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Havan N. Influence of anatomical factors on the efficacy of treating femoral pseudoaneurysms with ultrasound-guided compression technique: A prospective cohort study. Ir J Med Sci 2024; 193:1539-1544. [PMID: 38052750 DOI: 10.1007/s11845-023-03581-6] [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: 10/25/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Femoral pseudoaneursysm treatment is still controversial. AIMS The aim of this study was to evaluate the anatomic features related to femoral pseudoaneurysm (FPA) closure failure for ultrasound-guided compression (USGC). METHODS This was a single-center, prospective, cohort study. FPA patients admitted to the radiology department for USGC were included in the study. Age, sex, duration of FPA, thrombosis, ratio of thrombosis to FPA diameter, feeding artery, tortiosity, connection properties, length and width of the neck, volume, and fistula-to-common femoral artery (CFA) speed ratio were reported during color Doppler ultrasonography (CDUS) scanning. RESULTS The study was completed with 192 patients. FPA compression therapy was successful in 155 patients and failed in 37 patients. FPA without a narrow connection (p < 0.001), FPA without existing thrombosis (p < 0.001), a lower thrombosis ratio (p < 0.001), a longer duration of FPA (p = 0.035), a shorter neck length, a wider neck width (p < 0.001), and a higher fistula-to-CFA speed rate (p < 0.001) were related to FPA closure failure with USGC. ROC analysis of the fistula-to-CFA speed ratio showed that a ratio of 1.01 had 47% sensitivity and 63% specificity for USGC treatment failure (AUC, 0.72; p < 0.05). CONCLUSIONS Failure of FPA closure with USGC is closely related to anatomic features of FPA. Evaluating the anatomical features of FPA before deciding the treatment method can be beneficial for patients and clinicians.
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Affiliation(s)
- Nuri Havan
- Department of Radiology, Atasehir Florance Nightingale Hospital, Küçükbakkalköy, Işıklar Cd. No: 35/A, 34750, Ataşehir/Istanbul, Turkey.
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Osilama E, Satchell EK, Ballehaninna UK. Delayed ulnar artery pseudoaneurysm presentation after percutaneous cardiac intervention: A case report and review of the literature. Vascular 2024:17085381241238267. [PMID: 38447047 DOI: 10.1177/17085381241238267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE Here we present a case of a 62-year-old female with a delayed ulnar artery pseudoaneurysm presentation after cardiac catheterization. CASE REPORT A 62-year-old woman with multiple medical comorbidities including end-stage renal disease (ESRD) on hemodialysis (HD) and atrial fibrillation on tablet apixaban who presented 8 weeks after cardiac catheterization through right ulnar artery access with a pulsatile mass, pain, and tingling of her right-hand fingers. Ultrasound exam confirmed presence of ulnar artery pseudoaneurysm with >2 cm active chamber. This pseudoaneurysm was repaired via forearm exploration, evacuation of hematoma, and primary repair with non-absorbable sutures. CONCLUSION We report a case of delayed ulnar artery pseudoaneurysm presentation following cardiac catheterization through the right ulnar artery. Open surgical repair offers a definitive addressal of ulnar artery pseudoaneurysm and removes ulnar nerve compressive neuropathy with less risk of distal embolization in patients with delayed pseudoaneurysm presentation whenever ultrasound-guided thrombin injection (UGTI) is contraindicated.
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Affiliation(s)
- Eshiemomoh Osilama
- Department of General Surgery, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Emma K Satchell
- Department of General Surgery, Guthrie Robert Packer Hospital, Sayre, PA, USA
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Bruno A, Vendetti F, Papalexis N, Russo M, Papadopoulos D, Mosconi C. Percutaneous balloon-assisted ultrasound-guided direct thrombin embolization of superficial femoral artery pseudoaneurysm: a case series and literature review. CVIR Endovasc 2024; 7:19. [PMID: 38363514 PMCID: PMC10873257 DOI: 10.1186/s42155-024-00428-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/18/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Superficial femoral artery (SFA) pseudoaneurysms, a rare but potentially life-threatening complication, that can arise after vascular interventions or trauma. This case series explores the efficacy and safety of a minimally invasive treatment modality, percutaneous ultrasound-guided thrombin injection (PUGTI) combined with balloon occlusion, in three patients with SFA pseudoaneurysms. CASE PRESENTATION Three patients (age: 71-82 years; 3 female) with SFA pseudoaneurysms underwent PUGTI with balloon occlusion. The procedure involved direct thrombin injection under ultrasound guidance while occluding the parent artery using a balloon catheter. Follow-up was conducted at 1 week and 1 month post-procedure to assess technical success, complications, and recurrence. CONCLUSION PUGTI combined with balloon occlusion appears to be a safe and effective treatment for SFA pseudoaneurysms, particularly for larger pseudoaneurysms. The procedure is associated with a high technical success rate. Balloon occlusion may offer a safer alternative to direct thrombin injection without occlusion, as it potentially minimizes the risk of complications such as distal thromboembolism.
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Affiliation(s)
- Antonio Bruno
- Alma Mater Studiorum, Università Di Bologna, Bologna, Italy
| | | | | | - Mattia Russo
- Alma Mater Studiorum, Università Di Bologna, Bologna, Italy.
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Raupach J, Masek J, Venugopal S, Renc O, Lesko M, Radovan M. Complex endoleak treatment after failed endovascular aortic repair. CVIR Endovasc 2023; 6:35. [PMID: 37405522 DOI: 10.1186/s42155-023-00381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) has created new possibilities for patients with abdominal aortic aneurysms (AAAs), and in recent years it has become tremendously popular. Use of EVAR in selected groups of patients allows mortality and morbidity to be reduced in comparison to open repair. However, complications such as endoleaks (ELs) can be of great concern and warrant urgent therapy to prevent sac rupture. CASE PRESENTATION The case report presents urgent endovascular treatment of a high-risk type IA EL in a polymorbid 68-year-old patient 7 years after primary EVAR. The principle of treatment was parallel implantation of the proximal SG extension with the renal SG into the right renal artery (chimney technique). The subsequent type II collateral EL was treated by direct transabdominal AAA sac puncture and thrombin embolization. CONCLUSION EL can be a cause for urgent intervention, but specific anatomic features often require specialized SG types which are not readily available. The chimney technique allows the use of immediately available stent grafts to address endoleak in the setting of impending abdominal aneurysm rupture.
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Affiliation(s)
- Jan Raupach
- Department of Radiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 50005, Czech Republic.
- Faculty of Medicine in Hradec Kralove, Radiology, Charles University, Hradec Kralove, Czech Republic.
| | - Jan Masek
- Department of Radiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 50005, Czech Republic
| | - Sindharta Venugopal
- Department of Radiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 50005, Czech Republic
| | - Ondrej Renc
- Department of Radiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 50005, Czech Republic
- Faculty of Medicine in Hradec Kralove, Radiology, Charles University, Hradec Kralove, Czech Republic
| | - Michal Lesko
- Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Surgery, Charles University, Hradec Kralove, Czech Republic
| | - Maly Radovan
- The 1st Department of Internal Medicine - Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Internal Medicine, Charles University, Hradec Kralove, Czech Republic
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Jiaxin L, Yan L, Sheng Z, Zhiyi D, Jichang W, Shaoying L. Case report: Successful and effective percutaneous closure of a deep femoral artery pseudoaneurysm using proglide device. Front Surg 2023; 10:1109243. [PMID: 37066014 PMCID: PMC10102390 DOI: 10.3389/fsurg.2023.1109243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
A 61-year-old man developed severe swelling in the left lower extremity after interventional embolization of liver tumor. Ultrasound examination showed a pseudoaneurysm and thrombosis in the upper thigh on the left. To recognize the causes and determine the effective therapy, lower extremity arteriography was performed. The results revealed a pseudoaneurysm arised from deep femoral artery. Considering of the size of cavity and symptoms of patient, a new method was tried instead of traditional treatment using PROGLIDE device. Postoperative angiography showed a powerful blocking effect. This case study provide us a specific treatment for pseudoaneurysm, and this method provide us a new therapeutic strategy in clinical practice.
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Affiliation(s)
- Liu Jiaxin
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Li Yan
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhang Sheng
- Department of General Surgery, Children’s Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dong Zhiyi
- Department of General Surgery, Yulin Traditional Chinese Medicine Hospital, Yulin, China
| | - Wang Jichang
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Correspondence: Wang Jichang Lu Shaoying
| | - Lu Shaoying
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Correspondence: Wang Jichang Lu Shaoying
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Intra-pericardial thrombin injection as bailout strategy in iatrogenic pericardial tamponade. Neth Heart J 2023; 31:61-67. [PMID: 35648265 PMCID: PMC9892408 DOI: 10.1007/s12471-022-01701-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac tamponade is a rare but life-threatening complication of cardiac interventions. Despite prompt pericardiocentesis, clinical management can be challenging and sometimes haemodynamic stabilisation is difficult to achieve. Intra-pericardial thrombin injection after pericardiocentesis promotes haemostasis and acts as a sealing agent, as previously described for left ventricular free-wall rupture. We aimed to evaluate intra-pericardial thrombin injection as a bailout strategy for pericardial tamponade following percutaneous cardiac interventions. METHODS In a 5-year single-centre retrospective analysis we identified 31 patients with cardiac tamponade due to percutaneous intracardiac procedures. Intra-pericardial thrombin injection as a bailout strategy was administered in 5 of 31 patients (16.1%). RESULTS Patients receiving intra-pericardial thrombin were in a more critical state when thrombin was applied, as demonstrated by a higher rate of resuscitation (40% versus 26.9%) and a trend toward a prolonged stay in the intensive care unit (177.6 ± 84.0 vs 98.0 ± 31.4 h). None of the patients with pericardial tamponades treated with intra-pericardial thrombin needed cardiothoracic surgery. Mortality after 30 days was lower with intra-pericardial thrombin injection than with standard treatment (0% vs 15.4%). We observed no complications using intra-pericardial thrombin. CONCLUSION Intra-pericardial thrombin injection could be considered as a bailout strategy for patients with iatrogenic pericardial tamponade due to percutaneous procedures. We recommend further evaluation of this technique in the clinical management of refractory pericardial tamponade.
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Muglia R, Marra P, Dulcetta L, Carbone FS, Bonaffini PA, Sironi S. US-guided percutaneous thrombin injection to treat non-femoral artery pseudoaneurysms: preliminary experience and review of the literature. LA RADIOLOGIA MEDICA 2023; 128:125-131. [PMID: 36525178 DOI: 10.1007/s11547-022-01576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the clinical outcome of US-guided percutaneous thrombin injection in the treatment of non-femoral artery pseudoaneurysms (NFAP). MATERIALS AND METHODS Among all pseudoaneurysms treated in our institution, we retrospectively collected NFAP embolized with percutaneous thrombin injections from January 1, 2015, to December 31, 2021. The embolization was prompted for an ongoing antiaggregating/anticoagulation therapy, NFAP optimal US visibility, or high surgery-related risks. Causes, location, size and neck of NFAP, complications, number of repeated treatments, clinical success and patients clinical conditions at discharge were annotated. The endpoint for clinical success was the resolution of NFAP at postprocedural imaging, with no resort to surgery. RESULTS Eight consecutive patients (5 females, median age 73 years, range 46-84) underwent 16 procedures. Arterial damage was due to catheterization (3), CVC mispositioning (2), trauma, hemorrhagic diathesis and endoprosthesis endoleak. We treated humeral (2), subclavian (2), thyrocervical, anterior tibial, radial and pancreaticoduodenal arteries. Median pseudoaneurysm size was 530 mm2 (range 32-2400 mm2), with a thin (7/8) or non-visible (1/8) neck. No complications occurred. Clinical success was obtained in 7/8 patients (88%), with a single treatment in 4, multiple in 3 cases (4 embolizations, 3 and 2, respectively). One patient underwent surgical suture after the second failed attempt of percutaneous embolization. Seven patients were discharged in good clinical conditions; one died during hospitalization, due to the worsening of the underlying cardiac disease. CONCLUSIONS Percutaneous US-guided thrombin injection to treat NFAP is feasible in selected cases, with rare complications. Clinical success is often reached, also by repeated injections.
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Affiliation(s)
- Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy.
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
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Al Laham O, Shahrour A, Yahya O, Hamzeh H. Successful surgical repair of an eminently rare case of an incidental idiopathic Common Femoral Artery Pseudoaneurysm in a 6-year-old female child - A Case Report. Int J Surg Case Rep 2022; 96:107362. [PMID: 35777337 PMCID: PMC9284049 DOI: 10.1016/j.ijscr.2022.107362] [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: 05/22/2022] [Revised: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A Pseudoaneurysm is an abnormal outpouching of the arterial wall which progressively enlarges and could lead to catastrophic consequences. Ensuing damage could culminate in the loss of the affected extremity due to dissection, exsanguination, thromboembolism, or infection. Some presentations are symptomatic, whereas others are incidental findings. Timely surgical mediation is vital to eliminate the potential morbid sequelae. CASE PRESENTATION We present the case of a 6-year-old female, who was referred to the clinic due to an incidental finding of a pulsatile bulge in her right groin. We confirmed the presence of a visible pulsating bulge in the right groin associated with impalpable Popliteal and Pedal pulses. Preoperative imaging revealed an isolated Common Femoral Artery Pseudoaneurysm and hence, surgical intervention was successfully accomplished. CLINICAL DISCUSSION Surgical repair was achieved by pseudoaneurysmectomy and utilizing an autologous Saphenous Vein graft. From the proximal side, a primary end-to-end anastomosis was accomplished between the veinous graft and the right Common Femoral Artery (CFA). Whereas from the distal side, a direct end-to-end anastomosis was completed between the right Superficial Femoral Artery and the veinous graft. CONCLUSION Arterial pseudoaneurysms constitute immensely rare vascular emergencies. The pediatric population is particularly vulnerable because of the rarity of occurrence of this pathology in children. Surgical intervention is the gold standard approach. Meticulous follow-up protocols ought to be carried-out to limit the possibility of recurrence. Documentation is the main building block in our profession. Physicians should possess high sense of clinical awareness when presented with such a pathology.
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Affiliation(s)
- Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria,Corresponding author at: Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria.
| | - Ahmad Shahrour
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria
| | - Okab Yahya
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria
| | - Hisham Hamzeh
- Department of Vascular Surgery, Al-Mouwasat University Hospital, Damascus, Syria
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Zhao B, Zhang J, Ma J, Huang M, Li J, Ma X. Comparison of three different treatment methods for traumatic and Iatrogenic peripheral artery pseudoaneurysms. Orthop Surg 2022; 14:1404-1412. [PMID: 35678135 PMCID: PMC9251284 DOI: 10.1111/os.13315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To compare the efficacy of open surgery (OS), endovascular interventions (EIs), and ultrasound‐guided thrombin injection (UGTI) for the treatment of peripheral arterial pseudoaneurysms (PAs). Methods From January 1, 2001, to February 10, 2021, 38 patients diagnosed with traumatic and iatrogenic PAs treated with OS, EI, and UGTI were retrospectively analyzed. There were 18 females and 20 males, with an age of 56.47 ± 14.08 years (range,17–87 years). Anesthesia modality, operation duration, blood transfusion, duration of hospital stay, primary and secondary success rates, and complication rate were used to evaluate the surgical outcomes. Results There were 11 cases under regional anesthesia and 4 under general anesthesia in OS group, 9 under regional anesthesia and 1 under general anesthesia in EI group, and no regional or general anesthesia was required in UGTI group. There was no significant differences between any two groups (χ2 = 39.80, p < 0.05). The blood tranfusion amount (units) were 3.6 ± 6.0, 0.8 ± 2.5, 0.0 ± 0.0 for OS, EI, and UGTI groups, respectively, with significant difference between OS and UGTI groups (F = 3.03, p < 0.05). The operation duration (minutes) of OS, EI, and UGTI groups were 80.0 ± 41.9, 56.0 ± 8.4, and 22.7 ± 5.3, respectively, with significant difference between any two groups (F = 15.69, p < 0.05). The duration of hospital stay (days) were 47.7 ± 39.0, 31.5 ± 17.6, and 16.3 ± 9.5, repectively, with significant difference between any two groups (F = 47.73, p < 0.05). The primary clinical success rates were 80% (12/15), 90% (9/10), and 92.3% (12/13) in OS,EI, and UGTI groups, respectively, with no significant difference between any two groups (χ2 = 0.34, p > 0.05). The secondary clinical success rates were 100% for all three groups. The overall complication rates of OS, EI, and UGTI groups were 20% (3/15), 10% (1/10), and 7.7% (1/13), respectively, with no significant difference between any two groups (χ2 = 1.00, p > 0.05). The infection rates were 13.3% (2/15), 10% (1/10), and 0% (0/13) in OS, EI, and UGTI groups respectively, with no significant difference between any two groups (χ2 = 1.80, p > 0.05). The reintervention rates were 6.7% (1/15), 0% (0/10), 7.7% (1/13) in OS, EI, and UGTI groups, respectively, with no significant difference between two groups (χ2 = 0.95, p > 0.05). Neuralgia was relieved in all patients. Conclusions OS, EI, and UGTI are efficacious and safe options for the treatment of appropriate patients with traumatic and iatrogenic PAs. UGTI would be considered as a first‐line therapy for this condotion.
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Affiliation(s)
- Baocheng Zhao
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinChina
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
| | - Jinli Zhang
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
| | - Jianxiong Ma
- Biomechanics Research DepartmentBiomechanics Research Institute Affiliated to Tianjin Hospital, Tianjin HospitalTianjinChina
| | - Mei Huang
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
| | - Jin Li
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
| | - Xinlong Ma
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinChina
- Department of Traumatic OrthopedicsTianjin HospitalTianjinChina
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Ozawa H, Ohki T, Kaneko K, Momose M, Hirayama S. Ultrasound-Guided Thrombin Injection for Postcatheterization Pseudoaneurysms and Its Extended Indications. Ann Vasc Dis 2022; 15:22-28. [PMID: 35432654 PMCID: PMC8958405 DOI: 10.3400/avd.oa.21-00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Ultrasound-guided thrombin injection (UGTI) is an option for the treatment of postcatheterization pseudoaneurysms. This method is less invasive and less time-consuming compared with other procedures since it can be performed without general anesthesia, skin incision, or occlusion of the artery. Herein, we report on the efficacy of UGTI for postcatheterization bleeding complications. Methods: Postcatheterization bleeding complications include postcatheterization pseudoaneurysm and failed hemostasis. In this study, failed hemostasis was defined as cases in which hemostasis could not be accomplished by 30 min of manual compression following sheath removal. A retrospective study of eight cases in which we performed UGTI for postcatheterization bleeding complications between July 2016 and June 2019 at our institution was performed to evaluate technical success and recurrence of pseudoaneurysm or rebleeding events. Results: Among these eight cases, there were three cases of pseudoaneurysm and five cases of failed hemostasis. In all cases, technical success was achieved without any complications such as distal embolism or allergic reaction. There were no recurrences of pseudoaneurysm or rebleeding events during an average follow-up of 5.25 months. Conclusion: We believe that UGTI is effective not only for postcatheterization pseudoaneurysms but also for failed hemostasis.
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Affiliation(s)
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
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AIUM Practice Parameter 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 2021; 40:E17-E24. [PMID: 33555645 DOI: 10.1002/jum.15643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
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Shetty GS, Kamath GD, Srinivasan P. Transvaginal ultrasound-guided direct thrombin injection for the treatment of intramyometrial pseudoaneurysm in a young female with uterine hemorrhage after failed uterine artery embolization. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:385-389. [PMID: 32929773 DOI: 10.1002/jcu.22919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/28/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
Uterine artery pseudoaneurysm is an uncommon but important cause of severe uterine bleeding in the postpartum or postsurgical setting. The standard treatment options are endovascular uterine artery embolization and bilateral surgical internal iliac artery ligation for uterus conservation or hysterectomy. We report the case of a young female with hemorrhage from an intramyometrial pseudoaneurysm following repeated curettage and hysteroscopic excision of retained products of conception. Uterus preservation was of priority, and the patient underwent uterine artery embolization; however, the pseudoaneurysm persisted due to ovarian artery collaterals. The pseudoaneurysm was subsequently treated with transvaginal ultrasound-guided direct thrombin injection. The case highlights the advantages and disadvantages of the treatment options in such clinically challenging cases emphasizing the seldom employed direct injection of thrombin for the treatment of pseudoaneurysms.
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Affiliation(s)
- Gurucharan S Shetty
- Department of Imaging & Interventional Radiology, Fortis Hospital and Cancer Institute, Bangalore, India
| | - Gayathri D Kamath
- Department of Obstetrics & Gynecology, Fortis Hospital and Cancer Institute, Bangalore, India
| | - Pradeep Srinivasan
- Department of Imaging & Interventional Radiology, Fortis Hospital and Cancer Institute, Bangalore, India
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13
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Saydam O, Serefli D, Engin AY, Atay M. Ultrasound-guided thrombin injection for treatment of iatrogenic femoral artery pseudoaneurysms compared with open surgery: first experiences from a single institution. Ann Surg Treat Res 2020; 98:270-276. [PMID: 32411632 PMCID: PMC7200607 DOI: 10.4174/astr.2020.98.5.270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/11/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The frequency of iatrogenic femoral artery pseudoaneurysm (FAP) diagnoses has recently increased due to the growing use of diagnostic and interventional procedures involving large diameter sheaths, as well as more potent anticoagulation procedures. In this study, we aimed to present our experience with ultrasound-guided thrombin injection (UGTI) in patients with iatrogenic FAP. Methods We studied patients with FAP who were under anticoagulant or antiplatelet therapies preoperatively, or who had received a loading dose during an interventional procedure. The outcomes of patients with FAP treated with UGTI were compared with those of patients who underwent open surgical repair for pseudoaneurysms. Results Among the 55 patients included in this study, 24 had UGTI while 31 had open surgery. The success rate was 95.8% when taking into consideration primary and secondary attempts. The mean duration of the procedure was shorter in patients with UGTI (10.1 ± 3.54 minutes) when compared with those who underwent open surgery (76.55 ± 26.74 minutes, P ≤ 0.001). In addition, the total complication frequency was significantly higher in the open surgery group (P = 0.005), as was their length of hospital stay (P < 0.001). Cost analysis showed significant differences between UGTI ($227.50 ± $82.90) and open surgery ($471.20 ± $437.60, P = 0.01). Conclusion We have found that UGTI is the safer and more effective choice of treatment in appropriate patients with FAP, as opposed to surgery.
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Affiliation(s)
- Onur Saydam
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Deniz Serefli
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - A Yaprak Engin
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Atay
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Ultrasound-guided thrombin injection versus ultrasound-guided compression repair in the treatment of post-catheterization femoral artery pseudoaneurysm: King Saud University Medical Center Experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:114-119. [PMID: 32175151 DOI: 10.5606/tgkdc.dergisi.2020.18814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/23/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate the effectiveness of ultrasound-guided thrombin injection versus ultrasound-guided compression repair in the management of iatrogenic femoral artery pseudoaneurysms. Methods Between June 2006 and December 2015, a total of 29 consecutive patients (15 males, 14 females; mean age 54 years; range 26 to 81 years) with a femoral pseudoaneurysm treated by ultrasound-guided thrombin injection were retrospectively analyzed. These patients were compared with a historical group of 36 patients (21 males, 15 females; mean age 44 years; range 32 to 65 years) who underwent ultrasound-guided compression repair between February 1999 and May 2006. Medical records and vascular laboratory findings of all patients were reviewed. Successful treatment was defined as complete cessation of flow into the false lumen with preservation of flow in the femoral artery. Results The ultrasound-guided thrombin injection showed a success rate of 100%, whereas ultrasound-guided compression repair had a success rate of 80.5%, which was possibly affected by anticoagulant therapy, hypertension, and an aneurysm size of >6 cm. However, none of these factors did not affect the success of thrombin injections. Conclusion Ultrasound-guided thrombin injection is a highly successful, easy to perform, accepted, and well-tolerated method by patients. It is more effective compared to compression therapy in patients with hypertension, large aneurysms, and who are on anticoagulant therapy.
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Weissmann J, Griton Y, Mahajna S, Ajaj M, Fajer S. Ultrasound-Guided Thrombin Injection for Iliopsoas Pseudoaneurysm. J Pediatr Intensive Care 2019; 8:187-190. [PMID: 31404356 PMCID: PMC6687481 DOI: 10.1055/s-0039-1683385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/01/2019] [Indexed: 10/27/2022] Open
Abstract
Bilateral iliopsoas hematoma is an uncommon phenomenon, which has been described in individuals receiving anticoagulation therapy. The hematoma is caused by bleeding of arteries to the muscle. In rare cases, pseudoaneurysms can also be formed. We present a case of an adolescent, with partial factor XI deficiency, who experienced a mild fall. Imaging studies revealed large bilateral iliopsoas hematomas and bilateral iliopsoas pseudoaneurysms. One pseudoaneurysm was demonstrated by angiography and was embolized with micro coils. The second, more persistent one, was sealed via ultrasound-guided thrombin injection, with excellent morphological and clinical results.
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Affiliation(s)
| | - Yigal Griton
- Interventional Radiology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Shadi Mahajna
- Vascular Surgery Unit, Meir Medical Center, Kfar Saba, Israel
| | - Moanis Ajaj
- Vascular Surgery Unit, Meir Medical Center, Kfar Saba, Israel
| | - Simone Fajer
- Vascular Surgery Unit, Meir Medical Center, Kfar Saba, Israel
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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: 9] [Impact Index Per Article: 1.8] [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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Abstract
RATIONALE Pseudoaneurysm, the most common complication of femoral artery catheterization, involves the formation of a space between the lumen and the surrounding fibrous tissue through the damaged arterial wall. In patients treated with antiplatelet and anticoagulant agents, the incidence of vascular complications increases with the increasing use of minimally invasive procedures. PATIENT CONCERNS We experienced 2 cases of procedure-induced pseudoaneurysms. A 79-year-old man with right hemiparesis visited our hospital. Brain magnetic resonance imaging showed acute left middle cerebral artery territory infarction and severe stenosis of the left proximal carotid artery. The patient was prescribed apixaban and underwent carotid stenting through the right femoral artery. Hematoma and tenderness were observed in the right inguinal region after the procedure. The hemoglobin level decreased from 16.9 g/dL to 9.4 g/dL. Another 78-year-old man with left common carotid artery stenosis was admitted. We performed stent implantation through the right femoral artery and administered aspirin and clopidogrel. After the procedure, hematoma and tenderness of the puncture site were observed. The hemoglobin level decreased from 14.5 g/dL to 10.9 g/dL. DIAGNOSIS Emergency computed tomography confirmed a pseudoaneurysm with a massive hematoma in the right inguinal area. The patients were diagnosed with infection-associated right pseudoaneurysm for which an emergency puncture site repair was performed. INTERVENTIONS We performed resection of pseudoaneurysm and repaired puncture site. OUTCOMES The hemoglobin level was stabilized postoperatively and vital sign remained stable. LESSONS Pseudoaneurysm is an important complication of femoral artery puncture. The use of a hemostatic device was not superior to manual compression, and the incidence of this complication was significantly higher in patients who received anticoagulant or antiplatelet agents. A pseudoaneurysm may cause a bad prognosis. Therefore, the early detection of pseudoaneurysm and immediate treatment after femoral arterial puncture are needed.
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Affiliation(s)
- Seung-Ho Jeon
- Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju
| | - Hyun Goo Kang
- Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, Republic of Korea
| | - Hong-Jin Kim
- Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju
| | - Man-Wook Seo
- Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, Republic of Korea
| | - Byoung-Soo Shin
- Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, Republic of Korea
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Das SS, Behera S, Das G, Patro BP. Compartment syndrome as a late presentation of brachial artery pseudoaneurysm following shaft of humerus fracture. BMJ Case Rep 2019; 12:12/3/e228012. [PMID: 30872341 DOI: 10.1136/bcr-2018-228012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Peripheral artery pseudoaneurysm is rare in upper extremities compared with lower extremities. Early diagnosis and prompt management are two cornerstones of successful outcomes in these cases. Delay can lead to limb and life-threatening complications. We present a case of compartment syndrome of upper limb as a sequel to pseudoaneurysm of brachial artery for which we had to do shoulder disarticulation. The patient recovered uneventfully.
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Affiliation(s)
- Sudhanshu Sekhar Das
- Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India
| | - Sudarsan Behera
- Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India
| | - Gurudip Das
- Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India
| | - Bishnu Prasad Patro
- Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India
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20
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Karmegaraj B, Prabhu N, Kappanayil M, Kumar RK. Percutaneous ultrasound guided thrombin injection for axillary artery pseudoaneurysm following stenting of the arterial duct in two infants: Case report with review of literature. Catheter Cardiovasc Interv 2019; 94:727-731. [PMID: 30851076 DOI: 10.1002/ccd.28174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/09/2019] [Accepted: 02/18/2019] [Indexed: 11/07/2022]
Abstract
We report pseudoaneurysm of the axillary artery following stenting of the arterial duct in two infants. They were both successfully managed by ultrasound guided thrombin injection with preservation of native arterial flow. We also review the relevant literature.
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Affiliation(s)
- Balaganesh Karmegaraj
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, India
| | - Nirmalkumar Prabhu
- Department of Radiodiagnosis, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, India
| | - Mahesh Kappanayil
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, India
| | - Raman K Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, India
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21
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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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Lewandowski P, Baran J, Maciejewski P, Budaj A. A novel technique for iatrogenic pseudoaneurysm obliteration with ultrasound-guided thrombin foam injection. VASA 2018; 48:181-184. [PMID: 30322345 DOI: 10.1024/0301-1526/a000751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Iatrogenic pseudoaneurysms (IPA) are treated with ultrasound-guided thrombin injections (UGTI). We describe a novel technique for IPA repair that applies UGTI with thrombin foam (UGTFI). METHODS AND RESULTS Successful obliteration of 6 IPAs (IPA without a neck, n = 5; with a neck, n = 1) in 6 patients (2 males, aged 68 ± 1 years, 4 females, aged 59 ± 11 years) was performed by using UGTFI. The dose of administered thrombin was 25-75 IU. No microembolization phenomenon and no serious clinical complications were observed. CONCLUSIONS Treatment of IPA with UGTFI may reduce the embolization rate, risk of IPA cavity thrombin leakage, required drug dose. Use of the thrombin foam could be the next step in the development of the UGTI, particularly in the treatment of IPA without a neck.
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Affiliation(s)
- Paweł Lewandowski
- 1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Jakub Baran
- 1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Paweł Maciejewski
- 1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Andrzej Budaj
- 1 Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
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Griviau L, Chevallier O, Marcelin C, Nakai M, Pescatori L, Galland C, Midulla M, Falvo N, Loffroy R. Percutaneous ultrasound-guided balloon-assisted embolization of iatrogenic femoral artery pseudoaneurysms with Glubran ®2 cyanoacrylate glue: safety, efficacy and outcomes. Quant Imaging Med Surg 2018; 8:796-803. [PMID: 30306060 DOI: 10.21037/qims.2018.09.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Femoral pseudoaneurysm (PA) is a frequent complication of arterial access for endovascular procedures. Surgery has traditionally been considered as the gold standard of therapy. We aimed to report our experience of percutaneous ultrasound (US)-guided balloon-assisted embolization with cyanoacrylate glue for the treatment of iatrogenic femoral PAs. Methods Retrospective two-center study of patients with femoral iatrogenic PAs treated by N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran®2 glue embolization between July 2013 and November 2017. All patients underwent contralateral arterial access with balloon placement of an appropriate size in front of the PA neck before glue/lipiodol embolization in a 1:1 ratio by percutaneous US-guided puncture of the aneurysmal sac under fluoroscopy control. Results Twenty-three patients (12 females, 11 males; median age, 79 years; range, 18-93 years) were included. Median PA size was 34 mm (range, 17-60 mm). The median time to treatment was 5 days (range, 1-30 days). Twenty patients (86.9%) were successfully treated by glue injection alone. The three remaining patients (13.1%) with persistent PA or associated arterial-venous fistula were immediately treated during the same procedure by additional stent-graft. Then, overall immediate and 1-month clinical success rates were 100%. No surgical conversion was necessary. No recurrence was reported during the median follow-up of 11 months (range, 2-73 months). Two (8.7%) puncture-related complications occurred at the contralateral arterial access site, which spontaneously resolved. No non-target glue embolization occurred. Conclusions US-guided balloon-assisted glue embolization is safe and effective to treat iatrogenic femoral PAs in most cases, offering complete exclusion of the PA and avoiding the morbidity of open surgery.
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Affiliation(s)
- Loïc Griviau
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Clément Marcelin
- Department of Diagnostic and Therapeutic Imaging, Pellegrin University Hospital, Bordeaux, France
| | - Motoki Nakai
- Department of Radiology, Wakayama Medical University, Wakayamashi, Japan
| | - Lorenzo Pescatori
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Christophe Galland
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
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Oversier LMR, Corten BJGA, Barten DG, Elshof JWM. Pseudoaneurysm of the superior lateral genicular artery following anterior cruciate ligament repair. Acta Chir Belg 2018; 118:258-263. [PMID: 28946810 DOI: 10.1080/00015458.2017.1371491] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pseudoaneurysm is a rare complication of surgery of the knee. The pathogenesis of false aneurysm involves partial arterial laceration, which allows hemorrhage into surrounding soft tissues that confine it. Although most cases in literature described pseudoaneurysms after total knee arthroplasty, it can be associated with arthroscopic knee surgery too. METHODS Here, we report an uncommon case of a false aneurysm of the superior lateral genicular artery following anterior cruciate ligament ligamentoplasty using an autograft semitendinosus-tendon. RESULTS Three weeks after anterior cruciate ligament repair, a 25-year old man presented with a painful swelling on his right knee. Computed tomography angiography demonstrated a false aneurysm of the superior lateral genicular artery. Ultrasound-guided percutaneous thrombin injection was performed to exclude the pseudoaneurysm, and the patient recovered well. CONCLUSION Pseudoaneurysm is an uncommon complication of surgery or trauma of the knee. Although most cases in literature described pseudoaneurysms after total knee arthroplasty, it can be associated with arthroscopic knee surgery too. Ultrasound-guided thrombin injection can be a valuable treatment option.
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Affiliation(s)
- L. M. R. Oversier
- Emergency Department, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - D. G. Barten
- Emergency Department, VieCuri Medical Centre, Venlo, The Netherlands
| | - J. W. M. Elshof
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
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25
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Freeman BM, Powell BC, Devane AM, Hale AL, Gandhi SS. Traumatic Aorto-Cisterna Chlyi Fistula with Treatment of Aortic Pseudoaneurysm with CT-Guided Thrombin Injection. Ann Vasc Surg 2018; 54:145.e11-145.e14. [PMID: 29778611 DOI: 10.1016/j.avsg.2018.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Only 3 cases of aorto-cisterna chyli fistula have been described in the literature but none with a resulting pseudoaneurysm (PSA). METHODS A 68-year-old man presented following a motor vehicle collision. Imaging revealed a retroperitoneal hematoma with enhancement of the cisterna chyli, representing an aortic to cisterna chyli fistula. Three days later, computed tomography angiography showed resolution of the fistula, but revealed a PSA. The patient underwent arteriography that confirmed the PSA, and then a computed tomography-guided thrombin injection was performed. Follow-up imaging showed resolution of the PSA. RESULTS Only 3 cases of aorto-cisterna chyli fistula have been described. We hypothesize that this fistula was caused from his L2 vertebral body fracture, which avulsed the lumbar artery and injured the cisterna chyli. The cisterna chyli provided an outflow tract for the aortic injury. We believe this type of fistula follows a benign clinical course. Aorto-cisterna chyli fistula is rare, and reports point to spontaneous resolution. Our case is unique in that the patient progressed from a fistula to a PSA. Options for treatment of this PSA include covered stent graft, open repair, coil embolization, or thrombin injection. CONCLUSIONS This case report describes an extremely rare diagnosis and the natural history of this aorto-cisterna chyli fistula. Furthermore, the resulting aortic PSA was successfully treated with computed tomography-guided thrombin injection, which in the appropriate setting, should be considered an acceptable option.
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Affiliation(s)
- Brian M Freeman
- Department of Surgery, Greenville Health System, Greenville, SC
| | | | | | - Allyson L Hale
- Department of Surgery, Greenville Health System, Greenville, SC
| | - Sagar S Gandhi
- Department of Surgery, Greenville Health System, Greenville, SC
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Chen G, Wu L, Zheng L, Ding L, Wong T, Zhang S, Yao Y. Combining Percutaneous Ultrasound-Guided Hematoma Aspiration and Compression Repair to Treat Femoral Artery Pseudoaneurysm after Cardiac Catheterization. Int Heart J 2018; 59:333-338. [PMID: 29563376 DOI: 10.1536/ihj.17-026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to prospectively evaluate the safety and efficacy of a new developed method that uses percutaneous ultrasound-guided hematoma aspiration followed by targeted localized manual compression for treatment of femoral artery pseudoaneurysm after cardiac catheterization, which obviates thrombin use, surgery, and long-time compression.From January 2007 to July 2014, 32 patients (17 women; mean age, 55.3 ± 11.5 years) out of 8,725 consecutive cases undergoing cardiac catheterization via femoral access developed one pseudoaneurysm each ranging in size from 21 × 11 mm to 72 × 39 mm. Under ultrasound guidance, blood within the pseudoaneurysm was aspirated percutaneously using an 18-gauge needle, while the pseudoaneurysm neck and a nearby site over the pseudoaneurysm were manually compressed for 15 min. All patients underwent repeat ultrasound examination 24 hours later.Of the 32 pseudoaneurysms, 31 were successfully occluded, and 1 recurred in a patient with coexisting arteriovenous fistula, yielding an overall success rate of 96.9% (31/32). No further recurrence or procedure related complications were observed. The treatment approach is unlike open surgical repair with hematoma evacuation and arterial defect suturing, in that it entails hematoma aspiration and feeding flow blockage at the pseudoaneurismal neck.In this preliminary experience, combining percutaneous ultrasound-guided hematoma aspiration and manual compression appears safe and effective in treating femoral artery pseudoaneurysms after catheterization and avoids thrombin use, long-time compression, and surgery.
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Affiliation(s)
- Gang Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Lingmin Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Lihui Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ligang Ding
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Tom Wong
- Heart Rhythm Centre, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
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Stone PA, AbuRahma AF, Hayes JD, Flaherty SK, Elmore MS, Lohan JA. Selective use of Duplex Ultrasound after Successful Thrombin Injection of Pseudoaneurysms. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431670502900202] [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
Introduction Duplex-guided thrombin injection (DGTI) has been shown to be a safe and efficacious initial treatment of iatrogenic arterial pseudoaneurysms. Postinjection follow-up duplex ultrasound examination has become the accepted standard of care despite 1) the use of intraprocedural ultrasonography to monitor successful thrombosis, 2) a low post-DGTI recurrence rate, and 3) the relatively high cost of ultrasonography. A retrospective study of DGTI at our institution was conducted to examine the necessity of routine duplex ultrasound after successful DGTI, along with a review of the relevant literature. Patient Population/Methods A retrospective review was conducted of 82 patients with iatrogenic arterial pseudoaneurysms (12 complex; 25.6%) treated with DGTI after initial diagnostic duplex ultrasonography. Immediate routine follow-up duplex ultrasound was performed on 71 of 82 cases (86.6%), whereas 11 patients received only clinical follow-up at the surgeon's discretion. Patient demographics, pseudoaneurysm anatomy, procedural details, outcomes, and complications were retrospectively documented and analyzed. Results From January 2002 to November 2003, 82 patients (59.8% women) underwent DGTI for pseudoaneurysm, with the majority located in the common femoral artery (48 of 82; 58.5%). Eighty pseudoaneurysms (97.6%) were treated with DGTI, with 78 (95.1%) being initially successful. Four of 78 (5%) follow-up examinations were judged to be of clinical significance: 2 of 78 patients (2.6%) became symptomatic and experienced pseudoaneurysm recurrence, whereas 2 of 78 patients were found to have an additional, previously undocumented, pseudoaneurysm. Three of these four resolved with a second injection, whereas one resolved without additional treatment. No thromboembolic, allergic, or infectious complications related to DGTI occurred. Conclusions In concert with the available literature, this cohort confirms that DGTI is a safe and effective treatment of iatrogenic arterial pseudoaneurysms with a low rate of recurrence, complication, and need for conversion to surgical intervention. DGTI should undoubtedly be the initial treatment of choice for pseudoaneurysms; however, follow-up duplex ultrasonography can be reserved for the clinically symptomatic patient.
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Affiliation(s)
| | - Ali F. AbuRahma
- West Virginia University–Charleston Division, Charleston, WV
| | - J. David Hayes
- West Virginia University–Charleston Division, Charleston, WV
| | - Sarah K. Flaherty
- Charleston Area Medical Center Health Education & Research Institute, Charleston, WV
| | | | - James A. Lohan
- West Virginia University–Charleston Division, Charleston, WV
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Delayed Traumatic Aortic Pseudoaneurysm Formation Causing Vertebral Body Erosion and Back Pain: Case Report and Literature Review. World Neurosurg 2018; 110:232-239. [DOI: 10.1016/j.wneu.2017.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/21/2022]
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Valesano JC, Schmitz JJ, Kurup AN, Schmit GD, Moynagh MR, Atwell TD, Lewis BD, Lee RA, Callstrom MR. Outcomes of Ultrasound-Guided Thrombin Injection of Nongroin Arterial Pseudoaneurysms. J Vasc Interv Radiol 2017; 28:1156-1160. [PMID: 28578990 DOI: 10.1016/j.jvir.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate success and complication rates of percutaneous ultrasound-guided thrombin injection of nongroin pseudoaneurysms (PSAs). MATERIALS AND METHODS Retrospective review of a prospectively maintained institutional database yielded 39 cases of arterial PSAs occurring at nongroin sites that were treated with percutaneous ultrasound-guided thrombin injection between 2000 and 2016 (average patient age 69.2 y ± 14.0). Of PSAs, 74.4% (29/39) arose in the upper extremities, and 92.3% (36/39) were iatrogenic. The brachial artery was the most commonly affected vessel (51.3% [20/39]), and arterial access was the most common cause (56.4% [22/39]). Average overall PSA size was 2.4 cm (range, 0.5-7.2 cm); average amount of thrombin injected was 320 IU (range, 50-2,000 IU). Technical success was defined as absence of flow within the PSA immediately after thrombin injection. Treatment success was defined as sustained thrombosis on follow-up imaging obtained at 1-3 days after treatment. RESULTS Technical and treatment success rates of thrombin injections were 100% (39/39) and 84.8% (28/33), respectively. Longer term follow-up imaging (average 71 d; range, 12-201 d) was available for 7 of the treatment successes with 100% (7/7) showing sustained thrombosis. Comparing treatment successes and failures, there was no significant difference in average PSA size (2.3 cm vs 2.0 cm, P = .51) or average amount of thrombin injected (360 IU vs 180 IU, P = .14). There were no complications. CONCLUSIONS Ultrasound-guided thrombin injection is a safe, efficacious treatment option for PSAs arising in nongroin locations.
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Affiliation(s)
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Grant D Schmit
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Bradley D Lewis
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Robert A Lee
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Matthew R Callstrom
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Abdelgabar A, d'Archambeau O, Maes J, Van den Brande F, Cools P, Rutsaert RR. Visceral artery pseudoaneurysms: two case reports and a review of the literature. J Med Case Rep 2017; 11:126. [PMID: 28472975 PMCID: PMC5418714 DOI: 10.1186/s13256-017-1291-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/05/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Visceral artery pseudoaneurysms are relatively rare but have a high mortality rate in case of rupture. Their detection in the last decades is rising due to an increased use of computed tomography and angiography. However, due to the nonspecific nature of the clinical symptoms and signs, diagnosis is often delayed or missed. We describe two cases of patients presenting with nonspecific abdominal complaints and anemia leading to a diagnosis of visceral pseudoaneurysm. Both cases are successfully treated with a different endovascular intervention. CASE PRESENTATION The first case is a 67-year-old Caucasian man presenting with diffuse abdominal pain, vomiting, diarrhea, and weight loss. Digital angiography showed a complex pseudoaneurysm of the superior mesenteric artery. The patient was treated with stent placement and selective embolization of the afferent branches. The second patient is a 78-year-old Caucasian man with a history of chronic pancreatitis admitted with epigastric pain, rectal bleeding and melena. Angiography showed a pseudoaneurysm of the gastroduodenal artery. The patient was successfully treated with coil embolization. CONCLUSIONS We report two cases of visceral pseudoaneurysms and review the literature concerning etiology, presentation, diagnosis, and treatment. Visceral artery pseudoaneurysms should be considered in the differential diagnosis of a patient with nonspecific abdominal symptoms. Diagnosis is often made with computed tomography or computed tomography angiography but digital angiography remains the gold standard. Treatment options include surgical, endovascular or percutaneous interventions. The choice of treatment is case specific.
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Affiliation(s)
- Amna Abdelgabar
- Department of Vascular and Thoracic Surgery, Sint Vincentius Hospital, Antwerp, Belgium.
| | | | - Joachim Maes
- Department of Radiology, Sint Augustinus Hospital, Antwerp, Belgium
| | - Filip Van den Brande
- Department of Vascular and Thoracic Surgery, Sint Vincentius Hospital, Antwerp, Belgium
| | - Peter Cools
- Department of General Surgery, Sint Vincentius Hospital, Antwerp, Belgium
| | - Roger R Rutsaert
- Department of Vascular and Thoracic Surgery, Sint Vincentius Hospital, Antwerp, Belgium
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Mishra A, Rao A, Pimpalwar Y. Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms. J Clin Diagn Res 2017; 11:TC04-TC06. [PMID: 28571227 DOI: 10.7860/jcdr/2017/25582.9512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/10/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Arterial pseudoaneurysms are well known iatrogenic complication of percutaneous angiographic or interventional vascular procedures. In the past, the definitive treatment option was open surgical repair which is a relatively invasive procedure. In the last few years, Ultrasound (US) guided percutaneous thrombin injection has been gaining popularity as definitive treatment of pseudoaneurysms. AIM To evaluate efficacy and safety of US guided percutaneous injection of thrombin for treatment of iatrogenic femoral pseudoanurysms at a tertiary care interventional radiological and cardiology centre. MATERIALS AND METHODS A retrospective analysis was conducted on 38 consecutive patients, diagnosed to have iatrogenic femoral artery pseudoaneurysms by Doppler study, in the period from Jan 2013 to Jun 2016. All these patients were treated by US guided percutaneous injection of thrombin solution inside the pseudoaneurysm sac till contents became echogenic and flow inside the pseudoaneurysm stopped completely. One month further follow up in all these patients was done. RESULTS The dose of thrombin injected varied from 200-1000 IU (mean 300 IU). Immediate thrombosis was seen in all the pseusdoaneurysms. Follow up at 24-48 hours showed complete thrombosis and regression of pseudoaneurysm in all the patients except one in whom a small residual sac was seen which thrombosed completely on second thrombin injection. Further follow up at one month showed regression of aneurysms in all the cases. No significant post procedural clinically significant complications were seen in any of the patients. CONCLUSION US guided percutaneous thrombin injection is a highly successful and safe procedure for the treatment of iatrogenic femoral pseudoaneurysms.
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Affiliation(s)
- Atul Mishra
- Interventional Radiologist, Department of Radiodiagnosis and Interventional Radiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Akhilesh Rao
- Radiologist, Department of Radiodiagnosis and Interventional Radiology, Command Hospital (CC), Lucknow, Uttar Pradesh, India
| | - Yayati Pimpalwar
- Radiologist, Department of Radiodiagnosis and Interventional Radiology, Command Hospital (CC), Lucknow, Uttar Pradesh, India
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Management of an Iatrogenic Pseudoaneurysm of the Superior Gluteal Artery by Percutaneous Ultrasound-Guided Thrombin Injection: A Case Report. Ann Vasc Surg 2017; 38:317.e9-317.e11. [DOI: 10.1016/j.avsg.2016.05.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/06/2016] [Accepted: 05/08/2016] [Indexed: 11/30/2022]
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Ultrasound-guided thrombin injection for treatment of superficial traumatic pseudoaneurysms and associated expanding hematomas: experience in five patients. J Trauma Manag Outcomes 2016; 10:4. [PMID: 26929774 PMCID: PMC4770383 DOI: 10.1186/s13032-016-0034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/16/2016] [Indexed: 11/24/2022]
Abstract
Background Angiography allows for excellent characterization and treatment of traumatic pseudoaneurysms. However, ultrasound-guided thrombin injection for pseudoaneurysm thrombosis allows for radiation-free treatment of superficial pseudoaneurysms and superficial expanding hematomas. Methods A retrospective review of 5 patient cases treated under this paradigm was performed following institutional review board approval. Outcomes following intervention were recorded and compared amongst the patient cohort. Results Ultrasound-guided closure of traumatic pseudoaneurysms allowed for reduced procedural times and procedural invasiveness. Conclusions As demonstrated by the following cases, ultrasound guided thrombin injection is a good method of primary treatment for superficial pseudoaneurysms, or as an alternative treatment in cases where transcatheter embolization fails.
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Abstract
Iatrogenic pseudoaneurysms will continue to be a problem associated with arterial cannulation procedures. With the increasing trend toward minimally invasive procedures, vascular surgeons, as well as interventionalists will be performing more cannulation procedures; hence we will be more involved in the management of this complication more frequently. Treatment trends and efforts aimed at preventing iatrogenic pseudoaneurysms have evolved over the past decade. This article reviews the history and available literature on the subject, in conjunction with the experience of a center that performs over 10,000 cannulation procedures annually.
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Affiliation(s)
- Patrick A Stone
- Vascular Surgery Department, University of South Florida College of Medicine, Tampa, FL, USA
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35
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Bush RL, Bianco CC, Lin PH, Lumsden AB. Endovascular Treatment of an Endoleak Causing Rupture of a Previously Bypassed Popliteal Aneurysm. Vasc Endovascular Surg 2016; 38:257-61. [PMID: 15181508 DOI: 10.1177/153857440403800310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Enlargement of a previously bypassed popliteal aneurysm is rare. However, the possibility exists for persistent aneurysm expansion via geniculate collaterals. The authors report herein a patient who underwent successful endovascular treatment of a ruptured popliteal aneurysm that had been previously bypassed and presumably excluded.
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Affiliation(s)
- Ruth L Bush
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Mohammad F, Kabbani L, Lin J, Karamanos E, Esmael F, Shepard A. Post-procedural pseudoaneurysms: Single-center experience. Vascular 2016; 25:178-183. [PMID: 27370682 DOI: 10.1177/1708538116654837] [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] [Indexed: 11/16/2022]
Abstract
Objectives Pseudoaneurysms are a well-recognized complication of percutaneous angiographic procedures. Ultrasound-guided thrombin injection is currently the preferred treatment modality. This study was undertaken to evaluate our experience with the management of post-procedure pseudoaneurysms. Methods A retrospective study was undertaken of all patients who developed a post-procedure pseudoaneurysm between March 2004 and January 2013. Data were obtained from our prospectively maintained non-invasive vascular laboratory data base. Results Overall, 167 patients (80 men) with post-procedure pseudoaneurysms were identified. The mean age was 66 years. Post-procedure pseudoaneurysms developed following diagnostic coronary angiography (38%), coronary angioplasty (37%), peripheral vascular interventions (14.7%), or other access procedures (7.6%). Mean post-procedure pseudoaneurysm diameter was 2.8 ± 1.8 cm. One hundred forty-two post-procedure pseudoaneurysms were injected with thrombin under ultrasound guidance. Primary success rate was 93.5%. There were 12 (8.5%) procedural failures of which seven (58%) responded to reinjection, three (25%) required operative management, one was treated with ultrasound-guided compression, and one (8.3%) was simply observed. On multivariate analysis, failures were associated with increased aneurysm diameter ( p = 0.006; odds ratio 2.23, 95% CI 1.25 to 3.96), end-stage renal disease ( p = 0.013; odds ratio 1.15, 95% CI 1.09 to 1.78) and superficial femoral artery aneurysm origin ( p = 0.031; odds ratio 0.20, 95% CI 0.04 to 0.86). There were two episodes of thrombus formation in the femoral artery; one resolved with anticoagulation alone, and the other required thrombectomy. Conclusions Percutaneous ultrasound-guided thrombin injection is an effective and safe method for managing post-procedure pseudoaneurysms. Failure rates are low and associated with large aneurysm size, superficial femoral artery origin and end-stage renal disease.
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Affiliation(s)
- Farah Mohammad
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Loay Kabbani
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Judith Lin
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Efstathios Karamanos
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Fatema Esmael
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Alexander Shepard
- Division of General and Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
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Papadakis M, Zirngibl H, Floros N. Iatrogenic Femoral Pseudoaneurysm and Secondary Ipsilateral Deep Vein Thrombosis: An Indication for Early Surgical Exploration. Ann Vasc Surg 2016; 34:269.e13-5. [PMID: 27174354 DOI: 10.1016/j.avsg.2015.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/27/2015] [Accepted: 12/03/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Marios Papadakis
- Department of Vascular Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany.
| | - Hubert Zirngibl
- Department of Vascular Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany
| | - Nikolaos Floros
- Department of Vascular Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany
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38
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Kontopodis N, Tsetis D, Tavlas E, Dedes A, Ioannou C. Ultrasound Guided Compression Versus Ultrasound Guided Thrombin Injection for the Treatment of Post-Catheterization Femoral Pseudoaneurysms: Systematic Review and Meta-Analysis of Comparative Studies. Eur J Vasc Endovasc Surg 2016; 51:815-23. [DOI: 10.1016/j.ejvs.2016.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/11/2016] [Indexed: 12/20/2022]
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Hackl G, Gary T, Belaj K, Hafner F, Rief P, Deutschmann H, Brodmann M. Exoseal for puncture site closure after antegrade procedures in peripheral arterial disease patients. Diagn Interv Radiol 2015; 20:426-31. [PMID: 25010369 DOI: 10.5152/dir.2014.14002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Exoseal is a vascular clo-sure device consisting of a plug applier and a bio-absorbent polyglycolic acid plug available in sizes 5 F, 6 F, and 7 F. In this study, we aimed to evaluate the effectiveness and safety of the Exoseal vascular closure device (Cordis Corporation, Bridgewater, New Jersey, USA) for puncture site closure after antegrade endovascular procedures in peripheral arterial occlusive disease (PAOD) patients. MATERIALS AND METHODS In this retrospective study, a total of 168 consecutive patients who underwent an interventional procedure due to PAOD, were included. In each case, an antegrade peripheral endovascular procedure was performed via the common femoral artery using the Seldinger technique, and Exoseal 5 F, 6 F, or 7 F was used for access site closure. The primary endpoint was a technically successful application of Exoseal. All complications at the access site within 24 hours were registered as a secondary endpoint. RESULTS In a group of 168 patients (64.9% men, average age 71.9±11.9 years), the technical application of Exoseal was successful in 166 patients (98.8%). Within the first 24 hours after the procedure, 12 complications (7.2%) were recorded including, three pseudoaneurysms (1.8%) and nine hematomas (5.4%). None of the complications required surgical intervention. CONCLUSION Exoseal is a safe and effective device with high technical success and acceptable complication rates for access site closure after antegrade peripheral endovascular procedures.
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Affiliation(s)
- Gerald Hackl
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Styria, Austria.
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40
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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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Cauchi MP, Robb PM, Zemple RP, Ball TC. Radial artery pseudoaneurysm: a simplified treatment method. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1505-1509. [PMID: 25063417 DOI: 10.7863/ultra.33.8.1505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band (Terumo Medical Corporation, Somerset, NJ) have been variable and anecdotal, without objective measurements of adequate compression, making this technique prone to failure. In this report, we present an efficient, safe, and noninvasive management protocol using a pulse oximeter and the TR Band for treatment of radial artery pseudoaneurysms that is cost-effective and efficient and ensures correction without occlusion of the radial artery.
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Affiliation(s)
- Matthew P Cauchi
- Departments of Internal Medicine (M.P.C., P.M.R.), Emergency Medicine (R.P.Z.), and Cardiology (T.C.B.), Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia USA
| | - Paul M Robb
- Departments of Internal Medicine (M.P.C., P.M.R.), Emergency Medicine (R.P.Z.), and Cardiology (T.C.B.), Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia USA.
| | - Robert P Zemple
- Departments of Internal Medicine (M.P.C., P.M.R.), Emergency Medicine (R.P.Z.), and Cardiology (T.C.B.), Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia USA
| | - Timothy C Ball
- Departments of Internal Medicine (M.P.C., P.M.R.), Emergency Medicine (R.P.Z.), and Cardiology (T.C.B.), Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia USA
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Ultrasound-guided percutaneous thrombin injection of iatrogenic upper extremity pseudoaneurysms. J Vasc Surg 2014; 59:1664-9. [DOI: 10.1016/j.jvs.2014.01.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/10/2014] [Accepted: 01/11/2014] [Indexed: 11/18/2022]
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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 2014; 33:1111-1121. [PMID: 24866622 DOI: 10.7863/ultra.33.6.1111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Vergaro G, Emdin M, Del Corso A. Correction of procedural arterial pseudoaneurysms: established and novel procedures. Expert Rev Cardiovasc Ther 2014; 12:843-50. [DOI: 10.1586/14779072.2014.923308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aziz A, Green A, Maskova J, Rajagopalan S, Bachoo P. Pseudoaneurysm of the sural artery: a rare complication of lower limb angioplasty. Scott Med J 2014; 59:e7-e10. [PMID: 24682104 DOI: 10.1177/0036933014530056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Percutaneous transluminal angioplasty (PTA) is a common therapeutic option for the treatment of peripheral vascular disease. Pseudoaneurysm at the puncture site is a well-documented complication in patients. CASE PRESENTATION This case report describes a patient who presented to hospital several days following a left superficial femoral and popliteal artery PTA with lower limb pain and swelling. The working diagnosis included a deep vein thrombosis based on the Wells criteria. However, a combination of a duplex scan and computed tomography angiography confirmed a clinically rare occurrence of pseudoaneurysm of the sural artery, a branch of the popliteal artery. This was managed successfully with a thrombin injection, leading to complete resolution of the patient's symptoms. CONCLUSION This case highlights the importance of the technical aspects of performing a PTA. We believe that the guide-wire position was not confirmed to be completely in the popliteal artery upon inflation of the balloon.
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Affiliation(s)
- Abdul Aziz
- Core Surgical Trainee (CT2), Queens Medical Centre, Nottingham, UK
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Ladeira FN, Quintella AHDS, Carvalhido LT, Rezende LCDA, Abreu LSBD, Diniz PC, Pereira FL. Posttraumatic pseudoaneurysm of medial plantar artery in a child: treatment with percutaneous thrombin injection. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pseudoaneurysms of the medial plantar artery are rare. The authors describe a case of a pseudoaneurysm of the medial plantar artery of a child who had suffered a penetrating laceration injury. Diagnosis can be confirmed using Doppler ultrasound and magnetic resonance angiography. As an alternative to the conventional surgery technique, percutaneous Doppler ultrasound-guided thrombin injection is a safe and effective treatment.
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Ferramosca E, Serra C, Di Felice A, Mandreoli M, Brunocilla E, Santoro A. Ultrasound-guided trans-hepatic embolization of a renal artery pseudoaneurysm in a patient with acquired solitary kidney and with chronic renal failure secondary to phenacetin abuse. J Ultrasound 2014; 17:65-9. [PMID: 24616752 DOI: 10.1007/s40477-014-0063-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022] Open
Abstract
A patient with a pseudoaneurysm of the right renal artery underwent treatment with percutaneous approach. No complications were observed. Based on the experience described in this report, a percutaneous ultrasound guided approach can be proposed in selected patients. Renal insufficiency and allergic reactions are potential contraindications to angiography with conventional ionic iodinated contrast dye in patients who need endovascular stent-graft placement. Real-time contrast-enhanced ultrasound (CEUS) guided endovascular procedures may provide an alternative to overcome these limitations. We report an endovascular renal artery repair in a solitary kidney patient with an asymptomatic infrarenal aortic aneurysm and renal insufficiency due to phenacetin abuse. The precise placement of the stent-graft was performed with CEUS and intraprocedural angiographic fluoroscopy without the use of any nephrotoxic contrast dye. During follow-up, CEUS was used to exclude endoleaks, stent-graft failure or malposition.
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Affiliation(s)
- Emiliana Ferramosca
- Division of Nephrology, Dialysis and Hypertension, S. Orsola-Malpighi Hospital, Via P.Palagi #9, 40138 Bologna, Italy
| | - Carla Serra
- Ultrasound Section, Department of Internal Medicine and Gastroenterology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Antonio Di Felice
- Division of Nephrology, Dialysis and Hypertension, S. Orsola-Malpighi Hospital, Via P.Palagi #9, 40138 Bologna, Italy
| | - Marcora Mandreoli
- Division of Nephrology, Dialysis and Hypertension, S. Orsola-Malpighi Hospital, Via P.Palagi #9, 40138 Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Antonio Santoro
- Division of Nephrology, Dialysis and Hypertension, S. Orsola-Malpighi Hospital, Via P.Palagi #9, 40138 Bologna, Italy
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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: 3] [Impact Index Per Article: 0.3] [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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