The distinction between femoral artery pseudoaneurysms and other causes of groin masses: value of duplex Doppler sonography

With the increasing use of percutaneous transfemoral coronary angioplasty in conjunction with thrombolytic as well as anticoagulant therapy, the sonographic evaluation of groin masses, with particular emphasis on differentiating pseudoaneurysms from hematomas and other abnormalities, has become more common. Seventy-three sonograms of the groin in 60 patients (65 different groins) were reviewed retrospectively to determine the accuracy of duplex Doppler sonography in distinguishing femoral artery pseudoaneurysm (a surgical condition) from other causes of groin masses (e.g., hematomas) that are generally treated conservatively. Nineteen cases of pseudoaneurysm, 19 cases of hematoma, and 27 other conditions were studied. Of the 73 sonograms performed, 53 included duplex Doppler studies; one Doppler study was false-negative and two were possibly false-positive. The sensitivity, specificity, and accuracy of duplex Doppler sonography in the detection of femoral artery pseudoaneurysm was 95 +/- 5.8%, 94 +/- 6.4%, and 94 +/- 6.4%, respectively (95% confidence limit). We conclude that duplex Doppler sonography is of value in the differential diagnosis of groin masses.     

Spontaneous healing of cervical pseudoaneurysm in vertebral artery dissection under anticoagulant therapy

We report a 41-year-old woman with embolic stroke of the mid-pons attributed to embolism from vertebral artery dissection. Angiography revealed an occluded artery on one side and an incidental pseudoaneurysm of the midcervical portion of the vertebral artery on the other. After 3 months of warfarin therapy control angiography showed complete occlusion of the pseudoaneurysm. We discuss therapeutic choices and review the literature. Received: 3 January 1997 Accepted: 26 January 1997     

Superior Mesenteric Artery Stent-graft Placement in a Patient with Pseudoaneurysm Developing from a Pancreatic Pseudocyst

Pseudoaneurysm is a relatively rare but serious complication of pancreatitis which is often fatal. We report successful stent-graft placement in the superior mesenteric artery in a 45-year-old man with a pancreatic pseudocyst that grew during therapy for chronic pancreatitis and developed into a pseudoaneurysm. After a stent graft was inserted in the superior mesenteric artery, the pseudoaneurysm disappeared and no further complications developed. Stent-graft placement was considered to be a useful therapy for pseudoaneurysms in the superior mesenteric arterial region.     

Haemosuccus pancreaticus: treatment by arterial embolization

AIM: Haemosuccus pancreaticus is bleeding into the pancreatic duct from a peripancreatic artery. This condition most commonly follows pseudoaneurysm formation secondary to acute or chronic pancreatitis. It is a rare disorder, challenging in both diagnosis and therapy. We present an eight-year experience of managing these patients using endovascular embolization as the primary therapy. MATERIALS AND METHODS: We retrospectively reviewed the imaging, laboratory results and clinical notes of the five patients who presented to this institution between 1991-1999 with gastrointestinal bleeding subsequently found to be haemosuccus pancreaticus. RESULTS: There were four men and one women aged 38-75 years. All had a history of gastrointestinal haemorrhage and had acute (n=1) or chronic pancreatitis with a complicating pseudoaneurysm. All underwent embolization as the primary therapy for the pseudoaneurysm. There was immediate technical success in all cases without major complication. No patient required operative surgery for the pseudoaneurysm. Follow-up ranged from 18 months to 7 years. One patient died four years after embolization due to hepatic failure but the other four remain well without further gastrointestinal bleeding. CONCLUSION: Endovascular embolization is an effective and safe treatment for haemosuccus pancreaticus.     

股动脉假性动脉瘤彩色多普勒超声诊断及监测分析

目的：探讨彩色多普勒超声对股动脉假性动脉瘤诊断及监测疗效的价值。方法：经股动脉穿刺行冠状动脉介入术后发生股动脉假性动脉瘤37例,包括冠状动脉造影术后30例,冠状动脉支架置入术后7例,所有患者都用高频彩色多普勒超声诊断。在超声监控下,探头垂直加压压迫假性动脉瘤通道或破口直至内无血流通过。压迫失败后在超声引导下瘤腔内注射凝血酶,24h、1个月后复查超声。结果：37例中有27例一次性压迫2h后假性动脉瘤瘤腔闭合;6例一次压迫2h后超声显示瘤腔明显变小,动脉与瘤腔仍有少许血流相通,再次压迫2h后瘤腔闭合;4例压迫2次失败后在超声引导下瘤腔内注射凝血酶,其中3例取得较满意的效果,1例经验不足失败。结论：彩色多普勒超声诊断股动脉假性动脉瘤准确、简便、无创。且可在超声引导下行安全无创治疗。     

介入治疗在腹部外科术后消化道大出血中的应用价值

目的确定介入治疗在腹部外科术后消化道大出血中的应用价值。方法回顾性分析11例腹部外科手术后急性消化道大出血并经内科保守治疗无效而介入治疗的病例,总结其DSA结果及介入治疗价值。结果11例腹部外科术后消化道出血患者中DSA发现胃左动脉出血1例,胃十二指肠动脉假性动脉瘤4例,肝动脉假性动脉瘤2例,脾动脉假性动脉瘤1例,肠系膜下动脉分支血管感染性假性动脉瘤1例,肠系膜上动脉小分支血管出血2例。结论介入治疗是治疗腹部外科术后消化道大出血的有效方法。     

Percutaneous Stent-Graft Repair of a Mycotic Pulmonary Artery Pseudoaneurysm

Ruptured mycotic pulmonary pseudoaneurysm is a lethal complication. Emergent surgical repair is usually recommended, but still associated with a high mortality rate. We present a patient in whom mycotic pulmonary pseudoaneurysm was a complication after surgical lobectomy 2 weeks earlier. This patient had suffered from repeated massive hemoptysis. After emergent surgical repair of the ruptured pulmonary artery stump, another episode of massive hemorrhage occurred. The pulmonary arteriogram revealed a segmental stenosis and a large, wide-necked, lobulated pseudoaneurysm at the left proximal pulmonary artery. We deployed a balloon-expandable stent-graft (48 mm in length mounted on a 12 mm × 40 mm angioplasty balloon) across the stenotic segment and the neck of the pulmonary pseudoaneurysm. Hemostasis was achieved immediately and, under a 4-week antibiotic treatment, patient was transferred to a local hospital for medical care. This case report demonstrates the benefit of minimally invasive endovascular therapy in a critically ill patient. A literature review of the etiology and management of mycotic pulmonary pseudoaneurysm is included.     

Transcatheter embolization therapy of pseudoaneurysms in patients with chronic pancreatitis

Chronic pancreatitis is known to cause vascular disorders including pseudoaneurysm of peripancreatic arteries. Although the incidence of pseudoaneurysms due to pancreatitis detected by angiography has been reported as high as 10% in western literature, they are still considered rare in Japan. We reported two cases of pseudoaneurysm caused by chronic pancreatitis, one in splenic artery and the other in gastroduodenal artery, successfully treated by embolization. The embolizations were performed by occluding proximal splenic artery for splenic arterial aneurysm and gastroduodenal artery distal and proximal to the orifice for the aneurysm of gastroduodenal artery with stainless steel coils. Since the surgical therapy has high mortality rate, we consider transcatheter embolization is the treatment of choice for pseudoaneurysms caused by chronic pancreatitis.     

Treatment of Secondary Stent-Graft Collapse After Endovascular Stent-Grafting for Iliac Artery Pseudoaneurysms

We report the case of a patient who developed an asymptomatic pseudoaneurysm in the left external iliac artery after transplant nephrectomy. The pseudoaneurysm most probably arose as a suture aneurysm from the external iliac artery after removal of the graft renal artery. Obviously we can not exclude the possibility it was a true aneurysm, although this seems much less likely. The pseudoaneurysm was detected during a routine CT scan and was treated interventionally with a stent-graft. One month later the asymptomatic patient underwent a vascular ultrasound examination including color Doppler, power Doppler, and B-flow as a routine control. An endoleak with collapse of the stent-graft was diagnosed. There was no evidence of stent infection. At a reintervention, the pseudoaneurysm was successfully treated using two uncovered Palmaz stents at the proximal and distal edge of the stent graft. Peri- and post-interventional ultrasound and CT angiography confirmed the exclusion of the aneurysm without an endoleak.     

外伤性颈内动脉动脉瘤的介入治疗

目的：探讨外伤性颈内动脉动脉瘤介入治疗技术。方法：回顾性分析4例颈内动脉假性动脉瘤,1例蛇形动脉瘤,1例颈内动脉颈段巨大动脉瘤（直径〉25mm）,1例颈内动脉海绵窦瘘并发假性动脉瘤的介入治疗,其中后者采用可脱性球囊、带膜血管内支架介入治疗的方法。结果：5例一次性闭塞颈内动脉,1例颈内动脉颈段的巨大动脉瘤行带膜内支架治疗,保持了颈内动脉通畅,旷置了动脉瘤。另1例海绵窦的假性动脉瘤行球囊栓塞时,球囊滑入假性动脉瘤腔,术中出现鼻腔大出血,经抢救治疗后二次行球囊栓塞闭塞颈内动脉。结论：外伤性颈内动脉动脉瘤的介入治疗效果好、风险小、微创、并发症少。     

Delayed femoral vein thrombosis after ultrasound-guided thrombin injection of a postcatheterization pseudoaneurysm

Ultrasound-guided thrombin injection is a highly effective therapy for postcatheterization pseudoaneurysm. Despite a very low complication rate, a number of severe arterial thrombotic events have been reported. We present an unusual case of acute femoral vein thrombosis occurring several hours after successful treatment of femoral artery pseudoaneurysm by ultrasound-guided thrombin injection. Pathophysiologic mechanisms are discussed. This case highlights the potential hazards of instilling such a powerful thrombogenic substance in the immediate vicinity of other vascular structures.     

Seudoaneurisma de la cola pancreática: tratamiento percutáneo mediante inyección de trombina

Visceral artery pseudoaneurysms secondary to acute and/or chronic pancreatitis are a relatively common and potentially serious complication. Endovascular techniques are the most currently accepted techniques, given the higher morbidity-mortality of surgery. The thrombosis of the pseudoaneurysm using an ultrasound-guided percutaneous thrombin injection is emerging as a useful option in those cases in which endovascular embolisation is not possible. We present the case of a patient with a pseudoaneurysm of the transverse pancreatic artery secondary to chronic pancreatitis, and successfully treated by administering percutaneous thrombin.     

Massive hemoperitoneum due to ruptured inferior phrenic artery pseudoaneurysm after blunt trauma

There had been no previous reports of ruptured pseudoaneurysm of inferior phrenic artery shortly after blunt abdominal trauma. Traumatic arterial pseudoaneurysms are either iatrogenic or the result of penetrating injuries and one of the sequelae of trauma. Post-traumatic pseudoaneurysm develops at varying time intervals after the initial insult. To our knowledge, this is the first report of massive hemoperitoneum caused by ruptured inferior phrenic artery pseudoaneurysm after blunt trauma. Pseudoaneurysm of inferior phrenic artery in patient with diaphragm injury is potentially a life-threatening condition and requires urgent management. Diagnosis of ruptured inferior phrenic artery pseudoaneurysm is based on clinical assessment combined with radiological investigations. We report a case of ruptured left inferior phrenic artery pseudoaneurysm as one aspect of massive hemoperitoneum caused by blunt abdominal trauma.     

Pseudoaneurysm embolization and vasopressin infusion for lower gastrointestinal bleeding due to recurrence of urinary bladder carcinoma

We report a case that was successfully treated for massive lower gastrointestinal (LGI) bleeding due to a recurrent urinary bladder carcinoma. Treatment consisted of combination therapy including embolization of an inferior gluteal artery (IGA) pseudoaneurysm and low-dose arterial vasopressin infusion via a sigmoid artery (SA). A 57-year-old man presented with life-threatening sudden, massive LGI bleeding due to an obturator lymph node (LN) metastasis from a urinary bladder carcinoma. Computed tomography showed that the LN recurrence had invaded all the way to the sigmoid colon, and there was a pseudoaneurysm with extravasation inside the recurrence. An angiogram revealed a left IGA pseudoaneurysm. We therefore excluded the pseudoaneurysm by embolization with microcoils. Following this treatment the bleeding decreased, but intermittent LGI bleeding continued. Endoscopic examination showed the tumor with a huge ulcer inside the colonic lumen, and continuous oozing was confirmed. A second angiogram showed no recurrence of the IGA pseudoaneurysm and no apparent findings of bleeding. Then a 3F microcatheter was placed in the SA selectively using a coaxial catheter system, and vasopressin was infused at a rate 0.05 U/min for 12 h. Bleeding completely ceased 2 days later. There were no signs of ischemic gastrointestinal complications. Massive LGI bleeding has not recurred in 5 months.     

Pseudoaneurysm: a complication of faulty technique in femoral arterial puncture

Pseudoaneurysm is a well-documented but rare complication of retrograde femoral arterial puncture. We present six patients in whom pseudoaneurysm complicated this procedure. The pseudoaneurysm arose from the superficial femoral artery in five patients and from the profunda femoris artery in one. An arteriovenous fistula also arose from the superficial femoral artery in one patient. In no patient did the pseudoaneurysm arise from the common femoral artery. Two mechanisms are postulated as to why pseudoaneurysms rarely complicate puncture of the common femoral artery.     

Pseudoaneurysm and renal arteriovenous fistula after nephrectomy: two cases treated by transcatheter coil embolization

Pseudoaneurysms and arteriovenous fistulas of renal arteries are rare clinical lesions. Invasive renal procedures may lead to pseudoaneurysm or arteriovenous fistulas (AVFs). We report two pseudoaneurysms and arteriovenous fistula cases that were treated by transcatheter embolization with metallic coils. The first case is left main renal artery pseudoaneurysm after nephrectomy in a patient with a solid renal tumor. The second case is right main renal artery AVF with giant pseudoaneurysm after both gunshot injury and nephrectomy. On the basis of color Doppler sonography and computed tomography (CT) findings, cases were diagnosed as pseudoaneurysm after nefrectomy. Contrast-enhanced CT scans showed a hyperdense area within the hematoma consistent with pseudoaneurysm. Endovascular treatment with coil embolization succeeds to total occlusion in renal artery pseudoaneurysm. Delayed hemorrhage related to postnephrectomy may be life-threatening conditions because of diagnostic difficulties. AVF and pseudoaneurysm can be treated safely and successfully by transcatheter arterial embolization.     

A case of iatrogenic pseudoaneurysm of the pulmonary artery induced by a Swan-Ganz catheter

We report a case of iatrogenic pseudoaneurysm of the right pulmonary artery induced by a Swan-Ganz (SG) catheter. An SG catheter was inserted to the pulmonary artery before the esophageal surgery. Chest radiograph after the surgery showed a nodule in the right lower lung field. Based on the retrospective review of serial chest radiographies after SG catheter placement, we suspected iatrogenic pseudoaneurysm of the pulmonary artery caused by over-insertion of the catheter tip. Contrast-enhanced CT showed the nodular shadow with eccentric and marked enhancement continuing right A4b. We diagnosed a pseudoaneurysm of the pulmonary artery. The nodular shadow resolved spontaneously over a 2-month period.     

Liver abscess associated with hepatic artery pseudoaneurysm with arteriovenous fistula: imaging and interventional management

Hepatic artery pseudoaneurysm is an infrequently encountered entity that is usually seen secondary to trauma or surgical procedures. The clinical presentation is often due to complications such as massive intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm into the biliary tree or peritoneal cavity, respectively. Hepatic artery pseudoaneurysm, associated with a liver abscess, has very rarely been described in the literature. We present the imaging features of a case of liver abscess associated with a hepatic artery pseudoaneurysm and complicated by rupture and formation of an arteriovenous fistula. The case was successfully managed by percutaneous endovascular embolization. The association between a hepatic artery pseudoaneurysm and a liver abscess must not be overlooked, bearing in mind the potentially fatal associated complications which can be averted or treated by timely intervention.     

Hepatic artery pseudoaneurysms in adult living-donor liver transplantation: efficacy of CT and Doppler sonography

OBJECTIVE: The purpose of this study was to evaluate the efficacy of contrast-enhanced CT and Doppler sonography in the diagnosis of hepatic artery pseudoaneurysm after adult living-donor liver transplantation (LDLT). CONCLUSION: Because patients with hepatic artery pseudoaneurysm after LDLT can have diverse clinical presentations, routine imaging follow-up is important for early detection. Although Doppler sonography is limited in showing the pseudoaneurysm, contrast-enhanced CT, especially MDCT with CT arteriography, is effective in showing it in most patients.     

Subclavian Artery Occlusion and Pseudoaneurysm Caused by Lung Apex Mucormycosis: Successful Treatment with Transcatheter Embolization

Subclavian artery pseudoaneurysm and occlusion in young patients are usually post-traumatic. We report the case of a 33-year-old diabetic woman with subclavian artery occlusion and pseudoaneurysm formation caused by pulmonary mucormycosis infection. The patient presented with diabetic ketoacidosis, Horner’s syndrome, and absent left arm pulses. A cystic lesion of the left lung apex was found by imaging, was surgically resected, and was histologically diagnosed as mucormycosis infection. Magnetic resonance angiography depicted a left subclavian artery pseudoaneurysm and occlusion adjacent to the mucormycosis lesion. To protect against thromboembolic complications and rupture, the pseudoaneurysm was embolized with coils. The patient is clinically well 1 year after the intervention with no perfusion of the pseudoaneurysm.