The Changing Face of Femoral Artery False Aneurysms

Spontaneous Deep Femoral Artery False Aneurysm Simulating a Neoplasm: A Rare Case and Literature Review

A 70-year-old woman presented to our attention with a painless pulsating mass at the level of the upper left thigh without any previous history of trauma, arterial surgery, or puncture of the femoral artery. Duplex ultrasound showed a nodular angiomatous-like formation with deep venous compression; computed tomographic angiography and magnetic resonance imaging reported the presence of capsulated lesion vascularized by muscular branch of deep femoral artery (DFA). The patient underwent surgical excision of a very rare thrombized DFA branch false aneurysm. Spontaneous DFA false aneurysm, although rare, will be considered in absence of trauma or vascular catheterization or previous aneurysmal rupture.

Combined renin-angiotensin-aldosterone system blockade and statin therapy effectively reduces the risk of cerebrovascular accident in autosomal dominant polycystic kidney disease: a nationwide population-based cohort study

Fairly limited data reported the incidence and risk of cerebrovascular accident (CVA) in autosomal dominant polycystic kidney disease (ADPKD). Additionally, little is known regarding the therapeutic impact of renin-angiotensin-aldosterone system (RAAS) blockade and statin on reducing the occurrence of CVA in ADPKD. We utilized the data from Taiwan National Health Insurance Research Database (NHIRD) to perform a population-based cohort study (1997-2013). A total of 2,647 patients with ADPKD were selected from 1,000,000 general population after excluding patients with age<18, renal replacement therapy and concomitant diagnosis of CVA. Additionally, non-ADPKD subjects were assigned as comparison group by matching study cohort with age, gender, income and urbanization in 1:10 ratio (n=26,470). The results showed that ADPKD group had significantly higher frequency rate and cumulative incidence of CVA as compared with the non-ADPKD group (8.73% v.s. 3.93%, p<0.0001). Furthermore, the frequencies of both hemorrhagic and ischemic strokes were also significantly higher in the ADPKD than non-ADPKD group (all p-values <0.0001). After adjusting for age, gender and atherosclerotic risk factors with multivariate analysis, ADPKD independently carried 2.34- and 5.12-fold risk for occurrence of CVA and hemorrhagic stroke (95% CI: 2.02-2.72 and 4.01-6.54), respectively. Combination therapy [adjusted (a) HR=0.19, 95% CI: 0.11-0.31] was superior to either RAAS blockade (aHR=0.37, 95% CI, 0.28-0.5) or statin (aHR=0.44, 95% CI, 0.24-0.79) alone for reducing the CVA occurrence in the ADPKD population. In conclusion, ADPKD was associated with an increased risk of CVA occurrence. Combined RAAS blockade and statin therapy effectively reduces the risk of CVA in ADPKD.

Infected Iliac Pseudoaneurysm after Cardiac Catheterization Complicated by Girdlestone Pseudoarthroplasty for Recurrent Infection of Hip Prosthesis

We report a massive infected pseudoaneurysm of the right external iliac artery in the setting of Girdlestone pseudoarthroplasty (GSA) for chronic infection. Around the time of her GSA, the patient underwent cardiac catheterization with resultant pseudoaneurysm formation. Infection was likely due to spread from her previous chronic infection. Delay in presentation occurred due to attribution of her symptoms to her GSA. The patient underwent ligation of the right external iliac artery and hip disarticulation and was discharged on antibiotics. At follow-up, she had significantly reduced pain. Although vascular complications from orthopedic procedures are well described, this case seems to have been caused by secondary infection of her iatrogenic external iliac artery pseudoaneurysm.

Bilateral post-arterial puncture pseudoaneurysm in a patient with amyloidosis

Amyloidosis consists of deposition of insoluble fibrillar proteins in tissues and, causing dysfunction. In association with other factors, the condition can contribute to emergence of complications, such as pseudoaneurysms at arterial puncture sites. Pseudoaneurysms are becoming an ever-more common complication, which underscores the importance of identifying risk factors, so that their incidence can be minimized.

Femoral pseudoaneurysms requiring surgical treatment

BACKGROUND

Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than 6.000 angiographies and/or interventions annually.

OBJECTIVES

The aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair.

PATIENTS AND METHODS

In this retrospective study, 122 (0.06%) FPAs treated among 21060 patients over a period of five years were assessed. Patient characteristics and therapeutic procedures were analyzed through hospital records.

RESULTS

There were 15.163 (72%) coronary and 5.897 (27%) peripheral interventions, respectively. In 89 (73%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (28%) patients underwent open surgical repair. Indication for operative treatment was hemodynamic instability in 9 (7%) patients, rapidly expanding haematoma unsuitable for USGC or after unsuccessful USGC in 23 (19%). One (0.8%) patient had an arterio-venous fistula. Intraoperative findings suggest that atypical endovascular access (e.g. deep femoral artery, lateral or medial puncture) and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in 22 (67%) cases. Most patients had active antithrombotic therapy. Gender or the nature of procedure (diagnostic vs. intervention) did not increase risk for open repair. One (0.8%) patient died. No amputations were performed. Mean hospital stay of patients undergoing open surgical repair was 11 (range 4-36) days.

CONCLUSIONS

Technical puncture problems were identified in 2/3 of patients requiring open surgery.

Localized superficial femoral vein thrombosis coupled with iatrogenic arteriovenous fistulas presenting as pulmonary emboli

INTRODUCTION

'Localized' femoral vein thrombosis (FVT) is a relatively rare condition usually associated with traumas, external compression or iatrogenic etiologies and the consequence can be pulmonary embolism.

REPORT

This is the case of a 46-year-old woman who presented with pulmonary emboli secondary to 'localized' superficial FVT, coupled with post-puncture arteriovenous fistulas (AVFs), two days after trans-femoral vein radio-frequency cardiac ablation. After placing a temporary IVC-filter, the AVFs were sutured directly while the residual FVT was treated conservatively.

DISCUSSION

Close local monitoring and adequate medical and surgical management are mandatory to avoid possible dangerous complications, also in apparently 'low-risk' iatrogenic AVFs.

Endovascular repair of profunda femoral artery false aneurysms using covered stents

Pseudoaneurysms of the profunda femoral artery (PFA) have been reported following different types of trauma, mostly iatrogenic. We present three cases of PFA false aneurysm formation, two after vascular procedures and one as a result of a gunshot injury, which were successfully treated with the endovascular deployment of covered stents. Treating these patients by endoluminal means is an efficient and feasible minimally invasive approach. If the patient is relatively stable and there are no major compression issues, stenting could be considered as adequate therapy for these situations. Certainly, a larger series are needed in order to testify to the long-term results and ascertain the durability of such a repair.

Alternative treatment for postcatheterisation femoral false aneurysm

The incidence of femoral postcatheteriation pseudoaneurysm ranges from 0.1 to 2.0% in diagnostic procedures to 5% in therapeutic procedures. There are several treatment options for pseudoaneurysms, from conservative management to conventional surgical intervention. For medium-sized pseudoaneurysms, ultrasound-guided compression repair or percutaneous injection of thrombin/coagulation factor XIII are the treatments of choice. In this paper, we describe two cases of post-therapeutic catheterization pseudoaneurysm, in which endovascular and conventional surgery were combined. The association of these two modalities of treatment decreased blood loss in comparison with conventional surgery alone, besides reducing surgical trauma and hospital stay.

Huge anastomotic femoral pseudoaneurysm following aorto-bifemoral bypass

There has been recent concern that the number of patients at risk of femoral artery false aneurysms may be increasing, due to an increase in the number of cardiac and vascular radiological interventional procedures performed each year. Rarely, such pseudoaneurysms can develop around the anastomotic site of a femoral bypass graft. The present report describes the unusual presentation of a huge femoral pseudoaneurysm in a 70-year-old male patient who had an aorto-bifemoral bypass in the past. A surveillance CT angiogram of a previously diagnosed right femoral pseudoaneurysm revealed that it had reached a size of 10×7×cm - a considerable growth when compared to his previous scan. An urgent referral was then made to the vascular surgery team. He subsequently underwent a successful surgical repair of his right femoral pseudoaneurysm. Postoperatively, he had an uneventful recovery except for a mild wound infection, which was treated with intravenous antibiotics.

Delayed femoral pseudoaneurysm formation after percutaneous coronary intervention

Five femoral pseudoaneurysms were treated among 573 patients who underwent percutaneous coronary interventions. Four of the five patients suffered from diabetes mellitus and four patients needed regular hemodialysis due to chronic renal failure. One patient's course was complicated by infection. One patient was healed by compression therapy and four patients were treated successfully by surgery, which included an extraanatomic bypass and a thromboendoarterectomy. Diabetes and regular hemodialysis are major risks for the formation of femoral pseudoaneurysm after catheter intervention at present.

Use of Microsurgery and Iloprost in the Infantile Arterial Injuries

BACKGROUND

To evaluate the use and advantage of microsurgical intervention and intravenous iloprost administration in delayed infantile artery injuries.

METHODS AND RESULTS

Four patients were followed up and treated in our clinic between June 2003 and June 2006 for infantile artery injuries and distal ischemia. The average age of the 4 infants (3 girls, 1 boy) was 134.7+/-33.6 days. The reason for all of the artery injuries was iatrogenic. Tissue necrosis started in patches in 2 babies who were admitted at the 12(th) hour after ischemia (19(th) and 22(nd) hours), and therefore the artery was repaired by microsurgery. Iloprost infusion was also used in addition to the conservative treatments. The other 2 patients were assessed before the first 12 h after distal ischemia and were treated by iloprost without any surgical intervention. None of the patients lost any tissue or extremities during the 9 months (average) follow-up time. One of our patients died following the ventricular septal defect repair at the 9(th) month after a successful repair of artery.

DISCUSSION

We believe that intravenous iloprost infusion is very effective in the treatment of distal ischemia when used in addition to the conservative treatment methods for artery injuries in infants.

Surgical Approach to Vascular Complications of Intravenous Drug Abuse

OBJECTIVE

To assess the complications related to intravenous drug abuse.

DESIGN

Prospective study.

METHODS

Intravenous drug abusers (IVDAs) with vascular complications were assessed.

RESULTS

Sixty-two patients presented with swelling and tenderness in the groin, and 3 patients with similar lesions in the cubital fossa. Infected pseudoaneurysms and deep vein thrombosis (DVTs) were diagnosed in 41 and 31 patients respectively (27 patients had both lesions). In patients with infected pseudoaneurysms, 9 patients underwent excision with early revascularization and 32 patients underwent ligation without revascularization. For all patients with femoral vein thrombosis ligation and excision was performed. 4 patients with pure DVTs were managed conservatively. Disabling claudication occurred in 6 patients. Four of them underwent late revascularization with an acceptable outcome.

CONCLUSIONS

Ligation without revascularization is the appropriate treatment of infected pseudoaneurysms in IVDAs. Late revascularization is of great importance in patients with disabling claudication after treatment of addiction. Pure septic DVTs can be managed conservatively.

True and false aneurysms of the femoral artery

True aneurysms of the femoral artery are uncommon. They are most often identified in elderly males and are frequently associated with aneurysms at other locations. Femoral artery aneurysms that are symptomatic or larger than 2.5 cm should be repaired in order to prevent limb-threatening complications, such as rupture, thrombosis, or embolization. Open repair is the standard method of treatment and should be preceded by evaluation for coexisting aortoiliac or popliteal aneurysms, assessment of superficial femoral artery patency, and determination of the point of origin of the deep femoral artery relative to the aneurysm sac. Femoral artery pseudoaneurysms are most often seen in the setting of previous femoral artery catheterization but may also be associated with trauma, anastomotic leakage, or infection. The majority of femoral pseudoaneurysms less than 3 cm in diameter will spontaneously thrombose and may be observed with serial duplex ultrasound exams in asymptomatic patients. Symptomatic pseudoaneurysms, pseudoaneurysms with a diameter greater than 3 cm, and those found in patients who are anticoagulated should usually be treated. Ultrasound-guided thrombin injection is our preferred method for treating femoral pseudoaneurysm because of its low risk, high success rate, and efficacy in the setting of anticoagulation. Ultrasound-guided compression is an alternative method that may be considered when thrombin products are contraindicated. Open pseudoaneurysm repair should be undertaken in the setting of infection, rapid expansion, or if less-invasive methods are not technically feasible.

Pseudoaneurysm in children: diagnosis and interventional management

Pseudoaneurysms (PAn) are uncommon in adults and even less common in children. They are most often encountered after iatrogenic arterial injury. Presentation may be substantially delayed after the iatrogenic event, and diagnosis can be difficult, especially when the PAn occurs in an unexpected location. Treatment of PAn has evolved during the last two decades from a reliance on surgical resection to US-guided compression, coil embolization, covered stents, and stent-graft exclusion. More recently, direct percutaneous US-guided thrombin injection has been used in the treatment of PAn. We present three cases of successful PAn thrombosis by US-guided percutaneous thrombin injection in children, one of the epigastric artery and two of the femoral artery.