Ultrasound Assessment of Postprocedural Arterial Pseudoaneurysms: Techniques, Clinical Implications, and Emergency Department Integration

Point-of-Care Ultrasound for the Detection of Vascular Access Site Complications-The ULTRASITCOM Study

Background

Recent technological advancements have expanded access to ultrasound technology. Invasive cardiac procedures come with risks of vascular access complications, necessitating efficient detection methods for dangerous complications such as pseudoaneurysms. Current clinical practice has relied on physical examination, and often requires formal diagnostic imaging to diagnose these complications. The ULTRAsound Assessment of Access SITe COMplications study assessed the diagnostic accuracy of point-of-care ultrasound (POCUS) as an adjunct to physical examination for the detection of pseudoaneurysms following invasive cardiac procedures.

Methods

We conducted a single-center study that enrolled patients who underwent invasive cardiovascular procedures with suspected access site complications. Cardiology fellows were trained on the use of POCUS by a radiologist with expertise in vascular imaging. The primary outcome focused on the diagnostic odds ratio (DOR) of combined clinical and POCUS assessments compared to Doppler ultrasound or computed tomography.

Results

Among 111 participants, most were female (59.5%), with a mean age of 72.2 years, and with transfemoral access being most prevalent (67.6%). A total of 15 participants were found to have a pseudoaneurysm on formal diagnostic imaging. The combined clinical and POCUS assessments were highly sensitive and demonstrated superior DOR for detecting pseudoaneurysms compared to the physical examination alone (DOR 42.6 [95% CI, 34.6-50.6] vs 15.6 [95% CI, 11.7-19.5]; P < .01).

Conclusions

Point-of-care ultrasound is a highly sensitive tool for detecting pseudoaneurysms following invasive cardiovascular procedures. These findings suggest the potential integration of POCUS into routine practice, which could result in timely complication identification and management, thereby improving patient outcomes and reducing health care costs.

Radiological diagnosis and management of postlaparoscopic cholecystectomy right hepatic arterial pseudoaneurysm: A case report

Injuries to blood vessels occur in 0.8% of the cases following laparoscopic cholecystectomy. They may result from direct penetration while insertion of trocar or by thermal injury (electrocautery). Pseudoaneurysm of hepatic artery is a rare occurrence. It is a serious complication following acute or chronic injuries to hepatic artery, with only 0.06% to 0.6% of the cases being reported. Endovascular embolization is usually the first line treatment in the management of pseudoaneurysm of hepatic artery with high success rate. Surgical intervention should be considered if the embolization fails, pseudoaneurysm are infected or other vascular structures are compressed. Our case highlights a 48-year-old male presenting with complaints of pain abdomen and jaundice later diagnosed to be a case of pseudoaneurysm of right hepatic artery and was successfully managed with angiographic embolization, which is the first line of management.

Mucocutaneous Manifestations of Recreational Drug Use

Recreational drug use is increasingly common in the dermatology patient population and is often associated with both general and specific mucocutaneous manifestations. Signs of substance use disorder may include changes to general appearance, skin, and mucosal findings associated with particular routes of drug administration (injection, insufflation, or inhalation) or findings specific to a particular drug. In this review article, we provide an overview of the mucocutaneous manifestations of illicit drug use including cocaine, methamphetamine, heroin, hallucinogens, marijuana, and common adulterants to facilitate the identification and improved care of these patients with the goal being to connect this patient population with appropriate resources for treatment.