Arterial complications associated with cardiac catheterization in pediatric patients with a previous history of kawasaki disease

Objectives : To determine whether patients with Kawasaki Disease (KD) undergoing percutaneous catheter angiography were at increased risk of arterial complications at the point of arterial access compared to patients with structural heart abnormalities, but normal vessels. Background : Systemic arterial damage can occur as a result of KD. Methods : Medical histories of all patients with KD undergoing percutaneous catheter angiography at The Hospital for Sick Children between January 1990 and August 2008 were reviewed. Results : A total of 44 patients with KD underwent 82 catheter procedures. Of these, 3 were associated with important arterial complications (2 males; age: 4 months, 3 and 17 years). All patients who experienced complications had multiple large and/or giant coronary artery aneurysms and two were within 3 months of the acute phase of KD. All patients developed pseudoaneurysms of the femoral artery which had been utilized for catheter access. All pseudoaneurysms were treated with ultrasound‐guided thrombin injection and compression, and resolved with no long‐term complications. One patient also developed a substantial arteriovenous fistula of the femoral circulation which had to be surgically repaired with no permanent sequela. Odds for arterial complications in patients with KD were 10.4 times greater (95%CI: 3.2–33.8) than that noted for the general pediatric cardiac catheterization population (3.6% vs. 0.4%, P < 0.0001) which indicates higher risk associated with arterial access in patients with KD. Conclusions : Greater care in obtaining arterial access for angiography is warranted, especially in the first month directly following the acute phase, possibly related to systemic arterial damage associated with KD. © 2009 Wiley‐Liss, Inc.     

An unusual complication after aortic valve replacement

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa, though rare, can occur after aortic valve replacement. We report an asymptomatic patient who developed this unusual complication and describe the use of transesophageal and 3-dimensional echocardiography to help confirm the diagnosis.     

Successful treatment of spontaneous rupture of the internal carotid artery in an acute promyelocytic leukemia patient using ultrasound-guided thrombin injection

Spontaneous rupture and bleeding from the carotid artery in acute promyelocytic leukemia (APL) patients leading to pseudoaneurysm (PSA) formation has not been reported.We first successfully treated an APL patient with left internal carotid artery rupture during chemotherapy leading to PSA using ultrasound-guided thrombin injection (UGTI).A 10-year-old girl,who was diagnosed with APL,suddenly experienced left neck swelling,which expanded gradually and was not associated with pain,dizziness,palpitations,or labored breathing 2 days after the third session of chemotherapy (mitoxantrone + cytarabine) in a local hospital.She had no history of injury.     

Angioseal治疗难治性股动脉假性动脉瘤二例

股动脉假性动脉瘤是经股动脉介入诊疗术后常见的局部并发症之一,传统的治疗方法是外科手术修补或假性动脉瘤切除加人工血管置换。目前首选的治疗手段是在超声     

Point-Of-Care Ultrasound Diagnosis of Medial Plantar Artery Pseudoaneurysm Secondary to Penetrating Injury

BackgroundPseudoaneurysms of the foot are rare and can occur from a range of etiologies, including laceration from a foreign body. The majority of reported cases have been diagnosed by computed tomography, magnetic resonance imaging, or angiography. These tests require intravenous access and contrast, confer radiation, take time to perform and interpret, are expensive, and are not always readily available in the acute setting. No prior reported pseudoaneurysms of the foot have been diagnosed by point-of-care ultrasound (POCUS).Case ReportAn 8-year-old boy presented to the emergency department for evaluation of left foot pain and swelling 2 weeks after stepping on small pieces of broken glass. He had a 3 × 3 cm area of painful swelling and erythema at the medial plantar aspect of his foot. A cutaneous abscess was the working diagnosis and preparations were made for an incision and drainage procedure. However, POCUS revealed a medial plantar artery pseudoaneurysm. Incision and drainage would have led to unexpected arterial bleeding. Instead, the pediatric surgery service was consulted for pseudoaneurysm excision and arterial ligation.Why Should an Emergency Physician Be Aware of This?Incision of a pseudoaneurysm in the sole of the foot—thought to be an abscess based on clinical examination—would lead to unforeseen arterial bleeding. POCUS at the bedside can differentiate between simple abscess and pseudoaneurysm in order to guide appropriate and time-sensitive management. Historical and clinical clues to the diagnosis may include heavier-than-expected bleeding at the time of laceration and a pulsatile quality to the painful erythema and swelling.