurysm as a complication of angioplasty. How can it be prevented? HEART ASIA 2013; 5:144-7. [PMID: 27326111 DOI: 10.1136/heartasia-2013-010297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/17/2013] [Accepted: 06/26/2013] [Indexed: 11/04/2022]
Abstract
Femoral pseudoaneurysm is a common complication of repeated femoral puncture during cardiac catheterisation. We describe here the development of femoral pseudoaneurysms in a patient with Takayasu's arteritis, which healed in response to conservative treatment, and review the literature on the prevention and treatment of femoral pseudoaneurysm.
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Affiliation(s)
- Prabha Nini Gupta
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | - Abdul Salam Basheer
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | | | - Sabin Padmajan
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | - Satheesan Praveen
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | - Praveen Velappan
- Department of Cardiology , Medical College Trivandrum , Trivandrum, Kerala , India
| | | | | | | | - Unnikrishnan Madthipat
- Department of Cardiothoracic surgery , Sri Chitra Tirunal Institute of Medical Sciences , Trivandrum, Kerala , India
| | - Jayadevan R
- Department of Interventional Radiology , Sri Chitra Tirunal Institute of Medical Sciences, Trivandrum , Trivandrum, Kerala , India
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Kurosaka K, Kawai T, Shimohira M, Hashizume T, Ohta K, Suzuki Y, Shibamoto Y. Time-resolved Magnetic Resonance Angiography for assessment of recanalization after coil embolization of visceral artery aneurysms. Pol J Radiol 2013; 78:64-8. [PMID: 23493525 PMCID: PMC3596147 DOI: 10.12659/pjr.883769] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 01/15/2013] [Indexed: 11/09/2022] Open
Abstract
Background: Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, CT examination is susceptible to coil artifacts, which sometimes makes it difficult to assess recanalization. We report 2 cases where recanalization was successfully visualized using time-resolved magnetic resonance angiography after coil embolization of visceral artery aneurysms (one case of right internal iliac artery aneurysm and one case of splenic artery aneurysm). Repeat coil embolization was successfully performed. Case Report: Case 1. An 80-year-old male patient with right internal iliac artery (IIA) aneurysm underwent coil embolization. Aneurysm was located at the bifurcation of the right IIA and therefore, after making a femorofemoral bypass, the distal part of the right IIA, aneurysm and the common iliac artery were embolized with a coil. One year later, the size of the aneurysm seemed to have increased on CT. However, the details were not determined because of metal artifacts. Thus, time-resolved MRA was performed and showed minute vascular flow inside the aneurysm. Angiography was subsequently performed and blood flow inside the aneurysm was visualized similar to the findings in time-resolved MRA. Coil embolization was performed once more and vascular flow inside the aneurysm disappeared. Case 2. A 36-year-old male patient with a splenic artery aneurysm underwent coil packing with preservation of splenic artery patency. Four years later, coil compaction was suspected in a CT scan, but CT could not evaluate recanalization because of severe metal artifacts. Angiography was subsequently performed, showing recanalization of the aneurysm as did the time-resolved MRA. Therefore, coil embolization of the aneurysm and splenic artery was performed again. Conclusions: Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, it is sometimes difficult to assess recanalization with CT because of artifacts caused by metal. In our cases, recanalization of aneurysms was clearly shown by time-resolved MRA and re-embolization was successfully performed. In conclusion, time-resolved MRA appears to be useful in assessment of recanalization of visceral artery aneurysms after coil embolization.
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Affiliation(s)
- Kenichiro Kurosaka
- Department of Radiology, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Percutaneous treatment of iatrogenic pseudoaneurysms by cyanoacrylate-based wall-gluing. Cardiovasc Intervent Radiol 2012; 36:669-75. [PMID: 23161362 DOI: 10.1007/s00270-012-0502-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA. MATERIAL AND METHODS During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up. RESULTS PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 ± 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary. CONCLUSION PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.
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Abstract
Iatrogenic pseudoaneurysms are a complication of arterial catheterization performed for both diagnosis and intervention. Their incidence is approximately 1% following diagnostic catheterizations and 3.2% after interventional procedures. The symptoms of iatrogenic pseudoaneurysm are pain and swelling. The preferred method of treatment consists of thrombin injection under ultrasound guidance, although compression can be used. Most published research describes pseudoaneurysms that occurred close to the time of catheterization; the present case report describes a patient who presented two years postcatheterization with a symptomatic pseudoaneurysm.
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Oppenheimer J, Ray CE, Kondo KL. Miscellaneous pharmaceutical agents in interventional radiology. Semin Intervent Radiol 2012; 27:422-30. [PMID: 22550384 DOI: 10.1055/s-0030-1267854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Interventional radiologists employ a wide variety of drugs on a daily basis to improve patient experiences and outcomes during interventional procedures. The expectation is for the interventionalist to be well-versed in all pharmaceuticals used in the interventional suite. In this article, the authors review the following classes of common miscellaneous pharmaceutical agents used in interventional radiology: vasodilators, vasoconstrictors, antiemetics, bowel antiperistalsis agents, and prothrombotics.
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Eli E, Ansari H, Williams J, Carter M, Friedman P. Successful treatment of a two centimeter breast pseudoaneurysm with thrombin injection. Breast J 2012; 18:292-3. [PMID: 22583199 DOI: 10.1111/j.1524-4741.2012.01243.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Juranic J, Protic A, Sokolic J, Sustic A. Noninvasive technique of preventing thrombin escape into the systemic circulation during ultrasound-guided thrombin injection (UGTI) of the postcatheterization pseudoaneurysms. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Abstract
Introduction
Iatrogenic, postcatheterization pseudoaneurysms (PSA) of the femoral artery are a common complication after diagnostic and interventional procedures, with up to 7.7% incidence. Treatment includes surgical repair, ultrasound-guided compression (USGC) repair of the tract of the PSA, or recently ultrasound-guided thrombin injection (UGTI). Large (>1.8 cm) PSA sac with short (<3 mm) and/or wide (>3 mm) tract has higher complication ratio such as thromboembolic events after UGTI. Those cases are considered for protective balloon inflation during thrombin injection. The aim of our study was to evaluate the success rate of preventing escape of the thrombin during UGTI with simultaneous manual compression on ipsilateral iliac artery.
Methods and results
We reported 46 patients, 17 males and 29 females, aged 53–74 years, with iatrogenic, postcatheterization femoral artery PSA. Out of 46 patients, 7 were successfully treated with USGC. The rest of the patients were treated with UGTI with simultaneous manual compression on ipsilateral iliac artery to stop the flow in PSA, and to avoid thrombin escape into the native circulation. Success rate of UGTI with manual compression of ipsilateral iliac artery was 97% with the complication rate of 2.6%.
Conclusion
Our study confirms that UGTI treatment of the PSA of the femoral artery combined with compression of the ipsilateral iliac artery could be a safe and reliable method of the thrombin escape prevention into the systemic circulation, as good as more invasive and demanding methods.
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Kim YJ, Baek WK, Kim JY, Park SW, Jeon YS, Lee KH, Cho SG, Lim MK. Pseudoaneurysm of the popliteal artery mimicking tumorous condition. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80 Suppl 1:S71-4. [PMID: 22066090 PMCID: PMC3205379 DOI: 10.4174/jkss.2011.80.suppl1.s71] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 05/25/2010] [Indexed: 12/31/2022]
Abstract
Diagnosing pseudoaneurysms of the popliteal artery is usually straightforward in physical examinations and imaging findings. However, when a pseudoaneurysm shows a soft tissue mass with adjacent osseous change, it can mimic a bone tumor or a soft tissue sarcoma. We present a case of a 65-year-old man who had a pseudoaneurysm of the popliteal artery showing soft tissue mass and insinuating into the intramedullary cavity of the tibia. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis of an apparent soft tissue mass with pressure erosion in adjacent bone.
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Affiliation(s)
- Yeo Ju Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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AIUM practice guideline for the performance of peripheral arterial ultrasound examinations using color and spectral Doppler imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:137-142. [PMID: 21193717 DOI: 10.7863/jum.2011.30.1.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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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: 51] [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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Kapoor BS, Haddad HL, Saddekni S, Lockhart ME. Diagnosis and management of pseudoaneurysms: an update. Curr Probl Diagn Radiol 2009; 38:170-88. [PMID: 19464587 DOI: 10.1067/j.cpradiol.2008.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
"Pseudoaneurysm" is a term that describes disruption of an artery with patent flow in a defined space beyond the confines of the vessels. A pseudoaneurysm can involve any vascular bed and is usually associated with direct arterial injury or erosion of an artery by an adjacent tumor or inflammation. In this article, we discuss different clinical settings and various imaging modalities such as ultrasound, computerized tomography, magnetic resonance imaging, as well as conventional angiography used for the diagnosis of pseudoaneurysms. We also describe the role of newer endovascular, percutaneous, and traditional surgical approaches for the treatment of visceral and peripheral pseudoaneurysms in different clinical circumstances.
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Affiliation(s)
- Baljendra S Kapoor
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249-6830, USA.
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Ward E, Buckley O, Collins A, Browne RF, Torreggiani WC. The use of thrombin in the radiology department. Eur Radiol 2008; 19:670-8. [PMID: 18925399 DOI: 10.1007/s00330-008-1198-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 08/23/2008] [Accepted: 08/29/2008] [Indexed: 01/26/2023]
Abstract
Thrombin is a naturally occurring coagulation protein that converts soluble fibrinogen into insoluble fibrin and plays a vital role in the coagulation cascade and in turn haemostasis. Thrombin also promotes platelet activation. In the last few years, there has been a rapid increase in the use of thrombin by radiologists in a variety of clinical circumstances. It is best known for its use in the treatment of pseudoaneurysms following angiography. However, there are now a variety of cases in the literature describing the treatment of traumatic, inflammatory and infected aneurysms with thrombin in a variety of locations within the human body. There have even been recent reports describing the use of thrombin in conventional aneurysms as well as ruptured aneurysms. Its use has also been described in the treatment of endoleaks (type II) following aneurysm repair. In nearly all of these cases, treatment with thrombin requires imaging guidance. Recently, thrombin has also been used as a topical treatment post-percutaneous intervention to reduce or stop bleeding. Most radiologists have only a limited knowledge of the pharmacodynamics of thrombin, its wide range of utilisation and its limitations. Apart from a few case reports and case series, there is little in the radiological literature encompassing the wide range of applications that thrombin may have in the radiology department. In this review article, we comprehensively describe the role and pathophysiology of thrombin, describing with examples many of its potential uses. Techniques of usage as well as pitfalls and limitations are also described.
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Affiliation(s)
- E Ward
- Department of Radiology, Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland
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Ahmad F, Turner SA, Torrie P, Gibson M. Iatrogenic femoral artery pseudoaneurysms--a review of current methods of diagnosis and treatment. Clin Radiol 2008; 63:1310-6. [PMID: 18996260 DOI: 10.1016/j.crad.2008.07.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 07/02/2008] [Accepted: 07/03/2008] [Indexed: 12/18/2022]
Abstract
The common femoral artery is commonly used as arterial access for a wide range of radiological and cardiological procedures. Pseudoaneurysm formation is the most common arterial complication of femoral artery catheterization, and is diagnosed using colour Doppler ultrasound. Ultrasound-guided thrombin injection has replaced ultrasound-guided compression as the first-line treatment. The practicalities of thrombin injection (technique and types of thrombin available) and other treatment options are discussed. Awareness of pseudoaneurysm formation and the treatment options allows prompt diagnosis and successful treatment.
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Affiliation(s)
- F Ahmad
- Department of Interventional Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK.
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Transjugular liver biopsy: a retrospective analysis of 601 cases. J Vasc Interv Radiol 2008; 19:351-8. [PMID: 18295693 DOI: 10.1016/j.jvir.2007.09.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 09/02/2007] [Accepted: 09/08/2007] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To perform a retrospective analysis of all transjugular liver biopsies (TJLBs) performed during a 77-month period. The authors discuss the technical modifications adopted to achieve better procedural success and histopathologic yield apart from the safety profile of this procedure during the study period. MATERIALS AND METHODS Six hundred one consecutive patients underwent TJLB at the authors' institution during the study period. TJLB was performed when percutaneous biopsy was precluded, being judged unsafe. The left internal jugular vein (IJV) was accessed only when it was not possible to cannulate the right IJV, which was the routine access for this procedure. Biopsy samples were obtained from the right lobe after right hepatic vein cannulation. Left lobe biopsy was done only in select cases. In patients with shrunken liver and unfavorable hepatic veins for cannulation and in those with hepatic veno-occlusive disease, biopsy was performed with a transcaval approach under ultrasonographic (US) guidance, improving our technical success for this procedure over the years. RESULTS The overall technical success rate for the procedure was 98.8 % (594/601), the histopathologic positivity was 97% (576/594), and the overall complication rate was 2.5% (15/601). CONCLUSIONS With technical modifications such as transcaval liver biopsy and with access to US in the angiography suite, interventionalist can achieve higher technical success rates for this procedure. The authors' institutional experience with this procedure reiterates its high histopathologic positivity and safety profile both in adult and pediatric patients.
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D'Ayala M, Smith R, Zanieski G, Fahoum B, Tortólani AJ. Acute arterial occlusion after ultrasound-guided thrombin injection of a common femoral artery pseudoaneurysm with a wide, short neck. Ann Vasc Surg 2008; 22:473-5. [PMID: 18367371 DOI: 10.1016/j.avsg.2007.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 09/13/2007] [Accepted: 09/14/2007] [Indexed: 10/21/2022]
Abstract
Ultrasound-guided thrombin injection (UGTI) has emerged as the preferred treatment modality for pseudoaneurysms occurring as a result of percutaneous femoral arterial interventions. UGTI is safe and effective, with few complications. Native arterial thrombosis has been rarely reported in the literature following UGTI and has usually been attributed to excessive thrombin injection. We report a case of femoral arteria thrombosis occurring following UGTI of a 4 cm postcatherization pseudoaneurysm with a wide, short neck successfully treated by surgical intervention. The large size of the neck of this pseudoaneurysm likely contributed to the development of this complication.
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Affiliation(s)
- Marcus D'Ayala
- Department of Surgery, New York Methodist Hospital, Brooklyn, NY 11215, USA.
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Shojaiefard A, Khorgami Z, Kouhi A, Kohan L. Surgical management of aneurismal dilation of vein and pseudoaneurysm complicating hemodialysis arteriovenuos fistula. Indian J Surg 2008; 69:230-6. [PMID: 23132993 DOI: 10.1007/s12262-007-0032-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Pseudoaneurysm (PS) and aneurismal dilation of vein (ADV) are recognized complications of arteriovenous fistulas (AVF) in patients on hemodialysis. We present our experience about surgical management of these complications, which resulted in AVF preservation for continuing hemodialysis. MATERIAL AND METHODS Twenty-two patients underwent surgical repair of an aneurismal dilation of vein or a pseudoaneurysm arising from a native AVF. In 14 patients the aneurismal dilation of vein arose from the venous limb of AVF and in eight patients the pseudoaneurysm arose from an arteriovenous anastomotic site in the antecubital and anterior part of arm. The mean follow-up period was 15 months. Clamp Aneurysm Repair (CAR) was performed to repair the aneurismal dilation of venous limb of AVF and Tourniquet Aneurysm Repair (TAR) was performed to repair PS that arose from AVF in the antecubital and anterior part of arm. RESULTS In eight of the 14 patients with aneurismal dilation of vein, who underwent CAR procedure, vascular access was preserved. In three patients with aneurismal dilation of vein in snuffbox and one in forearm, the AVF had failed due to prior venous thrombosis of AVF. In two of 14 patients, there was no need for preservation of AVF because of renal transplantation. The technical success rate and patency rate during follow up period in CAR method was 100%. In seven of eight patients with psudoaneurysm in the antecubital and anterior part of arm, who underwent TAR procedure, the AVF remained patent. The technical success rate in TAR method was 87.5%, and the patency rate was 87.5%. Overall, technical success rate was 95.45% and patency rate was 93.75%. During the 15 months of follow up period hemodialysis program through the repaired AVF sustained as desired. CONCLUSIONS The surgical methods used in our study could effectively repair the aneurismal dilation of vein and psudoaneurysm arising from a native AVF, and it lead to preservation of the AVF patency for continuing hemodialysis. These methods are technically feasible, safe and cost-effective procedures. It does not require dissection and additional incision for control of the vein and artery proximal and distal to the aneurismal dilation of vein and pseudoaneurysm; result in shorter time of procedure without complications.
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Affiliation(s)
- A Shojaiefard
- Department of Surgery, Shariati hospital, Tehran University of Medical Science, Tehran, Iran ; Karegar Shomali AVE., Shariati Hospital, Tehran, Iran
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Minimally Invasive Therapy of Pseudoaneurysms of the Trunk: Application of Thrombin. Cardiovasc Intervent Radiol 2008; 31:535-41. [DOI: 10.1007/s00270-007-9272-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 11/05/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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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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50
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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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