Common Femoral Artery Pseudoaneurysm Research Articles

A Technique to Treat Common Femoral Artery Pseudoaneurysms: Prostar XL Percutaneous Vascular Closure Device

A Technique to Treat Common Femoral Artery Pseudoaneurysms: Prostar XL Percutaneous Vascular Closure Device

Emergency endovascular management of acute thoracic aortic pathology A safe and feasible option

Endovascular repair has revolutionised the emergency treatment of thoracic aortic disease. We report our 10 year experience using this treatment in emergency cases.A prospectively maintained vascular database was analysed. Patients’ medical records and CT images stored on the hospital PACS system were also reviewed. Statistical analysis was done using IBM SPSS V21.There were a total of 59 thoracic aortic stenting procedures of which 33 (60% males with a mean age of 58 yrs) were performed for emergency thoracic pathologies: traumatic transection (n = 10), ruptured aneurysm (n = 6), non-traumatic dissection (n = 8) and penetrating aortic ulcer (n = 9). All patients had self-expanding endografts implanted. Two patients required debranching procedures before the endovascular treatment.Thirty-day mortality was 12.1% (4/33). 70% of patients received a single device. There were 7 procedure related complications, 6 requiring re-intervention: thoracotomy and drainage in 2 patients, proximal graft extension in 2, open drainage of groin haematoma in 1 and open repair of a common femoral artery pseudo-aneurysm in one patient.In total 23 patients were transferred from 11 centres nationwide. There were no mortalities or other complications related to patient transfer from peripheral centres. Although acute thoracic aortic pathology is life threatening, appropriate blood pressure management and treatment of associated injuries can result in favourable outcomes. Endovascular repair is a safe and effective treatment option which enables patients to be treated with reduced morbidity and mortality. Transfer of patients with acute pathology to a tertiary centre can safely be performed.

Day-Case Treatment of Peripheral Arterial Disease: Results from a Multi-Center European Study.

The purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease. This was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals. Exclusion criteria were not related to the type of lesion and included unavailability of an adult able to take care of patient overnight; high bleeding risk and ASA score ≥4. Primary efficacy outcome was the rate of procedures performed on an outpatient basis requiring no further hospitalization and primary safety outcome was freedom from 30-day major complications' rate. The study included 652 patients (male 75%; mean age 68±10years; range: 27-93), 24.6% treated for CLI. In 53.3% of the cases a 6Fr sheath was used. Technical success was 97.1%. Haemostasis was obtained by manual compression in 52.4% of the accesses. The primary efficacy outcome occurred in 95.4% (622/652 patients) and primary safety outcome in 98.6% (643/652 patients). Major complications included five (0.7%) retroperitoneal hematomas requiring transfusion; one (0.1%) common femoral artery pseudoaneurysm successfully treated with US-guided thrombin injection, two cases of intra-procedural distal embolization treated with catheter-directed local thrombolysis and one on-table cardiac arrest necessitating >24h recovery. No major complication was noted after same-day discharge. Day-case endovascular procedures for the treatment of IC or CLI can be safely and efficiently performed in experienced IR departments of large tertiary hospitals.

Endovascular retrograde recanalization in Asian critical limb ischaemia patients

To evaluate endovascular retrograde recanalization of critical limb ischaemia (CLI) patients with chronic total occlusions (CTOs) in an Asian population. We conducted a single centre-based retrospective review of CLI patients with CTOs who had undergone endovascular retrograde recanalization using the subintimal arterial flossing with antegrade-retrograde intervention technique. A total of 40 CLI patients with CTOs underwent endovascular intervention. The median age was 71 years; 67.5% were males and Chinese accounted for 65% of the patients, of which 55% were in Rutherford category 6, 37.5% in category 5 and 7.5% in category 4. Antegrade-retrograde access was performed via the femoral artery in 39 cases and the brachial artery in one case for the proximal puncture, and the following arteries for the distal puncture: superficial femoral, n = 4 (10%); popliteal, n = 4 (10%); anterior tibial, n = 12 (30%); dorsalis pedis, n = 9 (22.5%); peroneal, n = 4 (10%) and posterior tibial, n = 7 (17.5%). Technical success was high at 92.5% (n = 37). After intervention, 25% (n = 10) had below-knee triple vessel runoff, 52.5% (n = 21) had double vessel runoff and 15.0% (n = 6) had single vessel runoff. Stenting for target vessel dissections was required in 12 patients. There were two cases of significant bleeding; one common femoral artery pseudoaneurysm was treated with ultrasound-guided thrombin injection and another case of distal puncture site bleeding only required compression. Limb salvage at 1 year was 92.5% (n = 37). The subintimal arterial flossing with antegrade-retrograde intervention technique is safe with high technical success rates and acceptable outcomes in Asian CLI patients with CTOs.

Management of vascular complications following transcatheter aortic valve implantation

Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are frequent and their management is challenging. To report the incidence, predictors and management of VCs following percutaneous transfemoral TAVI (TF-TAVI) at a single centre. We analyzed 102 consecutive patients who underwent percutaneous TF-TAVI between August 2008 and December 2013. All endpoints were evaluated at 30 days and 6 months according to Valve Academic Research Consortium-2 criteria. VC percutaneous treatment success was defined as residual stenosis<30%, absence of blood extravasation and absence of surgical or repeat endovascular intervention at 30 days. Twenty-two patients (22%) experienced VCs, including five patients (5%) with major VCs. Mortality at 30 days was significantly higher in patients with major VCs than in patients without major VCs (60% vs 3%; P=0.001). Patients with VCs had more life-threatening or major bleeding (23% vs 5%; P=0.02), but no difference in terms of need for blood transfusion was observed. Endovascular treatment was used in 13 of 22 patients with VCs (59%) and was successful in 11 of these 13 patients (85%). Primary surgical repair was necessary in only 1/22 (5%) patients, for a common femoral artery pseudoaneurysm 2 weeks after the TAVI procedure. VCs following TF-TAVI are frequent. Major but not minor VCs are associated with increased mortality. Percutaneous management of VCs is feasible and safe, and surgery is rarely needed.

Favorable Single-Operator Experience with VasoSeal , a Vascular Closure Device with Extravascular Collagen in a Large High-Risk Cohort of Patients Undergoing Percutaneous Coronary Interventions

BACKGROUND: Prolonged duration of manual or mechanical compression at the site of femoral artery access after sheath removal upon completion of coronary procedures followed by extended period of bed rest has significant logistical and practical problems for both patients and hospital staff. The availability of vascular closure devices (VCDs) has ushered in a new era in the routine clinical practice in the catheterization laboratory. AIM: The aim of this prospective study was to assess the effectiveness and safety of the use of the VCD VasoSeal, a collagen plug, in patients undergoing cardiac catheterization and/or percutaneous coronary intervention (PCI). PATIENTS AND METHODS: VasoSeal was employed over 2.5 years in 388 consecutive patients mostly presenting with acute coronary syndromes and subjected mainly to PCI procedures performed via transfemoral arterial access. All the patients who underwent PCI were given 7,000 IU of heparin intravenously during the procedure and had been receiving or were acutely loaded with dual antiplatelet therapy (aspirin and clopidogrel). The majority (90.7%) of patients also received a platelet glycoprotein IIb/IIIa inhibitor during and for 12-14 hours after the procedure. The sheaths were removed at the end of the procedure and hemostasis achieved with VasoSeal. RESULTS: Deployment of the VCD was successful in 99.2%. Complete hemostasis without bleeding or hematoma was obtained in 95.4% of cases (370/388). In 3 patients VasoSeal could not be or was partially deployed. The mean time required for the placement of VasoSeal was 1 min. The mean time-to-hemostasis was 3 min. The mean time-to-mobilization was 3 hours. Only one patient developed a pseudoaneurysm of the right common femoral artery; the lesion was treated with ultrasonography -guided compression. In addition, 13 small local hematomas and 2 large inguinal hematomas (one requiring blood transfusion) were recorded. In 2 cases retroperitoneal bleeding occurred, requiring blood transfusion in one of them. Local infection (cellulitis) responding to antibiotic treatment was observed in 2 patients. No patient required local surgical intervention. CONCLUSION: VasoSeal was a safe collagen closure device characterized by a high success rate of deployment and highly successful hemostasis with few manageable complications in a very high-risk patient cohort undergoing PCI under heavy anticoagulation and antiplatelet drug therapy. In these patients this vascular closure device reduced the time-to-hemostasis and time-to-mobilization and the incidence of complications.

Common Femoral Artery Pseudoaneurysm Associated with Arteriovenous Fistula

Background Thrombin injection (TI) is a common modality for the treatment of femoral artery pseudoaneurysm (PSA) of arterial access sites. It has decreased the need for open repair in this cohort of patients who often have increased surgical risk. Deep venous thrombosis and venous thromboembolism (VTE) have been reported after TI for PSA in the presence of an arteriovenous fistula (AVF). A combined treatment modality using ultrasound-guided TI with concomitant balloon occlusion of the AVF is described. Patient A high cardiac risk patient presented with a large pulsatile right groin mass after cardiac catheterization. Ultrasound identified a PSA arising from the right common femoral artery. The anatomy was suitable for TI; however, a large AVF also was present. The patient was a poor surgical candidate because of cardiac morbidity and body habitus. Methods The patient was taken to the hybrid vascular operative suite. Conscious sedation was administered. Venous access was obtained via the right internal jugular vein. Venography identified the AVF in the right common femoral vein. Thrombin was injected into the right groin PSA using direct ultrasound visualization. Simultaneous fluoroscopic-guided balloon inflation was used to occlude the common femoral vein and prevent flow through the AVF. Postinjection venography and Doppler examination of the femoral vessels were performed. Results The PSA was successfully occluded. There was no identifiable venous thrombus. Doppler examination also showed resolution of the AVF. There were no clinical signs or symptoms of pulmonary embolism. Conclusion TI of femoral artery PSA associated with AVF has increased risk of VTE. Concomitant venous occlusion during TI of a PSA may decrease the risk of VTE in the setting of a large AVF. This has the potential to expand the indications for TI in the high-risk surgical patient.

Femoral artery pseudoaneurysm due to Candida albicans in an injection drug user

Candida arteritis is an uncommon condition but important to recognize due to the risk of significant morbidity and the difficulty in management of the enduring fungal infection. The authors report a rare case of a man with a femoral artery pseudoaneurysm with persistent Candida albicans infection, as a complication of infective endocarditis. The 23-year-old man, with a history of chronic intravenous drug use and Type I diabetes mellitus, presented with left groin pain, paresthesia of his left foot, and a pulsatile mass in the inguinal region. On imaging, he was found to have a pseudoaneurysm of the left common femoral artery, which later ruptured. Further investigation revealed vegetations on the mitral and aortic valves as well. Initial blood cultures were negative. He underwent multiple surgical interventions including replacement of the mitral and aortic valves and resection of the left common femoral artery with autogenous revascularization. In addition, he was commenced on intravenous antifungal therapy. Postoperatively, he continued to experience significant pain in the left groin and had two episodes of rerupture of the femoral artery that was consequently surgically repaired. Histological examination of the resected valves revealed vegetations with a mixture of fungal elements and bacterial cocci. The femoral artery resection specimens revealed evidence of infectious arteritis and the presence and persistence of C. albicans organisms in subsequent specimens. This case highlights the importance of an accurate diagnosis and aggressive management of fungal mycotic aneurysms in at-risk populations.

Spontaneous External Rupture of Femoral Pseudoaneurysm

Drug abuse can lead to many life-threatening complications, the most frequent of which are overdoses and infections.We report here the case of a 38-year-old long-term drug abuser found dead in a near-sitting position on his bed at home, by his roommate. A pillow imbued with blood was recovered on his right groin region. At autopsy, we observed a ruptured pseudoaneurysm (false aneurysm) of the right common femoral artery. No obvious signs of infection were present. This article focuses the attention of the reader on an unusual complication of parenteral drug abuse with a rare but potentially lethal outcome; to the best of our knowledge, this is the first report of a fatal hemorrhage from a ruptured arterial femoral pseudoaneurysm as a complication of drug injection in the forensic literature.

A “modified crossover technique” for vascular access management in high‐risk patients undergoing transfemoral transcatheter aortic valve implantation

To describe results from our "modified crossover technique" for vascular access management during transcatheter aortic valve implantation (TAVI). Vascular access management remains a major cause of complications following TAVI due to the large bore sheaths required. All suitable patients undergoing TAVI in our center, between June and August 2011, underwent our "modified crossover technique," which enables the passage of a balloon through left radial access and inflation in the proximal iliac to allow percutaneous closure in a clean field. In total, 15 patients were included: the logistic EuroSCORE was 19.7 ± 12.1% and STS score 5.7 ± 5.6%. The mean therapeutic femoral access site diameter was 8.1 ± 1.0 mm. Ten (66.7%) patients received Edwards SAPIEN™ XT (two using the new E-sheath) and five (33.3%) patients a Medtronic CoreValve ReValving System® device. The "modified crossover technique" was used successfully in all patients. There were three vascular complications occurring at the therapeutic access site: one rupture of the external iliac artery, one Prostar failure, and one pseudoaneurysm of the right common femoral artery. All complications were successfully treated percutaneously with covered stent implantation via access from the contralateral femoral artery. In view of the balloon inflation from the left radial artery, the complications could be treated in a clean field with minimal blood loss. Our "modified crossover technique" using the left radial artery as the diagnostic site for balloon inflation appears a helpful adjunct in managing TAVI vascular access sites.

Treatment of Infected Pseudoaneurysm of Femoral Artery after Vascular Closure Device Deployment: A Practical Solution

Like other invasive procedures, percutaneous coronary interventions are associated with complications. Most common access site for these procedures is common femoral artery. Complications such as groin and retroperitoneal hematoma can be encountered as well as pseudoaneurysms, arteriovenous fistulas, acute arterial occlusion, and infection. When infected pseudoaneurysm occurs, surgical treatment can be extremely difficult. We present a case of the patient in whom infected pseudoaneurysm of common femoral artery developed after percutaneous coronary intervention and was successfully treated by surgical excision and autoarterial graft insertion.

Color-Doppler-Ultrasound guided compression to repair common femoral artery pseudoaneurysm

Background The insurgence of post-catheterization pseudoaneurysms has dramatically increased among the elderly if compared to the past, due to the spreading of endovascular treatments, both of diagnostic and surgical nature. The case presented here shows the usefulness of eco Color Doppler in this kind of pathology.

Behcet's Disease presenting as Bilateral Common Femoral Artery Pseudo-aneurysms

We present a 25-year-old Chinese male who was diagnosed with Behcet's disease after suffering bilateral femoral artery pseudo-aneurysms. This was treated surgically by excising the pseudo-aneurysm and achieving vascular continuity by harvesting the long saphenous vein as a conduit. Arterial pseudo-aneurysms are rare vascular manifestations in Behcet's disease and management with vein is advisable as patients are frequently on long-term immunosuppression which puts them at risk of infections with prosthetic grafts. Behcet's Disease Presenting as Bilateral Common Femoral Artery Pseudo-aneurysmsEJVES ExtraVol. 17Issue 6PreviewWe present a 25-year-old Chinese male patient who was diagnosed with Behcet's disease after suffering bilateral femoral artery pseudo-aneurysms. This was treated surgically by excising the pseudo-aneurysm and achieving vascular continuity by harvesting the great saphenous vein as a conduit. Arterial pseudo-aneurysms are rare vascular manifestations in Behcet's disease and management with vein is advisable as patients are frequently on long-term immunosuppression which puts them at risk of infections with prosthetic grafts. Full-Text PDF Open Access

Behcet's Disease Presenting as Bilateral Common Femoral Artery Pseudo-aneurysms

We present a 25-year-old Chinese male patient who was diagnosed with Behcet's disease after suffering bilateral femoral artery pseudo-aneurysms. This was treated surgically by excising the pseudo-aneurysm and achieving vascular continuity by harvesting the great saphenous vein as a conduit. Arterial pseudo-aneurysms are rare vascular manifestations in Behcet's disease and management with vein is advisable as patients are frequently on long-term immunosuppression which puts them at risk of infections with prosthetic grafts.

Emergency Stent Grafting After Unsuccessful Surgical Repair of a Mycotic Common Femoral Artery Pseudoaneurysm in a Drug Abuser

Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.

Large Pseudoaneurysm Associated with Compressive Symptoms after Cardiac Catheterization

This case study follows a patient who presented with a right burning thigh pain and diffuse swelling 6 months after cardiac catheterization. The patient had a medical history of coronary artery disease, hypertension, and at the time was also on warfarin therapy for atrial fibrillation. This persistent discomfort and pain was limiting her ambulation and prompted a trip to the emergency room; she was then sent to our lab for further evaluation for a pseudoaneurysm. In the course of evaluating this patient with duplex ultrasound and Doppler waveforms, a very large common femoral artery pseudoaneurysm (PSA) with a short &lt;2-mm neck and obvious significant compression of the common femoral artery and common femoral vein was identified. Because of the short neck of the PSA, an open surgical repair was performed. Surgical notes observed significant compression of the common femoral nerve as well as the common femoral artery and vein. Postoperatively, there were no complications, and the patient has had some improvement in her neurological symptoms as well as completes resolution of the swelling of her right leg. Although postcardiac catheterization complications are minimal (0.5%), the use of ultrasound imaging is a simple and cost-effective means of addressing persistent patient discomfort and pain after cardiac catheterization.

Acute Arterial Occlusion after Ultrasound-Guided Thrombin Injection of a Common Femoral Artery Pseudoaneurysm with a Wide, Short Neck

Ultrasound-guided thrombin injection (UGTI) has emerged as the preferred treatment modality for pseudoaneurysms occurring as a result of percutaneous femoral arterial interventions. UGTI is safe and effective, with few complications. Native arterial thrombosis has been rarely reported in the literature following UGTI and has usually been attributed to excessive thrombin injection. We report a case of femoral arteria thrombosis occurring following UGTI of a 4 cm postcatherization pseudoaneurysm with a wide, short neck successfully treated by surgical intervention. The large size of the neck of this pseudoaneurysm likely contributed to the development of this complication.

Percutaneous Thrombin Injection of a Femoral Artery Pseudoaneurysm with Simultaneous Venous Balloon Occlusion of a Communicating Arteriovenous Fistula

An 82-year-old woman developed acute occlusion of her right coronary artery. She underwent percutaneous coronary stent placement and aortic balloon pump installation. In the postprocedural period, she developed a common femoral artery pseudoaneurysm (PSA) that communicated with the common femoral vein via an arteriovenous fistula (AVF). After unsuccessful ultrasound-guided compression, ultrasound-guided thrombin injection of the PSA was performed, with simultaneous balloon occlusion of the common femoral vein at the level of the AVF. There was complete thrombosis of the PSA and AVF.

Management of a retained catheter in an arteriovenous malformation

The long-term effects of retained catheters in patients are not well known; therefore, the clinical presentation may differ. The authors present the case of a 21-year-old man with a pseudoaneurysm of the left common femoral artery, which developed 3 months after a transfemoral microcatheter embolization of a cerebral arteriovenous malformation (AVM) in which the catheter was inadvertently glued into the AVM and was retained at the groin.

Tuberculous pseudoaneurysm of the femoral artery complicated by cutaneous tuberculosis of the foot: A case report

An infected pseudoaneurysm of the right common femoral artery in a 69-year-old patient receiving methotrexate therapy was confirmed to have been caused by Mycobacterium tuberculosis. After surgical excision of the aneurysm and revascularization using femoral vein, cutaneous manifestations of M tuberculosis infection in the foot complicated the course. We hypothesized that methotrexate may have triggered the reactivation of dormant tuberculosis in this patient. Because extrapulmonary tuberculous pseudoaneurysms are clinically similar to other types of infected pseudoaneurysm, M tuberculosis infection should always be suspected during the initial diagnosis. We propose that mycobacterial cultures should be routine when initial cultures and Gram stain are negative.