改良法超声引导下注射凝血酶治疗股动脉假性动脉瘤

目的探讨改良法超声引导下注射凝血酶治疗股动脉假性动脉瘤的价值。资料和方法 49例股动脉假性动脉瘤患者于超声引导下穿刺注射凝血酶,穿刺时压迫瘤颈使瘤内血流消失,瘤内血栓形成后逐级放松压迫力度直至瘤内填满血栓。分析假性动脉瘤的体积、分型、颈部长度宽度、凝血酶用量等对疗效的影响,观察其并发症。结果 49例患者术前经彩色多普勒超声确诊,其中单纯型37例,复杂型12例,动脉瘤平均体积为10.5±6.0cm3,瘤颈部宽度2.8±0.6mm,颈部长度6.1±1.4mm,平均凝血酶用量277±120U。46例一次成功,3例第一次注射后复发,经第二次注射后成功,其中单纯型1例,复杂型2例。未发生动脉或静脉栓塞等并发症。结论改良法超声引导下注射凝血酶治疗股动脉假性动脉瘤是一种高效、安全的方法,并发症少,可作为治疗的首选方法。     

超声引导下注射凝血酶治疗心导管术后股动脉假性动脉瘤的探讨

目的:评价超声引导下注射凝血酶治疗股动脉假性动脉瘤的效果。材料和方法:心导管术后股动脉假性动脉瘤13例,超声引导下瘤内注射凝血酶栓塞治疗。结果:12例治疗成功,1例失败,无严重并发症发生。结论:超声引导下注射凝血酶是治疗股动脉假性动脉瘤安全、有效的方法。     

Outcomes of Ultrasound-Guided Thrombin Injection of Nongroin Arterial Pseudoaneurysms

Purpose

To evaluate success and complication rates of percutaneous ultrasound-guided thrombin injection of nongroin pseudoaneurysms (PSAs).

Percutaneous Ultrasound-Guided Thrombin Injection as First-Line Treatment of Pancreatic Pseudoaneurysm

Pancreatic pseudoaneurysms are a rare but potentially fatal complication of pancreatitis. Surgical intervention and transcatheter embolization are not always feasible therapeutic options. In this report we present a case of a pseudoaneurysm secondary to pancreatitis which, despite being angiographically invisible, was successfully embolized with a single ultrasound-guided percutaneous injection of thrombin.     

Percutaneous Thrombin Injection Based on Computational Fluid Dynamics of Femoral Artery Pseudoaneurysms

ObjectiveTo analyze the computational fluid dynamics (CFD) of femoral artery pseudoaneurysm (FAP), identify a suitable location and timing for percutaneous thrombin injection (PTI) based on this analysis, and report our clinical experience with the procedure.Materials and MethodsCFD can be used to analyze the hemodynamics of the human body. An analysis using CFD recommended that the suitable location of the needle tip for PTI is at the center of the aneurysm sac and the optimal timing for starting PTI is during the early inflow phase of blood into the sac. Since 2011, seven patients (three male and four female; median age, 60 years [range, 43–75 years]) with FAP were treated with PTI based on the devised suitable location and time. Prior to the procedure, color Doppler ultrasonography was performed to determine the location and timing of the thrombin injection.ResultsThe technical success rate of the PTI was 100%. The amount of thrombin used for the procedure ranged from 200 IU to 1000 IU (median, 500 IU). None of the patients experienced any symptoms or signs of embolic complications during the procedure. Follow-up CT images did not reveal any embolism in the lower extremities and showed complete thrombosis of the pseudoaneurysm.ConclusionBased on our study of CFD, PTI administered centrally in the FAP during early inflow, as seen on color Doppler, can be an effective technique.     

Human Thrombin Injection for the Percutaneous Treatment of Iatrogenic Pseudoaneurysms

PURPOSE: Thrombin injection is becoming well established for the percutaneous management of iatrogenic pseudoaneurysms. All the published series to date use bovine thrombin, and there have been reports of adverse immunologic effects following its use. Our study aimed to assess the efficacy of human thrombin injection for pseudoaneurysm occlusion. METHODS: Fourteen patients with iatrogenic pseudoaneurysms underwent a color Doppler ultrasound examination to assess their suitability for percutaneous human thrombin injection. Human thrombin 1000 IU was then injected into the pseudoaneurysm sac under sterile conditions and with ultrasound guidance. A further color Doppler ultrasound examination was performed 24 hr later to confirm occlusion. RESULTS: All 14 pseudoaneurysms were successfully occluded by human thrombin injection. In two cases a second injection of thrombin was required, but there were no other complications, and all pseudoaneurysms remained occluded at 24 hr. CONCLUSION: Ultrasound-guided human thrombin injection is simple to perform, effective and safe. We recommend that human thrombin becomes the agent of choice for percutaneous injection into iatrogenic pseudoaneurysms.     

Treatment of a Splenic Artery Pseudoaneurysm by Endoscopic Ultrasound-Guided Thrombin Injection

We present a case of a splenic artery pseudoaneurysm secondary to pancreatitis that was successfully treated by transgastric injection of thrombin under endoscopic ultrasound guidance. There has been no recurrence on follow-up CT angiography, and thus complex surgery or endovascular intervention has been avoided.     

CT-guided Injection of N-butyl Cyanoacrylate Glue for Treatment of Chylous Leak after Aorto-mesenteric Bypass

Lymphangiography and thoracic duct embolization are well-described techniques for the diagnosis and treatment of thoracic lymphatic leaks refractory to conservative treatment. However, thoracic duct embolization is not an option in patients with abdominal chylous leaks. The present report describes a 68-year-old man who underwent an aortomesenteric bypass complicated by a high-output postoperative chylothorax (>2,000 ml/day) and chylous ascites (>7,000 ml/paracentesis). Ultrasound-guided intranodal lymphangiography demonstrated a retroperitoneal lymphatic leak tracking along the vascular graft into the peritoneal cavity. Computed tomography-guided lymphatic duct occlusion with N-butyl cyanoacrylate glue was performed, resulting in successful treatment of both chylothorax and chylous ascites.     

Endovascular Treatment of Mycotic Aortic Pseudoaneurysms with Stent-Grafts

Mycotic aortic aneurysms remain a therapeutic challenge, especially in patients who are not suitable for open surgery. Endovascular treatment with stent-grafts in this indication is still disputed. Between January 2002 and January 2006, six patients with mycotic aneurysms of the thoracoabdominal or abdominal aorta were admitted to our department. All patients were male, aged 57–83 years (mean, 74.6 years). The mycotic aneurysms were diagnosed on the basis of clinical signs of infection, on CT, and, in four cases, on a positive blood culture. In all patients the mycotic aortic aneurysms were treated endovascularly by stent-graft implantation. Technical and clinical success was achieved in all patients. There was no in-hospital or 30-day mortality. In the follow-up period (range, 2–47 months) four patients died of cancer, cardiac failure, or unknown cause (one case). Two patients are still alive with nearly complete regression of the aneurysms. We conclude that treatment of mycotic aortic aneurysms with stent-grafts may be an alternative in selected patients.     

Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series

CardioVascular and Interventional Radiology - We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of...     

Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing

Purpose

Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA.

Material and Methods

During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up.

Results

PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 ± 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary.

Conclusion

PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.     

Endovascular Treatment of Anastomotic Pseudoaneurysms after Aorto-iliac Surgical Reconstruction

Purpose To assess the effectiveness of endovascular treatment of anastomotic pseudoaneurysms (APAs) following aorto-iliac surgical reconstruction. Materials We retrospectively evaluated 21 men who, between July 2000 and March 2006, were observed with 30 APAs, 13 to the proximal anastomosis and 17 to the distal anastomosis. The patients had had previous aorto-iliac reconstructive surgery with a bypass due to aneurysm (15/21) or obstructive disease (6/21). The following devices were used: 12 bifurcated endoprostheses, 2 aorto-monoiliac, 4 aortic extenders, 1 stent-graft leg, and 2 covered stents. Follow-up was performed with CT angiography at 1, 3, and 6 months after the procedure and yearly thereafter. Results Immediate technical success was 100%. No periprocedural complications occurred. Four patients died during follow-up from causes not related to APA, and 1 (treated for prosthetic-enteric fistula) from sepsis 3 months after the procedure. During a mean follow-up of 19.7 months (range 1–72 months), 2 of 21 occlusions of stent-graft legs occurred 3 and 24 months after the procedure (treated with thrombolysis and percutaneous transluminal angioplasty and femorofemoral bypass, respectively) and 1 type I endoleak. Primary clinical success rate was 81% and secondary clinical success was 91%. Conclusion Endovascular treatment is a valid alternative to open surgery and can be proposed as the treatment of choice for APAs, especially in patients who are a high surgical risk. Further studies with larger series and longer follow-up are necessary to confirm the long-term effectiveness of this approach.