Percutaneous occlusion of femoral artery pseudoaneurysm by para-aneurysmal saline injection.

The increasing number of coronary interventions and more aggressive anticoagulation is associated with a larger number of iatrogenic femoral pseudoaneurysms (PAs). The majority of PAs clot spontaneously or can be repaired by ultrasound-guided compression or ultrasound-guided thrombin injection. The therapeutic armamentarium for the remaining PAs ranges from different interventional procedures to surgical occlusion. In a small case series, we describe our initial experiences with a new, less invasive approach after unsuccessful compression therapy. Ultrasound-guided injection of 52 +/- 33 ml saline beneath the communication tract of the PA yields to rapid occlusion in six consecutive patients. During 4 weeks of follow-up, the PAs remained occluded in all patients and surgical intervention could be avoided.     

Incidence and predictors of post-catheterization femoral artery pseudoaneurysms

BackgroundFemoral artery pseudoaneurysm (FAP) is a troublesome complication after transfemoral catheter procedures. The incidence and predictors of FAP as a separate entity have not been extensively studied.AimDetect prospectively the incidence and predictors of post catheterization FAP.MethodsFrom June 2009 till June 2011, we prospectively included all patients who underwent catheterization from the femoral approach. Duplex ultrasound was performed in cases with clinical suspicion of vascular complications. Clinical data and procedural variables were compared with a control group of 200 randomly selected patients. We performed univariate analysis and a logistic regression model for multivariate analysis.ResultsThe incidence of FAP was 3.42%. Eighty FAPs (66.7%) were related to a diagnostic catheterization while 40(33.3%) were related to an interventional procedure. The mean age of patients with FAP was 55.36 ± 10.68 yrs; 57.5% were females. At diagnosis 81.66% of the patients were on antiplatelet therapy, 35% were on heparin or warfarin and 16.66% were on both, with mean value of INR for patients on warfarin 2.2 ± 0.76. FAPs were connected to the common femoral artery in 29.1% of patients, to the SFA in 54.1% and to the profunda in 16.6%. Female gender, obesity and hypertension significantly enhanced the risk for FAP. Also diagnostic angiography, low puncture, multiple punctures and the use of dual antiplatelet and/or anticoagulant therapy were independent procedure-related risk factors for FAP.ConclusionFemoral artery pseudoaneurysms are not uncommon. Female gender, obesity, hypertension, the use of antiplatelet and/or anticoagulant therapy and faulty puncture techniques are independent risk factors for FAPs.     

Fatal complication after thrombin injection for post-catheterization femoral pseudoaneurysm

Femoral artery pseudoaneurysm (FAP) is one of the most common vascular complications after cardiac and peripheral angiographic procedures. Ultrasound-guided thrombin injection is the standard procedure for the treatment of FAP. Complications such as thrombotic events with leg ischemia after thrombin leakage into the femoral artery or immunogenic consequences are rare. Our experience indicates the need for caution when treating FAP, as severe complications can occur after thrombin injection in a femoral pseudoaneurysm, leading to a fatal event.     

Treatment of femoral artery pseudoaneurysm with percutaneous thrombin injection.

Pseudoaneurysm formation of the femoral artery is a well-known complication following catheter-based vascular procedures. Ultrasound-guided compression or surgical correction are commonly used for its repair. We describe a new method of treatment for femoral pseudoaneurysm. The pseudoaneurysm is visualized by contralateral angiography and thrombosed with a percutaneous thrombin injection while the distal vessel is isolated with a brief balloon inflation. Fluoroscopically guided percutaneous thrombin injection is a promising, minimally invasive technique for the treatment of iatrogenic pseudoaneurysm, especially in patients with compromised distal circulation.     

彩色多普勒超声监测下加压治疗股动脉穿刺后假性动脉瘤

目的探讨彩色多普勒超声监测下加压治疗股动脉穿刺后假性动脉瘤的疗效。方法股动脉穿刺术后假性动脉瘤形成患者11（男7,女4）例,年龄41～72（57±4）岁。在彩色多普勒血流显像的监测下,以交通口为中心,沿股动脉长轴方向,持续加压,间断放松。结果10例（91%）患者加压治疗15～80（48±14）min假性动脉瘤闭合,2d、1周、3周后复查,均未见复发;1例加压20min后,仍见分流,放弃治疗。结论彩色多普勒超声监测下加压治疗股动脉穿刺术后假性动脉瘤有较高的临床价值。     

Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives.     

Sonographically guided thrombin injection for the treatment of femoral artery pseudoaneurysm

The formation of pseudoaneurysm in the femoral artery after cardiac catheterization is a well-recognized complication occurring in 1%-4% of cases. It is traditionally managed surgically and has a high morbidity. Prolonged ultrasound-guided compression of the neck of the pseudoaneurysm, and ultrasound-guided injection of thrombin into the aneurysm are newer modalities of treatment especially for small aneurysms. We describe the case of a giant pseudoaneurysm of the right femoral artery, post-arteriography, which was successfully managed with ultrasonographically guided percutaneous thrombin injection.     

A cost effective endovascular approach for management of post-catheterization profunda femoris artery pseudoaneurysm using thrombin

Post-catheterization PSA is one of the most commonly encountered vascular complications of cardiac and peripheral angiographic procedures. We report the case of patient who developed deep-seated profunda femoris artery pseudoaneurysm (PSA) following cardiac catheterization. Despite, repeated ultrasound guided compressions the PSA failed to close and instead produced local site pressure ulcers. The secondary infection followed which precluded use of percutaneous thrombin injection. The PSA was finally closed via a total endovascular technique combining intravascular thrombin injection and coil embolization, thus obviating the need for expensive measures like cover stents or invasive surgical repairs.     

Ultrasonographic contrast injection enhances safety of thrombin - induced obliteration of femoral artery pseudoaneurysm

Thrombin injection is known as an efficient and safe method of femoral artery pseudoaneurysms treatment, however, it can be complicated by peripheral thrombosis to accidental casual thrombin injection into femoral artery. We present our own procedure modification. Before thrombin injection we inject into pseudoaneurysm a small volume of ultrasonographic contrast. Doppler signal enhancement confirms proper niddle position.     

改良的超声引导下徒手压迫治疗股动脉假性动脉瘤41例

目的:评价超声引导下徒手压迫法治疗心血管介入术后股动脉假性动脉瘤(PSA)的疗效。方法:对3060例介入术后发生股动脉PSA的41例患者采取改良的超声引导下徒手压迫法,压迫30~150min不等,观察PSA闭合情况。结果:41例患者成功闭合37例,总成功率为90·2%,均无复发。1次压迫成功闭合25例,2次压迫成功闭合9例,3次以上压迫成功3例;失败4例,最终3例转外科行PSA修补术,1例拒绝再手术出院随访。结论:改良的超声引导下徒手压迫法治疗介入术后PSA安全可靠、疗效高且容易掌握,可以作为治疗大部分PSA的首选方法。     

Treatment of iatrogenic femoral pseudoaneurysm by ultrasound-guided compression therapy and thrombin injection

Development of an arterial pseudoaneurysm is a common complication following cardiac catheterization. We analyzed data from 6,300 patients who received left heart catheterization at our institution. One day after the procedure, approximately 10% of the patients were examined with duplex sonography. In 204 patients (3.0%), a pseudoaneurysm of the femoral artery was diagnosed. All patients underwent compression therapy. Thereby, 159 of the pseudoaneurysms could be treated successfully. The remaining 45 pseudoaneurysms had a maximal diameter of more than 1.5 cm. Forty-two patients underwent ultrasound and biopsy-line-guided thrombin injection without complications. This strategy resulted in a successful occlusion in 41 cases. Pseudoaneurysms smaller than 2 cm can be treated with compression therapy. Larger pseudoaneurysms can be occluded by thrombin injection using ultrasound guidance. Patients with a pseudoaneurysm with a wide "neck" should be treated surgically, because the risk of an arterial occlusion following thrombin injection cannot be excluded.     

Successful direct thrombin injection of a femoral artery pseudoaneurysm in an anticoagulated patient with a mechanical mitral valve

Femoral pseudoaneurysm is a complication of cardiac catheterization and may be related to the use of anticoagulants, antiplatelet agents, larger diameter sheaths and prolonged duration of sheath insertion. The treatment ranges from direct compression with or without direct thrombin injection to surgical repair. The present report describes a unique scenario of postcardiac catheterization femoral artery pseudoaneursym in a patient with a pre-existing mechanical mitral valve requiring anticoagulation. The potential systemic effects of thrombin made the patient reluctant to undergo treatment and made thrombin administration a challenging proposition. The present report suggests that thrombin injection for treating femoral pseudoaneursym in patients with mechanical heart valves on chronic anticoagulation can be performed safely.     

Traumatic ascending aortic transection with pseudo-aneurysm

We present a 64-year-old woman who was brought to the emergency department after suffering a motor vehicle accident, involving multiple soft tissue and bone trauma. Even though she was free from cardiovascular symptoms for the last three years, her past medical history of aorto-coronary bypass surgery prompted preoperative consultation. The diagnostic images showed a unique visualization of an ascending aortic traumatic pseudoaneurysm by transthoracic and transoesophageal echocardiogram as well as with cardiac catheterization.