Post-traumatic pseudoaneurysm of the common hepatic artery with duodenal fistula

BackgroundPost-traumatic pseudoaneurysm of the hepatic artery is rare, especially after blunt abdominal trauma; an even more rare occurrence is enteric fistulisation.Case outlineA 29-year-old man was admitted with an acute episode of upper gastrointestinal bleeding three months after blunt abdominal trauma and was found to have an hepatic artery pseudoaneurysm with duodenal fistula. Surgical treatment was by ligature of the artery and duodenal closure with omental patch.DiscussionThere is one previous case report of hepatic artery pseudoaneurysm as a delayed complication of blunt abdominal trauma. The presence of a haematoma in the hepatoduodenal ligament after blunt trauma should raise the suspicion of hepatic artery injury, and surgical exploration may prevent the subsequent development of pseudoaneurysm. CT scan has become an important instrument both in diagnosis and in surgical planning.     

Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection

Post-traumatic hepatic artery pseudoaneurysm is uncommon, appearing in approximately 1% of hepatic trauma cases. Most are extrahepatic (80%) and have a late onset. Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications, especially breakage. Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices. Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection. We present a case of post-traumatic hepatic artery pseudoaneurysm that was successfully treated using this combined technique.     

Percutaneous vascular surgical closure of the brachial artery

For the first time, a suture mediated closure device was used to obtain hemostasis after a catheterization procedure was performed via the brachial artery approach. Two successive catheterization procedures, using the right and left brachial arteries, were performed in a patient, contraindicated for a procedure through the femoral approach. In both cases the closures were successful and without complications. An aggressive anticoagulation regimen could safely be prescribed to this patient because of the percutaneous surgical achievement of hemostasis. This technique should provide interesting clinical benefits in selected patients undergoing catheterization via the brachial approach.     

Post-traumatic pseudoaneurysm of the mitral-aortic intervalvular fibrosa

The case of a patient with large pseudoaneurysm of the mitral-aortic intervalvular fibrosa following a blunt chest trauma is presented. A two dimensional echocardiographic study revealed a large aneurysmal sac situated between the posterior aortic root and the left atrium, which expanded in systole and partially collapsed in diastole. An echo-free space which represented the mouth of the aneurysm was seen just below the posterior aortic cusp in the junctional zone between the two valves, called mitral-aortic intervalvular fibrosa. Nuclear magnetic resonance imaging showed a better resolution of the echocardiographic feature. Cardiac catheterization and surgery confirmed the diagnosis.     

Single ultrasound-guided local high-dose thrombin injection in the treatment of giant brachial artery pseudoaneurysm: A case report

Rationale:Pseudoaneurysm (PSA) is a common complication related to vascular intervention, and surgical therapy is the primary method. However, a giant brachial artery PSA over 2 weeks is rarely observed. Due to the adhesion of surrounding tissue, thrombus organization, the extensive injury, and the high expense of transluminal stent-graft placement, a single ultrasound-guided local high-dose thrombin injection can be a therapy option. Such cases are rarely reported.Patient concerns:A 71-year-old man with a history of left elbow fossa interventional puncture presented to our hospital with a pulsatile mass in the left elbow fossa. He had a history of cerebral infarction 32 years prior without sequelae, emphysema for more than 2 years, hyperlipidemia for 3 months, and prostatic hyperplasia for 8 months. After conservative therapy, the lumbar compression fracture produced by trauma 24 years ago healed, and the intracranial hematoma induced by trauma ten years ago was absorbed.Diagnosis:Ultrasound examination showed giant mixed echoes on the posterior medial side of the left brachial artery.Interventions:The patient underwent a single ultrasound-guided local high-dose thrombin injection to treat giant brachial artery PSA.Outcomes:Following therapy, the ultrasonography revealed that extensive thrombosis immediately formed in the cavity, and the internal blood flow signals had completely vanished. A week later, a physical examination showed that the PSA had shrunk with no apparent tenderness and that the texture had hardened. Pulsation and vascular murmurs disappeared. Ultrasound showed that the PSA was reduced, and no blood flow signals were found.Lessons:A single ultrasound-guided local high-dose thrombin injection had a considerable effect in curing large iatrogenic PSA. However, when deciding on the best therapy, specificity must be taken into account.     

Endovascular treatment of subclavian pseudoaneurysm causing delayed brachial plexus paralysis

Pseudoaneurysms of the subclavian artery are rarities. Due to their close relationship to the brachial plexus in the shoulder girdle, delayed lesions of the brachial plexus are possible. We report a case of a subclavian pseudoaneurysm following fracture of the clavicle, and the endovascular treatment using a balloon-expandable stent-graft.     

Myocardial tuberculoma with rupture and pseudoaneurysm formation--successful surgical treatment

A case of left ventricular pseudoaneurysm due to rupture of a myocardial tuberculoma is presented. The diagnosis of pseudoaneurysm was initially suggested by echocardiography and was confirmed by angiocardiography. The aetiology was suggested at operation and confirmed by histological examination. This is a very rare condition which is usually diagnosed only at necropsy.     

Myocardial tuberculoma with rupture and pseudoaneurysm formation--successful surgical treatment.

A case of left ventricular pseudoaneurysm due to rupture of a myocardial tuberculoma is presented. The diagnosis of pseudoaneurysm was initially suggested by echocardiography and was confirmed by angiocardiography. The aetiology was suggested at operation and confirmed by histological examination. This is a very rare condition which is usually diagnosed only at necropsy.     

Endovascular treatment of life-threatening pseudoaneurysm of the hepatic artery after pancreaticoduodenectomy

Pseudoaneurysm is a life-threatening complication after pancreaticoduodenectomy. An endovascular covered stent was employed for treatment of pseudoaneurysm of the common hepatic artery after pancreaticoduodenectomy. A 77-year-old female underwent pylorus-preserving pancreaticoduodenectomy for lower bile duct cancer. She complained of hematochezia but upper gastrointestinal endoscopy did not find a bleeding source. Angiography was performed and pseudoaneurysm of the common hepatic artery was discovered. Since no collateral perfusion to the liver was detected, embolization of the common hepatic artery was considered to expose the patient to the danger of severe hepatic dysfunction. Successful exclusion of the pseudoaneurysm was completed with an endovascular covered stent. Inflow of the hepatic artery was secured and no hepatic dysfunction developed. Patency of the stent was confirmed at 5 months follow-up. An endovascular covered stent can be a feasible modality for selected cases of the hepatic arterial pseudoaneurysm.     

New technique for treatment of postcatheterization radial artery pseudoaneurysm

We report a new technique for treatment of radial artery pseudoaneurysm (RAP) caused by transradial access (TRA) for coronary angiography. Traditional extrinsic compression with radial flow cessation leads to a local milieu likely associated with an increase in probability of radial artery occlusion (RAO). Our technique involves obtaining ipsilateral radial artery access distal to the neck of the RAP followed by a prolonged sheath dwell time covering the neck of the RAP which allows the RAP sac to thrombose and maintains radial artery lumen patency. © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.     

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.     

Case report: acute thrombotic occlusion and pseudoaneurysm of the brachial artery diagnosed by Doppler ultrasound after nondiagnostic angiography

The swift and accurate diagnosis of acute arterial occlusion and limb ischemia is critical to prevent morbidity from this vascular emergency as reported by Bettman et al. (Radiology 215:101–105, 2000). There are a number of imaging modalities available to the diagnosing physician. However, the most appropriate modality may vary according to the clinical presentation. We present an atypical case of acute thrombosis of the brachial artery, which could not be diagnosed by conventional angiography, but was identified successfully with Doppler ultrasound. We also briefly discuss the issues surrounding vascular imaging in this case and overview the strengths and weaknesses of available imaging modalities.

     

Case report: acute thrombotic occlusion and pseudoaneurysm of the brachial artery diagnosed by Doppler ultrasound after nondiagnostic angiography

The swift and accurate diagnosis of acute arterial occlusion and limb ischemia is critical to prevent morbidity from this vascular emergency as reported by Bettman et al. (Radiology 215:101–105, 2000). There are a number of imaging modalities available to the diagnosing physician. However, the most appropriate modality may vary according to the clinical presentation. We present an atypical case of acute thrombosis of the brachial artery, which could not be diagnosed by conventional angiography, but was identified successfully with Doppler ultrasound. We also briefly discuss the issues surrounding vascular imaging in this case and overview the strengths and weaknesses of available imaging modalities.     

latrogenic pseudoaneurysm of the innominate artery

Central venous cannulation by the subclavian approach is a commonly performed procedure with an overall complication rate of up to 11%. In the English literature, however, there has been no previous documentation of pseudoaneurysm of the innominate artery as a complication of right subclavian vein catheterization. We report a case of a 55-year-old woman on chronic hemodialysis admitted to the hospital with pneumonia and sepsis who underwent multiple attempts at placement of a right subclavian vein catheter. These were unsuccessful and resulted in arterial puncture. The patient was discharged, but returned to the hospital 2 weeks later with shortness of breath and stridor. Evaluation revealed a pseudoaneurysm of the innominate artery with compression of the airway, which was successfully repaired.     

Endovascular treatment of innominate artery stenosis via the bilateral brachial approach

Endovascular treatment (stenting) has evolved as an effective and safe treatment modality for symptomatic subclavian and innominate artery disease. Most of these patients have comorbid conditions associated with atherosclerotic vascular disease, which is responsible for the access site and increased difficulty of procedure. We report a case of symptomatic innominate artery stenosis with concomitant atherosclerotic disease of the abdominal aorta successfully treated with using coronary devices and the pull-through technique via the bilateral brachial approach.     

Percutaneous treatment of a femoral artery pseudoaneurysm using the StarClose vascular closure system

Formation of a femoral artery pseudoaneurysm is not infrequent after femoral arterial access. We successfully treated a pseudoaneurysm of the femoral artery using the StarClose vascular closure system. Closing device can be an alternative option for the treatment of pseudoaneurysm. © 2011 Wiley Periodicals, Inc.