Femoral Artery False Aneurysms Research Articles

Lateral circumflex femoral artery false aneurysm as a complication of intertrochanteric hip fracture with displaced lesser trochanter

We present a patient who suffered an unstable intertrochanteric hip fracture and underwent osteosynthesis with a trochanteric nail. During the postoperative period, he presented a pseudoaneurysm of the lateral circumflex branch of the deep femoral artery secondary to a displaced fracture of the lesser trochanter. With the suspected diagnosis due to indirect clinical and radiological signs and confirmation by Doppler ultrasound and computed tomography angiography, a transverse arterial embolization with resolution of the symptoms was carried out. The pseudoaneurysm of the deep femoral artery or its branches is a very rare complication after intertrochanteric hip fractures, which must be taken into account in the late appearance of edema and hematoma in the thigh and evidence of medial and superior displacement of the lesser trochanter. The diagnosis is confirmed by CT angiography and the treatment by percutaneous arterial embolization has good results without the need of excising the lesser trochanter.

Treatment of Post Cardiac Catherization Femoral Artery False Aneurysms Using Ultrasound Guided Compression Therapy : Experience at King Hussein Medical Center

Treatment of Post Cardiac Catherization Femoral Artery False Aneurysms Using Ultrasound Guided Compression Therapy : Experience at King Hussein Medical Center

Systemic or Endoventricular Thrombolysis to Treat HeartWare Left Ventricle Assist Device Thrombosis: A Clinical Dilemma.

Endoventricular thrombolytic procedure (ETP) has been used to treat continuous-flow left ventricle assist device (CF-LVAD) thrombosis. The study aims to investigate the occurrence of complications after ETP. Data were retrospectively reviewed and analyzed in a series of patients who underwent CF-LVAD followed by ETP. Since November 2010, 20 patients underwent HeartWare CF-LVAD implantation at our institute. Four patients (20%) developed pump thrombosis and underwent a total of nine ETPs with tissue plasminogen activator infused into the left ventricle. The mean age was 60.2 ± 9 years. ETP was performed via either the femoral (n = 6) or radial artery (n = 3). Five ETPs (55.5%) were complicated by left and right radial artery occlusion, two by groin hematomas, and one by femoral artery false aneurysm. ETP carries a strong risk of vascular access complications that, in CF-LVAD patients, may add to the already complex clinical profile and economic burden; thus, a less invasive treatment is advisable whenever required.

Complications of Endomyocardial Biopsy in Heart Transplant Patients: A Retrospective Study of 2117 Consecutive Procedures

Background Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of graft rejection after heart transplantation (HT). Our purpose was to evaluate the rate of complications of this invasive procedure. Methods This was a retrospective study of 175 patients, who were transplanted between November 2003 and October 2010 and survived more than 1 month after surgery. We evaluated the number of inconclusive EMB and described the incidence, nature, and subsequent management of several complications associated with this procedure. Results Over a period of approximately 7 years, we performed 2217 EMB yielding 4972 specimens, namely, an average of 2.3 fragments per procedure. The majority of EMBs (95.3%) were performed by the femoral approach. Only 12 EMB (0.57%) were inconclusive. The overall complication rate was 0.71%. During puncture, one patient experienced a vasovagal reaction and another one, a femoral artery false aneurysm. During the biopsy, there was one case of cardiac perforation with tamponade, two cases of supraventricular tachycardia, and three atrioventricular conduction abnormalities. In 19 patients, histological analysis revealed chordal tissue, but only two patients developed mild tricuspid regurgitation. We observed five cases of coronary artery fistulae. The clinical outcomes were favorable in all cases. Conclusion EMB proved to be a suitable, safe method to monitor rejection after HT.

The Changing Face of Femoral Artery False Aneurysms

Objectives. To review the aetiology and method of treatment of all femoral artery false aneurysms from a single centre during the last 9 years.Design. Retrospective case-note study.Methods. All patients with a diagnosis of false aneurysm were identified from the hospital data-base between January 1995 and September 2003. A manual search of the case-notes was performed, and data collected on the location, cause and method of repair of the false aneurysm. For all patients with a diagnosis of femoral artery false aneurysm, the patients' medical and drug history and admission time attributable to the false aneurysm were recorded.Results. One hundred and seven patients were identified. Seventy-nine had false aneurysms of the femoral artery. The majority (40.5%) were caused by coronary angiography, the second commonest cause being breakdown of previous graft anastomosis (29.1%). Over time, the method of treatment became increasingly radiological (most commonly ultrasound-guided thrombin injection), resulting in a significantly reduced hospital admission time (P=0.018).Conclusions. The incidence of femoral artery false aneurysms appears to be increasing. This is largely a result of an increase in the number of cardiac interventional and diagnostic procedures performed. The introduction of ultrasound-guided thrombin-injection has reduced the inpatient stay of patients with femoral false aneurysms.

Treatment of iatrogenic femoral artery false aneurysms with ultrasound-guided thrombin injection.

The aim of this paper is to review our results of treating iatrogenic pseudoaneurysms of the femoral artery with ultrasound-guided thrombin injection. A retrospective review was carried out of all patients referred for this procedure over a 1-year period from December 1999 to December 2000. Forty-five patients were referred and, of these, 44 were eligible for this treatment, with 300-2500 units of thrombin being injected directly into the false aneurysms under ultrasound guidance. The procedure was well tolerated with no patients requiring sedation or analgesia. There was a primary success rate of 95%, although in four of the patients, there was recurrence on repeat ultrasound performed 2-5 days post-procedure and a second injection of thrombin was required for permanent thrombosis to be achieved. No complications relating to the procedure occurred. Our results confirm increasing evidence in the published research that thrombin injection of femoral artery false aneurysms is a safe and effective treatment.

Thrombin injection versus compression of femoral artery pseudoaneurysms

Objective: The compression of femoral artery pseudoaneurysms is a time consuming, painful, and sometimes unsuccessful procedure. Thrombin injection has been advocated as a superior alternative. In this study, we compare our experiences with both techniques. Methods: All the records of femoral artery false aneurysms that were treated in the vascular laboratory from January 1996 to April 1999 were retrospectively reviewed. Treatment with ultrasound scan–guided compression was compared with treatment with dilute thrombin injection (100 U/mL). Results: Both groups had similar demographics and aneurysm sizes ( P > .2). Of the pseudoaneursyms, 88% were caused by cardiac catheterization and the others were the results of femoral artery access for cardiac surgery (6%), arteriography (5%), and renal dialysis (1%). Compression was successful in 25 of 40 patients (63%). Nine persistent aneurysms necessitated operation, and six were treated successfully with thrombin injection. Primary thrombin injection successfully obliterated 21 pseudoaneurysms in 23 patients. Overall, 27 of 29 pseudoaneurysms were treated successfully with thrombin injection (93%). Thrombosis occurred within seconds of the thrombin injection and required, on average, 300 units of thrombin (100 to 600 units). The patients who underwent successful compression required an average of 37 minutes of compression (range, 5 to 70 minutes) and required analgesia on several occasions. No patients in the thrombin group required analgesia or sedation. Neither group had complications. A cost analysis shows that thrombin treatment results in considerable savings in vascular laboratory resource use but not in overall hospital expenditures. Conclusion: Ultrasound scan–guided thrombin injection is a safe, fast, and painless procedure that completely obliterates femoral artery pseudoaneurysms. The shift from compressive therapy to thrombin injection reduces vascular laboratory use and is less expensive, although it does not significantly impact hospital costs. (J Vasc Surg 1999;30:1052-9.)

Vascular complications of total abdominal perfusion and aortic stop-flow infusion

During a 2 year period (1992-1993), 149 patients with advanced abdominal cancer underwent total abdominal ischemic perfusion (TAP) and stop-flow infusion (SFI) 159 times in an attempt to achieve palliation. These procedures and aortic stop-flow infusion require insertion of balloon catheters into the abdominal aorta and inferior vena cava by a transfemoral approach. Flow is arrested for 15 minutes, during which time chemotherapeutic agents are infused into the aorta, distal to the balloon occlusion. Femoral access is by a surgical incision. The passage of the catheters is guided by fluoroscopy. Some tumor response was observed in 35% of the patients. Ten patients had major vascular complications; two iliac artery aneurysms were lacerated and required emergency repair. There were two femoral artery false aneurysms that required surgical correction, one early and one late. Aortic dissection was detected in four patients, but these did not require surgical intervention. Two patients had thrombosis distal to the occluded vessel, both required surgical intervention. To reduce the incidence of these vascular complications we recommend: (1) a clinical and vascular laboratory evaluation before the procedure, and (2) angiography of normal flow in patients with underlying vascular disease.

Désinsertion de valve aortique récidivante au cours d'un magic syndrome: échec des bolus de cyclophosphamide associés à la corticothérapie

A 22 year-old man had buccal and genital aphtae with pseudofolliculitis, polyarthritis, recurrent episodes of ear and nose chondritis. Aortic insufficiency led to replacement with 2 successive prosthetic valve dehiscences. Despite 6 monthly cyclophosphamide and prednisone, he developped a third prosthetic dehiscence and a femoral artery false aneurysm after catheterization.

Infected femoral artery false aneurysms in drug addicts: Evolution of selective vascular reconstruction

Fifty-four infected femoral artery false aneurysms resulting from chronic drug addiction were managed surgically with an 11% amputation rate and no mortality. Angiography localized the arterial segment involved, which in turn influenced the type of operation performed. Twenty-six aneurysms of anatomically isolated femoral artery segments were ligated and excised without resultant amputation. However, of the 28 aneurysms involving the common femoral bifurcation, 18 required triple ligation and excision that led to six amputations. Six of the 28 aneurysms were reconstructed with autogenous saphenous vein grafts, three by prosthetic grafts, and one by primary anastomosis. No amputations followed vascular reconstruction. However, all synthetic grafts eventually developed septic complications that required graft removal. On the basis of this experience we recommend ligation and excision for single artery segment aneurysms and immediate autogenous reconstruction for selected common femoral bifurcation lesions. This approach has proved safe and has reduced our amputation and graft complication rates. Extensive uncontrollable wound sepsis may contraindicate revascularization. Under these circumstances we estimate a 33% risk of amputation when the common femoral bifurcation is excised.

Infected femoral artery false aneurysms in drug addicts: Evolution of selective vascular reconstruction

Infected femoral artery false aneurysms in drug addicts: Evolution of selective vascular reconstruction