Internal iliac artery pseudoaneurysm: an unusual cause of sciatica and lumbosacral plexopathy

This report describes an unusual case of lumbosacral plexopathy resulting from internal iliac artery pseudoaneurysm. A 50-yr-old woman presented with multiple penetrating trauma to the thorax, abdomen, and left buttock. Several weeks after the injury, severe sciatica and motor dysfunction developed in her left leg. Progressively worsening pain was followed by left foot drop. An electrodiagnostic evaluation suggested a lower lumbosacral plexopathy. Magnetic resonance imaging showed a hematoma extending adjacent to the left lumbosacral plexus. Computerized tomographic angiography revealed a left internal iliac artery pseudoaneurysm. The pseudoaneurysm was excised surgically. In the early postoperative period, the patient reported total relief of pain. Her motor function recovered gradually over several weeks; however, some residual weakness of foot dorsiflexion persisted. With this case presentation, we underscore that an arterial pseudoaneurysm should be remembered as an etiologic possibility of lumbosacral plexopathy and sciatica, especially in patients with history of iatrogenic or accidental trauma. An increased awareness of this rare cause of sciatica and lumbosacral plexopathy may enable early intervention alternatives.     

Phasic disappearance of left circumflex coronary artery from an early complication of mitral valve surgery

LV pseudoaneurysm can be a late complication of mitral valve replacement. In our case, it was an early postoperative complication. This pseudoaneurysm was causing compression of LCX artery during systole, leading to presentation of NSTEMI two weeks after the surgery.     

Lumbar artery pseudoaneurysm in traumatic spinal cord injury: a case report

Lumbar artery pseudoaneurysm is a rare vascular complication of trauma. This case report concerns a 24-year-old man with a lumbar-level spinal cord injury (SCI) secondary to a gunshot wound who developed severe exacerbation of low back and flank pain during inpatient rehabilitation. Diagnostic investigations at an acute care hospital revealed a left lumbar artery pseudoaneurysm. This was treated by transcatheter embolization, which resulted in a marked reduction in pain. The patient resumed inpatient rehabilitation without further complications. This case report highlights the importance of early diagnosis of lumbar artery pseudoaneurysm, a potentially fatal complication that can occur in patients with traumatic lumbosacral SCI. Physiatrists should include lumbar artery pseudoaneurysm in the differential diagnosis for back, flank, or abdominal pain in this patient population.     

Emergency Point-of-Care Ultrasound Diagnosis of a Femoral Artery Pseudoaneurysm

BackgroundIatrogenic femoral artery pseudoaneurysm formation after intervention of the femoral artery may present weeks after intervention. We report a case of a patient with delayed pseudoaneurysm diagnosis that was ultimately diagnosed with bedside ultrasound. Importantly, our case demonstrates a patient who had a left-sided atherectomy and angioplasty with microcatheter access of the right femoral artery.Case ReportA 68-year-old man with multiple comorbidities presented to the Emergency Department (ED) with right inguinal pain, swelling, and overlying skin changes 17 days after an interventional radiology-guided left-sided femoral artery atherectomy and angioplasty. His first postoperative ED visit at an outside hospital led to the diagnosis of a hematoma vs. abscess, with attempted bedside drainage. On presentation to our ED, a bedside ultrasound confirmed arterial pseudoaneurysm formation of the right femoral artery.Why Should an Emergency Physician Be Aware of This?In patients presenting with the constellation of symptoms after arterial site intervention of either side, iatrogenic pseudoaneurysm should be in the differential. Although the patient had atherectomy and angioplasty of the left femoral artery, it is important to highlight that both femoral arteries were accessed during intervention, and thus, both sites are at risk for pseudoaneurysm formation. Emergency sonography can be a useful tool to diagnose, expedite treatment, and avoid potentially harmful invasive procedures in patients presenting with pain and swelling after arterial site intervention.     

Disruption of the iliocolic artery after blunt trauma

Injury to the superior mesenteric artery and branches is an uncommon event, which is typically associated with penetrating injury and high mortality. A case is presented of rupture of a branch of the superior mesenteric artery (iliocolic artery) after blunt trauma. The case illustrates the more occult presentation and better overall prognosis associated with this type of injury as compared with injury to the proximal superior mesenteric artery. In addition this case highlights the importance of vigilance in patients who deteriorate after initial resuscitation.     

Pseudoaneurysm of the proximal superficial femoral artery following blunt trauma in a footballer: A rare case report

Pseudoaneurysm of superficial femoral artery without any femoral fracture following blunt trauma is a rare clinical entity. Most cases of pseudoaneurysm of superficial femoral artery present to the hospital following penetrating injury, femoral fracture, and surgical procedures. Failure of management of pain despite taking analgesics should lead to suspicion of pseudoaneurysm.     

Traumatic Pseudoaneurysm and Arteriovenous Fistula Detected by Bedside Ultrasound

Background

The case of late presentation of a pseudoaneurysm and an arteriovenous fistula (AVF) of the common femoral artery and vein secondary to penetrating trauma is reported. Traumatic AVF and pseudoaneurysm may be present within a variety of clinical conditions, which sometimes makes it difficult to detect them clinically. Undiagnosed AVF can lead to clinical manifestations mostly secondary to increased output generated by the fistula.

Case Report

A 31-year-old man presented to the Emergency Department (ED) for wound care follow-up. A week before, he had suffered a stab wound to the medial thigh and the primary suture was performed in our ED. During his first visit to our ED, the vascular examination revealed palpable dorsalis pedis and tibialis posterior pulses. The formal Doppler ultrasound was negative. During his second presentation, however, the physical examination was remarkable for a palpable thrill and continuous bruit in the left mid-thigh region. Also, an ultrasound with a 7.5-MHz linear probe demonstrated a pseudoaneurysm and an AVF between the femoral artery and vein.

Conclusion

The mechanism of the injury, wound location and tract, and physical findings after a penetrating thigh trauma can help to predict femoral artery injury. Also, occult injuries to the medial thigh after penetrating trauma may be easily overlooked on the physical examination. Furthermore, bedside ultrasound performed by an emergency physician may be helpful in diagnosing occult vascular injuries.     

Radial Artery Pseudoaneurysm

A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band (Terumo Medical Corporation, Somerset, NJ) have been variable and anecdotal, without objective measurements of adequate compression, making this technique prone to failure. In this report, we present an efficient, safe, and noninvasive management protocol using a pulse oximeter and the TR Band for treatment of radial artery pseudoaneurysms that is cost‐effective and efficient and ensures correction without occlusion of the radial artery.     

Access-site complications and their management during transradial cardiac catheterization

Transradial access for cardiac catheterization is now widely accepted among the invasive cardiology community as a safe and viable approach with a markedly reduced incidence of major access-related complications compared with the transfemoral approach. As this access technique is now being used more commonly for cardiac catheterization, it is of paramount importance to be aware of its complications and to understand their prevention and management. Some of the common complications of transradial access include asymptomatic radial artery occlusion, nonocclusive radial artery injury and radial artery spasm. Among these complications, radial artery spasm is still a significant challenge. Symptomatic radial arterial occlusion, pseudoaneurysm and radial artery perforation are rarely reported complications of the transradial approach. Early identification of these rare complications and their immediate management is of vital importance. Arteriovenous fistula, minor nerve damage and complex regional pain syndrome are very rare but have been reported. Recently, granulomas have been reported to be associated with the use of a particular brand of hydrophilic sheaths during the procedure. Generally, access-site complications can be minimized by avoiding multiple punctures, selection of smaller sheaths, gentle catheter manipulation, adequate anticoagulation, use of appropriate compression devices and avoiding prolonged high-pressure compression. In addition, careful observation for any ominous signs such as pain, numbness and hematoma formation during and in the immediate postprocedure period is essential in the prevention of catastrophic hand ischemia.     

Access-site complications and their management during transradial cardiac catheterization

Transradial access for cardiac catheterization is now widely accepted among the invasive cardiology community as a safe and viable approach with a markedly reduced incidence of major access-related complications compared with the transfemoral approach. As this access technique is now being used more commonly for cardiac catheterization, it is of paramount importance to be aware of its complications and to understand their prevention and management. Some of the common complications of transradial access include asymptomatic radial artery occlusion, nonocclusive radial artery injury and radial artery spasm. Among these complications, radial artery spasm is still a significant challenge. Symptomatic radial arterial occlusion, pseudoaneurysm and radial artery perforation are rarely reported complications of the transradial approach. Early identification of these rare complications and their immediate management is of vital importance. Arteriovenous fistula, minor nerve damage and complex regional pain syndrome are very rare but have been reported. Recently, granulomas have been reported to be associated with the use of a particular brand of hydrophilic sheaths during the procedure. Generally, access-site complications can be minimized by avoiding multiple punctures, selection of smaller sheaths, gentle catheter manipulation, adequate anticoagulation, use of appropriate compression devices and avoiding prolonged high-pressure compression. In addition, careful observation for any ominous signs such as pain, numbness and hematoma formation during and in the immediate postprocedure period is essential in the prevention of catastrophic hand ischemia.     

Giant pseudoaneurysm of the external carotid artery causing stroke: A case report

We report a patient in whom mechanical compression of the internal carotid artery by a giant external carotid artery pseudoaneurysm caused a stroke. This was a case of vascular Eagle syndrome due to the impingement of an elongated styloid process on the external carotid artery with subsequent dissection and formation of a pseudoaneurysm. Carotid ultrasonographic examination allowed distinguishing the pseudoaneurysm from other vascular and solid masses of the neck.     

Large femoral aneurysm as a late complication after vessel closure device application

Summary Four months after a diagnostic coronary angiography followed by application of a vascular closure device, a female patient presented with an acute femoral pulsing tumor with strong pain in the groin area. There was no prior trauma. Color duplex sonography showed a large pseudoaneurysm of the right femoral artery. In addition, signs of an old hematoma were documented. Due to the large tumor affecting the arterial perfusion of distal arteries, the pseudoaneurysm was treated immediately by thrombin injection. After this procedure, arterial perfusion in the tumor was not detectable anymore and local symptoms decreased rapidly. This is a rare case of late pseudoaneurysm after femoral artery puncture.     

CT angiogram and endovascular stent graft for an axillary artery gunshot wound

A patient with an axillary artery gunshot wound pseudoaneurysm was evaluated and managed with computed tomographic angiogram and endovascular stent graft. Vascular injuries resulting from penetrating trauma or interventional vascular procedures are relatively uncommon. Subclavian and axillary arterial injuries may be associated with substantial morbidity and mortality if not managed expeditiously. The inaccessibility of these arteries makes stent graft treatment particularly attractive. The stable patient with a pseudoaneurysm or an arteriovenous fistula seems to be the ideal candidate to treat in this way. As computed tomography (CT) technology has evolved, CT angiography has become an integral part of the initial assessment of proximal extremity vascular injuries.     

彩色多普勒超声在诊治股动脉假性动脉瘤中的应用价值

目的评价彩色多普勒超声对股动脉假性动脉瘤的诊断价值及彩超引导下对其压迫修复的疗效。方法对28例股动脉插管术后穿刺部位出现搏动性肿块和（或）血管杂音的患者行彩色多普勒超声检查，并在彩超引导下对股动脉假性动脉瘤进行压迫治疗，治疗后经彩超跟踪复查评价其疗效。结果28例股动脉假性动脉瘤患者全部检出，与临床和MRI、血管造影或手术结果符合率100％（28／28）。彩超引导下25例股动脉假性动脉瘤经压迫治愈，3例压迫后未能完全修复而行手术治疗。结论彩色多普勒超声对股动脉假性动脉瘤有较高的诊断价值，且在引导压迫修复股动脉假性动脉瘤方面简便、安全、可靠，可作为首选的治疗方法，对不适宜压迫修复的患者行手术等治疗。     

Diagnosis of a Facial Artery Pseudoaneurysm Using Emergency Bedside Ultrasound

Background: Pseudoaneurysms of the extracranial arterial system are rare. We report a case of a facial artery pseudoaneurysm initially mistaken for an abscess. With bedside ultrasound performed in the Emergency Department (ED) by the treating physician, the mass was identified as a pseudoaneurysm. Objectives: In this report we review the anatomy of the extracranial arterial system of the head and neck, discuss the pathogenesis and clinical presentation of pseudoaneuryms, and present diagnostic imaging and treatment options for pseudoaneurysms of the face. Case Report: A 51-year-old man presented with facial swelling and pain at the site of a laceration that he had sustained 1 month previously. Before incision and drainage, bedside ultrasound was performed in the ED by the treating physician to confirm the presumptive diagnosis of abscess with possible foreign body. The ultrasound revealed the mass to be a pseudoaneurysm. Conclusions: Although pseudoaneurysms of the head and neck are rare, a history of trauma should prompt the consideration of a vascular injury with the need for imaging before drainage procedures of a presumed abscess. To our knowledge, the use of clinician-performed bedside ultrasound to detect facial artery pseudoaneurysms has never been reported.     

Ultrasonographic diagnosis of uterine artery pseudoaneurysm after hysterectomy.

The development of an arterial pseudoaneurysm is a rare but reported complication of pelvic surgery. Typically the lesion is discovered because the patient has symptoms related to delayed rupture of the pseudoaneurysm, causing hemorrhage. We report a case in which an uterine artery pseudoaneurysm was detected 14 days after vaginal hysterectomy by TVUS, which was performed prior to a transvaginal drainage procedure to treat an infected pelvic hematoma.     

Ultrasonographically guided manual compression of femoral artery injuries.

To determine the success and complication rates of ultrasonographically guided manual compression in patients with femoral arterial injuries after femoral arterial catheterization, we performed 53 sonographically guided compression repairs in 51 patients. Ultrasonographically guided compression repair was performed on 40 pseudoaneurysms in non-anticoagulated patients, seven pseudoaneurysms in anticoagulated patients, four arteriovenous fistulas on non-anticoagulated patients, and one pseudoaneurysm combined with an arteriovenous fistula. One pseudoaneurysm underwent two separate ultrasonographically guided compression repairs: once when the patient was anticoagulated and once after anticoagulants were withheld. Ultrasonographically guided compression repair was successful in 37 of 48 pseudoaneurysms (77%). Of the 40 pseudoaneurysms in non-anticoagulated patients, ultrasonographically guided compression repair was successful in 36 (90%). This repair technique failed in all seven pseudoaneurysms in anticoagulated patients. Ultrasonographically guided compression repair was successful in 13 of 16 (81%) multilobulated pseudoaneurysms but failed in all arteriovenous fistulas and the one case of pseudoaneurysm combined with an arteriovenous fistula. Ultrasonographically guided compression repair is a safe and effective alternative to surgery for the repair of pseudoaneurysms, including multilobulated pseudoaneurysms. The procedure does not appear to be effective in the anticoagulated patient or in patients with an arteriovenous fistula.     

Radial artery mycotic pseudoaneurysm: an unusual complication of catheterization

Radial artery pseudoaneurysms are rare, and those that become infected are rarer still. We present the case of a patient who developed a radial artery pseudoaneurysm as a late complication of arterial catheterization. Blood cultures were positive for Staphylococcus aureus, and a pulsatile mass, with associated tissue necrosis, was palpable over the radial artery. The diagnosis was confirmed by gray-scale and color Doppler sonography, which showed a partially thrombosed pseudoaneurysm and turbulent flow in the pseudoaneurysm and native artery.     

Congenital right coronary artery aneurysm causing myocardial infarction, pseudoaneurysm formation, and right atrial compression.

We present a case of a young woman with symptoms of acute myocardial infarction and found to have a nonatherosclerotic coronary aneurysm of the right coronary artery, which ruptured and formed a pseudoaneurysm. The pseudoaneurysm was sufficiently large that it mimicked an atrial mass on diagnostic imaging modalities. With the attendant risk of further rupture and compression of the heart chambers, the patient underwent successful resection of the aneurysm and pseudoaneurysm with single vessel bypass surgery.     

Iatrogenic pseudoaneurysm of femoral artery: case report and literature review

The case of a patient who developed a femoral artery pseudoaneurysm (FAP) following cardiac catheterization is described. It is one of the most troublesome complications after various invasive cardiovascular procedures related to the femoral arterial access site. Iatrogenic pseudoaneurysms (IPA) form when an arterial puncture site fails to seal, allowing arterial blood to ooze into the surrounding tissues and form a pulsatile hematoma. The FAP occurs in 0.8% to 2.2% after interventional procedures. This problem has become more significant due to the exponential growth of interventional cardiology. Doppler flow mapping has been the mainstay of diagnosis. Diagnostic criteria include: swirling color flow in a mass separate from the affected artery, and a typical "to-and-fro" Doppler waveform in the pseudoaneurysm neck. Ultrasound-guided compression repair has replaced the need for surgical repair of FAP. It has been shown to be a safe and cost-effective method for achieving pseudoaneurysm thrombosis. However, it carries considerable drawbacks including long procedure times, discomfort to patients, high recurrence rate in patients receiving anticoagulant therapy and an overall 3.6% complication rate. Recently, percutaneous thrombin injection in the FAP has gained popularity despite complications associated with the initial use of high dose thrombin (average dose of 1,100 IU). The technique was refined when low-dose thrombin injections were studied and proved to have the same efficacy and consistently high success rates (average dose used 192 IU). However, there is a theoretical risk of developing type I IgE-mediated allergic reaction to bovine thrombin. The indications, advantages, disadvantages, and complications of the various treatment modalities are discussed in this report and review of the literature. Other treatments with collagen injection are also discussed in detail.