Exclusion Of Pseudoaneurysm Research Articles

Exclusion of a left main pseudo aneurysm complicating SCAD by two overlapping DES - a case report.

SCAD is now recognized as an important cause of ACS in women, and its treatment is generally based on conservative therapy leading to complete cure. However, complete cure is not systematic, and data are lacking to identify patients at risk of malignant progression and to define the best therapeutic strategy.A 36-year-old woman with STEMI on SCAD extending from the LM to the middle LAD and circumflex artery, evolving under medical treatment to a large LM pseudo aneurysm. After CT evaluation and IVUS measurement, the patient underwent pseudo aneurysm exclusion by implantation of two overlapping DES on his collar. The choice of conservative treatment in the initial phase, given the extension of SCAD to all left coronary arteries, and the management of this voluminous LM pseudo aneurysm by implantation of two overlapping DES rather than by a covered stent or coil embolization, can be discussed here.

Abstract 12115: TAVR Endocarditis Complicated by Aortic Root Pseudoaneurysm

Case Presentation: An 83-year-old man with hypertension, hyperlipidemia, atrial fibrillation, non-obstructive CAD, and severe AS status post TAVR 4 months prior was transferred from an outside hospital with reported persistent fever for one week. He had no other procedure recently including dental work. He was found to have staphylococcus epidermidis bacteremia in multiple blood cultures. His outside hospital TEE showed pulsatility of the non-coronary sinus with possible vegetations on the noncoronary cusp of the TAVR. On physical examination, he was afebrile, normotensive, and well appearing. His cardiovascular examination, laboratory tests, and chest radiograph were unremarkable, and he denied any chest pain or shortness of breath. His ECG revealed rate-controlled atrial fibrillation. A cardiac CTA revealed a 6 mm mobile hypodense thickening of the non-coronary prosthetic cusp, suspicious for vegetation and a contrast opacifying outpouching in the aortic root near the aorto-mitral curtain, suspicious for pseudoaneurysm. The patient underwent TAVR explantation, pseudoaneurysm exclusion, and AVR using a 23 mm bioprosthesis (Figure). He was discharged 8 days later on antibiotic treatment. At follow-up, the patient felt well with no complaints. Discussion: TAVR endocarditis with resulting aortic root pseudoaneurysm is an immensely rare entity, where there is lack of clinical data with regards to management. Guidelines of prosthetic valve endocarditis (for both TAVR and SAVR) recommend surgical treatment in such cases, although this recommendation was mostly based on the SAVR literature and many patients who undergo TAVR are at higher surgical risk at baseline. Recent studies on TAVR explantation showcase the risky nature of surgery in these patients, with high mortality rates, making treatment decisions less clear. Careful multidisciplinary discussion of risk and benefits is vital to guide clinical decision making in these complex patients.

Giant Right Coronary Artery Pseudoaneurysm Exclusion With Atrial Septal Defect Closure Device Following Coronary Rupture

Giant Right Coronary Artery Pseudoaneurysm Exclusion With Atrial Septal Defect Closure Device Following Coronary Rupture

AORTIC STENOSIS IN A COMPLEX CASE OF MAJOR VASCULAR SURGERY

<h3>Introduction</h3> Aortic stenosis (AS) in non-cardiac surgery increases perioperative risk of complications (1) <h3>Methods</h3> Case report of single patient <h3>Results</h3> A 70-year-old lady with complicated type 2 diabetes with renal, retinal and coronary affection is admitted to a district general hospital (DGH) with a decompensated heart failure. She is known to have hypertension, restrictive pneumopathy due to obesity (Body Mass Index of 49), stable angor with 2 stents in circumflex and right coronary artery, a moderate AS with moderately impaired Left ventricular function, and an untreated umbilical hernia. On admission microcitic anaemia was diagnosed with hemoglobin of 7.4 g/dl thought to be due to NSAID administration. After red blood cell (RBC) transfussion and deplective treatment was instituted, her dyspnea improved. Nevertheless, after 10 days of hospital admission she started with fever and positive blood cultures for Enterococcus faecium and Staphylococcus aureus Methicillin-resistant (MRSA). No vegetation was found in transthoracic and transoesophageal echocardiography, CT brain was normal but in the CT of the abdomen a infrarenal pseudoaneurysm of the Aorta was evidenced. She was transferred to our centre for treatment of the mycotic pseudoaneurysm. Uppon arrival to a PET-scan confirmed the active infective focus in the infra-renal Aorta. She was started on daptomicin+ ceftaroline. Due to high risk of opened surgery an endovascular exclusion of pseudoaneurysm was proposed to prevent aortic rupture. Discussion with heart team took place and aortic ballon valvuloplasty was deemed too risky due to infection scenario and moderate grade of AS. Preoperative optimisation was performed increasing furosemide due to congestive lung signs in chest X-ray. Uppon her arrival at interventional radiology suite, she was monitored invasively with left radial artery blood pressure and central venous pressure via right internal yugular vein. Intraoperative approach was based on conscious sedation with remifentanil and local anaesthesia. Neverthless, equipment for converting to a general anaesthesia was prepared and a second consultant anaesthetist kept available to give assistance to this remote area in case of emergency. During the procedure she maintained tendency to hypertension with mean arterial pressure of 100-110 mmHg and central venous pressure of 22 mmHg. Total diuresis was 100 ml. Blood gas analysis revealed Hb of 8.5 g/dl, p02 of 120 mmHg with 35% of facemask oxygen and pCO2 of 38 mmHg. 1 unit of RBC was transfused. The pseudoaneurysm was excluded with no residual leak. Postoperatively, she was admitted to a surgical intensive care unit where she stayed for 20 hours. After 12 days of uncomplicated hospital admission, she was discharged to original DGH hospital. <h3>Discussion</h3> Aortic stenosis in vascular surgery modify perioperative approach including intraoperative monitoring, type of anaesthesia and postoperative ICU admission. Preoperative optimisation and multidisciplinar assessment via Heart team of Aortic valvuloplasty is recommended. We report a high risk patient with heart failure and moderate AS that underwent an uneventful endovascular exclusion of mycotic pseudoaneurysm under conscious sedation and local anaesthesia.

Splenic Artery Embolization: Endovascular and Percutaneous Trans-splenic Approach

Abstract Background Splenic artery embolization is becoming a widely acceptable procedure for nonsurgical management in many clinical settings such as pseudoaneurysms or to salvage splenic functions in portal hypertension, hypersplenism, and secondary prophylaxis in variceal hemorrhage. Various published meta-analyses of splenic artery embolization found an overall success rate of 90% in vascular abnormality. Methods Retrospective study of all splenic artery embolization procedures in 1 year (January 2017–2018) to analyze various indications, procedure technique, and its modification as well as outcome measurement and complications. Results Total 16 splenic artery embolization procedures were performed including one case of percutaneous trans-splenic glue embolization in 1-year duration. Procedure Indication It included pseudoaneurysm (n = 7, 44%); trauma (n = 1, 6%); adjuvant to surgical splenectomy in hypersplenism (n = 3, 18%); secondary prophylaxis in portal hypertension, portosystemic varices with/without reduced platelet counts, or ascites (n = 4, 25%); and Budd-Chiari syndrome (n = 1, 6%). Total 13 (81%) procedures were elective, whereas emergency embolization was performed in 3 (18.7%). Endovascular technical success was 93.7% (n = 15) cases. Percutaneous trans-splenic embolization was performed in one (6%) case in which access to bleeding point was not possible. The embolic agents included combination of metallic coils (n = 14, 87.5%), Gelfoam (n = 6, 37.5%), polyvinyl alcohol (PVA) particles (n = 5, 31%), and cyanoacrylate glue (n = 3, 18.7%). Complication rate was low with development of splenic abscess with infected pyothorax in one (6%) case of hypersplenism requiring pigtail drainage with uneventful full recovery. Conclusion Splenic artery embolization provides safer nonsurgical options in management of cases such as trauma, hypersplenism, portal hypertension for control of hemorrhage and preservation of splenic function. Endovascular embolization facilitates complete exclusion of pseudoaneurysms in majority with percutaneous splenic embolization using glue or coils as a safer alternative where endovascular access to bleeding vessels is difficult.

Images demonstrate exclusion of pseudo-aneurysm 6 months after surgery

Images demonstrate exclusion of pseudo-aneurysm 6 months after surgery

Utilization of stent grafts in the management of arteriovenous access pseudoaneurysms.

Objective Endovascular stent graft repair for exclusion of pseudoaneurysm is currently being explored to replace open surgical repair as current management. The objective of the study was to evaluate the clinical safety and efficacy of endovascular stent graft intervention in pseudoaneurysms complicating arteriovenous reconstructions in patients on chronic hemodialysis. Methods A retrospective analysis of all pseudoaneurysms treated with stent grafts at our institution over a period of five years was performed. The indications for endovascular intervention included bleeding from the pseudoaneurysm, infection, and significant skin compromise overlying the pseudoaneurysm or combination of the above. The rates of technical success, complication, and primary patency were measured at one-week, one-month, and six-month follow-up. Results A total of 33 endovascular stent graft interventions in 29 patients were performed for the treatment of pseudoaneurysms. The average age of patients was 68 years (range 31-90 years), with 13 female. Diabetes and hypertension were present in 15 and 22 patients, respectively. In eight patients, there was evidence of active infection at the fistula site. The choice of stent grafts include Viabahn ( n = 31), Wallgraft ( n = 1), and i-Cast ( n = 1). The initial technical success rate was 94%. The two failed interventions included occlusion of inflow artery with immediate conversion to open procedure ( n = 1) and incomplete pseudoaneurysm exclusion ( n = 1). Primary patency at one month and six months was 83 and 60%, respectively. An additional balloon angioplasty of outflow tract or central stenosis was performed in 18 cases (54%). The explanation of stent grafts due to persistent or recurrent bacteremia/site infection was required in four out of eight patients. The average time to explanation was 93 days (range 6-204 days). Conclusion The stent graft implantation is a safe, minimally invasive and efficient way to control and manage arteriovenous accesses with pseudoaneurysms. In the presence of infection, this approach may be less durable.

Endovascular Stent Grafting in Posttraumatic Tibial Artery Pseudoaneurysms: Case Report

AbstractInfrapopliteal pseudoaneurysms are rare and usually occur secondary to trauma. Though there are no consensus regarding the management of the same, endovascular treatment has become an alternate option to open surgical management. In this report, we describe two cases of posttraumatic infrapopliteal pseudoaneurysms involving crural arteries. Both the cases were managed successfully with endovascular stent graft placement with complete exclusion of pseudoaneurysm. Our results show that endovascular stent grafting is a good alternative to open repair in infrapopliteal pseudoaneurysms, although long-term efficacy of this approach needs to be established.

Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device

BackgroundA post-irradiated carotid pseudoaneurysm at the skull base can cause life-threatening blowout syndrome. Conventional treatments include parent vessel occlusion, endovascular coiling or covered stenting. Use of the Pipeline embolization device...

Large Aortic Pseudoaneurysm and Subsequent Spondylodiscitis as a Complication of Endovascular Treatment of Iliac Arteries

Both aortic pseudoaneurysm following endovascular aortoiliac reconstruction and spondylodiscitis subsequent to endograft infections are rare complications. We present a case of aortic false aneurysm following iliac arteries treatment complicated by spondylodiscitis after its endovascular repair. In this patient, a huge aortic pseudoaneurysm was diagnosed and treated in an emergency setting a few days after the procedure. A left aortomonoiliac endograft was placed and a femoro-femoral crossover bypass was performed. Afterward, the patient developed a stent graft infection and a lumbar spondylodiscitis. The patient was managed with a conservative treatment and, after 4 years, he continues to live. Analyzing this case, we would like to point out the following aspects: any procedure, although well established and technically simple, can cause life-threatening complications; hematomas resulting from endovascular exclusion of large pseudoaneurysms could be drained, to prevent bacterial infections.

Transarterial embolization for acute head and neck bleeding: Eight‐year experience with emphasis on rebleeding risk in cancer patients

To present our 8-year experience with transarterial embolization for head and neck bleeding, with an emphasis on the need for repeated procedures in patients treated for head and neck cancer. Retrospective case series. Tertiary university-affiliated medical center. The cohort included 49 patients who underwent transarterial embolization for acute head and neck bleeding in 2004 to 2012. Outcome measures included procedural success, recurrence, complications, and outcome. Mean patient age was 60.3 years. Indications for transarterial embolization were bleeding from a tumor (42%), nasal bleeding (36%), bleeding related to neck trauma (8%), tracheal stomal bleeding (8%), and other (4%). Twelve of 21 patients with tumors had been treated by chemoradiation. At least one repeated procedure was required in 11 patients, of whom nine had a history of chemoradiation and surgery for cancer; four of them required a stent for exclusion of pseudoaneurysm, and in six the recurrence presented late after the initial procedure (1 month to 5 years). Major complications included cerebrovascular accident in one patient and death due to major bleeding in two cases. Twenty-one patients died during follow-up, including nine patients with cancer. Eleven deaths occurred up to 4 years after embolization. Transarterial embolization is an important tool for the control of head and neck bleeding. Special attention should be given to patients after chemoradiation for cancer. Every effort should be made to control the bleeding because some patients may gain a reasonable lifespan and improved quality of life. 4.

Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization

To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up. Sixty-one patients (39 men; mean ± standard deviation age 66.1 ± 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 ± 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III). Among the 48 patients, 26 (54 %; 17 men, aged 64.3 ± 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 ± 9.5 months (range 12-42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved. Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.

Endoscopic extraction of vascular embolization coils that have migrated into the biliary tract in a liver transplant recipient

Hepatic artery pseudoaneurysm (HAA) is a rare vascular complication of liver transplantation. Minimally invasive radiological interventions are generally considered before seeking surgical treatment of HAA. Coil embolization of the aneurysmal sac and or exclusion of pseudoaneurysm by deploying a stent over the aneurysm are effective interventions to control hemobilia arising from the HAA. Migration of coils inside the bile duct is a rarely reported complication in post-hepatic transplantation. Treatment options remain largely unexplored due to the rarity of its occurrence. Endoscopic retrograde cholangiographic removal of migrated vascular coils in the common bile duct following embolization of HAA has not been described in a liver transplant setting. We report a liver transplant recipient who underwent uneventful and successful endoscopic removal of migrated coils into the bile duct.

Technical Strategy for the Endovascular Management of Ascending Aortic Pseudoaneurysm

We present two cases of ascending aortic pseudoaneurysm exclusion with off-the-shelf aortic stent grafts. The right common carotid artery was used for access to facilitate graft delivery. Control of graft deployment was aided using a compliant right atrial occlusion balloon to lower cardiac output at the time of deployment. Transesophageal echocardiography facilitated the sizing and positioning of the right atrial balloon and was used to survey the heart and ascending aorta on successful exclusion of the pseudoaneurysm. These simple maneuvers made an uncommon procedure straight forward, predictable, and successful.

Analysis of Infection Risk Following Covered Stent Exclusion of Pseudoaneurysms in Prosthetic Arteriovenous Hemodialysis Access Grafts

Purpose: To determine whether exclusion of pseudoaneurysms with the use of a covered stent in prosthetic arteriovenous (AV) hemodialysis access grafts impacts the incidence of eventual AV graft infection. Materials and Methods: Review of an interventional radiology database for prosthetic AV graft interventions involving stent deployment anywhere within the AV graft circuit revealed 235 interventions in 174 patients between November 2004 and December 2008. Incidence of AV graft infection was analyzed based on stent type (bare metal vs covered), location, and indication for stent deployment on a per-stent, per-procedure, and per-graft basis. Results: A total of 16.3% of the stent-implanted AV grafts were eventually surgically excised as a result of graft infection. Covered stents used to treat an intragraft pseudoaneurysm were more commonly associated with subsequent graft infection compared with bare or covered stents deployed within the graft for other reasons: 42.1% versus 18.2% (P .011). Stents deployed in an intragraft location were also associated with a higher incidence of graft infection compared with those deployed at the venous anastomosis or outflow vein: 26.9% versus 6.9% (P .001). No significant difference was identified in infection rates between bare and covered stents. Conclusions: Covered stent exclusion of intragraft pseudoaneurysms demonstrated a significant correlation with eventual prosthetic AV graft infection.

Analysis of Infection Risk following Covered Stent Exclusion of Pseudoaneurysms in Prosthetic Arteriovenous Hemodialysis Access Grafts

Analysis of Infection Risk following Covered Stent Exclusion of Pseudoaneurysms in Prosthetic Arteriovenous Hemodialysis Access Grafts

Guidelines are Local, Commentary on “Analysis of Infection Risk following Covered Stent Exclusion of Pseudoaneurysms in Prosthetic Arteriovenous Hemodialysis Access Grafts”

Guidelines are Local, Commentary on “Analysis of Infection Risk following Covered Stent Exclusion of Pseudoaneurysms in Prosthetic Arteriovenous Hemodialysis Access Grafts”

Analysis of Infection Risk following Covered Stent Exclusion of Pseudoaneurysms in Prosthetic Arteriovenous Hemodialysis Access Grafts

Purpose To determine whether exclusion of pseudoaneurysms with the use of a covered stent in prosthetic arteriovenous (AV) hemodialysis access grafts impacts the incidence of eventual AV graft infection. Materials and Methods Review of an interventional radiology database for prosthetic AV graft interventions involving stent deployment anywhere within the AV graft circuit revealed 235 interventions in 174 patients between November 2004 and December 2008. Incidence of AV graft infection was analyzed based on stent type (bare metal vs covered), location, and indication for stent deployment on a per-stent, per-procedure, and per-graft basis. Results A total of 16.3% of the stent-implanted AV grafts were eventually surgically excised as a result of graft infection. Covered stents used to treat an intragraft pseudoaneurysm were more commonly associated with subsequent graft infection compared with bare or covered stents deployed within the graft for other reasons: 42.1% versus 18.2% ( P = .011). Stents deployed in an intragraft location were also associated with a higher incidence of graft infection compared with those deployed at the venous anastomosis or outflow vein: 26.9% versus 6.9% ( P < .001). No significant difference was identified in infection rates between bare and covered stents. Conclusions Covered stent exclusion of intragraft pseudoaneurysms demonstrated a significant correlation with eventual prosthetic AV graft infection.

Endovascular Treatment of a Giant Aorto-Ostial Renal Artery Pseudoaneurysm

Vascular complications after lumbar laminectomy are rare, but are potentially life-threatening. A 59-year-old man presented with progressive and worsening abdominal pain over several weeks. Multidetector computed tomography angiography revealed a large aorto-ostial left renal artery pseudoaneurysm 3 years after lumbar laminectomy. The pseudoaneurysm was successfully treated with a combination of various endovascular techniques ("jailed" microcatheter technique, stent-graft implantation, thrombin injection, balloon remodeling technique, Onyx application), with preserved patency of the left renal artery and pseudoaneurysm exclusion on 6-month follow-up multidetector computed tomography angiography. The size and location of this pseudoaneurysm and the combination of different techniques for endovascular treatment provides an update on current endovascular technology. Combination of different endovascular techniques can be a safe and feasible alternative for the treatment of complicated iatrogenic postlaminectomy vascular injuries and renal artery pseudoaneurysms.

Endovascular treatment of iatrogenic axillary artery pseudoaneurysm under echographic control: A case report

AimBrief case report of the treatment of a large axillary artery pseudoaneurysm after a pacemaker using a left brachial cutdown and a retrograde delivery of a covered stent using ultrasound and fluoroscopic guidance. The patient's renal function precluded the use of contrast materials.Case ReportA 77 years old man presenting with acute renal failure and haemoglobin decrease arrived with an expanding pseudoaneurysm of the left axillary artery from a pacemaker placement. Considering the site of the lesion and patient's comorbidities, under echographic control, a Hemobahn® stent-graft was placed; fluoroscopy assisted manipulation of guidewires and sheaths into the aortic arch. The procedure was successfully ended without any complications. At 8 months the stent graft was still patent.ConclusionUltrasound guidance may represent an alternative for pseudo-aneurysm exclusion without any use of contrast medium, especially in those patient where lesions are easily detectable using ultrasonography and when comorbidities contraindicate aggressive surgical or angiographic approach.