Femoral Artery Pseudoaneurysm Research Articles

Risk factors for delirium in patients aged 60 years and over with recent myocardial infarction

Abstract Introduction Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem. Modifiable and unmodifiable risk factors may influence delirium appearance. Purpose The study aimed to assess the prevalence and characteristic of delirium risk factors in patients ≥ 60 years of age hospitalized due to acute myocardial infarction (AMI). Methods The study included 405 consecutive patients (mean age: 73.1[8.5], males: 248/61.2 %) hospitalized due to AMI divided and characterized according to the in-hospital delirium presence. The following sets of data were analysed: demographic data, length of hospitalization, type of AMI, coronary intervention, multimorbidity, accompanying symptoms, psychiatric conditions, and pharmacotherapy used. Results Of 405 patients, 57 (14%, mean age: 80.9[7.3] years, males: 33/58%) experienced delirium. Patients with delirium were older (80.9[7.3] vs 71.82[8.1] years), all of them presented multimorbidity, they more frequently used polypharmacy (96.5 vs 30.2%) and their hospitalization was longer (8.0[1.4] vs 4.6[1.0] days) as compared to the patients without delirium. Patients with delirium more frequently experience in-hospital reversible problems: periprocedural complications (limited number of radial access, prolonged compression and pain after the procedure, pseudoaneurysm of femoral artery, as well as the following accompanying symptoms: fever (40.4% vs 0.9%), infections (78.9% vs 3.7%), pulmonary oedema (73.7% vs 0.6%), hypoxemia (91.1% vs 98.3%), urinary catheter (96.5% vs 17.2%), dehydration (89.5% vs 6.6%), and insomnia (71.9% vs 0.3%) compared to patients without delirium (Table 1). Delirium was also associated with mild (49.1% vs 0.3%, p<0.0001) and moderate (47.4% vs 9.2%) dementia and symptoms of mild depression (59.6% vs 2.3%) (P<0.0001 for all). Valvular heart disease (OR=4.78; 95%CI: 1.10-2.70; p<0.0001, pulmonary oedema (OR=66.79; 95%CI: 12.04-370.34, p<0.001), and dehydration (OR=37.26; 95%CI: 10.50-132.27, p<0.001) were risk factors for delirium occurrence. Analysis of all factors related to delirium revealed that the coexistence of ≥ 11 concerned 44% of the delirium population (Table 1). Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14% of patients ≥ 60 years old. Multimorbidity and polypharmacy regard most of the subjects with delirium. The potent reversible complications of the in-hospital course of AMI associated with delirium should be recognized and limited to prevent this problem.Table1.Number of delirium risk factors.

Trans-ankle intervention assisted ultrasound-guided thrombin injection for iatrogenic femoral artery pseudoaneurysm.

Trans-ankle intervention assisted ultrasound-guided thrombin injection for iatrogenic femoral artery pseudoaneurysm.

A case of Iatrogenic Pseudo Aneurysm of Femoral Artery

A 55-year-old woman was admitted hospital in-patient unit withfever and breathlessness for 5 days. Pertinent medical history included chronic kidney disease (CKD), poorly controlled Diabetes with retinopathy, Hypertension and Bronchial asthma. After admission patient was found to be severely anaemic and her stool was black and tarry. Blood transfusion was required for correction of anaemia. Endoscopy of upper GIT was planned after stabilization. RT PCR for COVID-19 was positive. After couple of days she became desaturated in spite of high level of oxygen delivery and was shifted to ICU. Bangladesh Crit Care J September 2024; 12 (2): 179-180

Clinical Evaluation of a Novel Compression Device For Ultrasound-Guided Repair of Femoral Artery Pseudoaneurysms: A Double-Blind Clinical Trial

Background: Femoral artery pseudoaneurysm is a well-known complication after conventional angiography. Today, the treatment of choice for this condition is noninvasive repair using manual ultrasound-guided compression. Objectives: This study aimed to evaluate the efficacy of a novel compression device in improving angiography-induced pseudoaneurysm treatment compared to manual ultrasound-guided compression repair. Patients and Method: A double-blind, randomized clinical trial was performed on patients with femoral angiography-induced pseudoaneurysm in the Radiology Department of Ghaem Hospital, Mashhad, Iran. Based on color Doppler ultrasound exams, patients diagnosed with a pseudoaneurysm within 72 hours of angiography were included in the study. Patients were excluded if they had complete blockage, complete pseudoaneurysm thrombosis, abscess, surface tissue infection, or open wound in the area. The patients were allocated to a manual ultrasound-guided compression group or a device-assisted compression group using simple randomization with a sealed envelope method. After collecting demographic data, the patients underwent an ultrasound exam of the groin to determine and record the size of the pseudoaneurysm and the ratio of thrombosis to open lumen. The therapeutic success rate was defined as complete lumen thrombosis after conducting the compression procedure one to three times. Also, the pain score was measured during compression using the Visual Analog Scale based on a scale of 0 - 10. The duration of successful procedures was also documented. The patients were monitored for 6 hours for any side effects. The level of statistical significance was set at P < 0.05 for all tests. Results: The study was performed on 22 patients (13 males/9 females) with a mean age of 65.5 ± 3.5 years divided into two groups of device-assisted (n = 11) and manual ultrasound-guided (n = 11) compression repair. The two groups did not differ significantly in terms of demographic variables or initial ultrasound variables associated with the pseudoaneurysm. The device-assisted compression group was found to have lower pain intensity (5.0 ± 1.0 vs. 6.0 ± 0.8; P = 0.024) and a significantly higher success rate (100% vs. 45.5%; P = 0.004) compared to the manual compression group. None of the patients showed any side effects. Conclusion: This preliminary study showed that the proposed device is completely safe and may improve the success rate while decreasing pain scores during ultrasound-guided compression procedures. Using a large multicenter study design, evaluating the efficacy of the novel device for hemostasis during sheath removal and adding new equipment to the device, such as manometers to apply controlled pressure, are suggested for future studies.

Clinical Outcome of Surgical Treatment of Giant Femoral Artery Pseudoaneurysms

Femoral artery was used as an access site for cardiovascular procedures and by IV drug abusers, Femoral Artery Pseudoaneurysm (FAP) was a common complication associated with these procedures. Objective: To evaluate clinical outcome of surgical repair of femoral artery pseudoaneurysms. Methods: The prospective study was conducted in Doctors Hospital, Lahore from October 2022 to October 2023. The study included patients with giant femoral artery pseudoaneurysms who required surgical intervention. Data from a total of 50 patients were included in whom both peripheral vascular interventions and percutaneous cardiac catheterization was performed. Patients were followed up at 1-, 3-, 6- and 12 months postoperatively. SPSS version 23.0 was used for data analysis. Results: All patients underwent open surgical treatment. Of 50 patients, 25 (50%) had SFA pseudoaneurysm, 20 (40%) had CFA pseudoaneurysm and 5 (10%) had PFA pseudoaneurysm. The mean duration of clinical manifestations was 16.30 ± 7.74 days. Surgical repair was successful in all 50 (100%) patients and distal ischemia was fully resolved. There was no case of limb loss or post-operative mortality. One patient had an infection in the groin wound and had raised Total leucocyte count (TLC), which was resolved by early drainage and antibiotic treatment. Patients were followed up at 1, 3, 6, and 12 months and there were no signs of clinical or angiographic evidence of post-operative complications and changes in distal pulse. Conclusion: Surgical repair was first-line treatment for giant FAP. It was clinically feasible and has a high success rate and low complication rate.

Compare efficacy and safety of autologous blood clot injection with C-clamp vascular closure device in treatment of iatrogenic pseudoaneurysm after femoral artery puncture.

Iatrogenic femoral artery pseudoaneurysm (FAP) is a complication following femoral artery puncture, with an incidence rate of 0.2%-5.5% post-cardiac catheterization procedures. Management typically involves observation or interventional treatments such as ultrasound-guided compression (UGC) or ultrasound-guided thrombin injections. This study compares the efficacy and safety of ultrasound-guided autologous blood clot injection (UGCI) with C-clamp vascular closure device-assisted UGC in treating FAP. Conducted at a high-volume training and research center, this prospective study enrolled patients with iatrogenic FAP post-femoral artery puncture. Patients were randomized into two treatments: UGC with a C-clamp device or UGCI. Primary endpoints were thrombosis induction within 24 h, average procedure time, and length of hospital stay (LOS). The study included 105 patients with 51 undergoing UGCI and 54 undergoing UGC. UGCI achieved a primary success rate of 96% versus 63% for UGC. The mean procedure duration for UGCI was significantly shorter (22 min) compared with UGC (49 min, p ⩽ 0.0001). LOS was also reduced in the UGCI group (1.5 days) compared to the UGC group (4.5 days). Complication rates were low for both procedures, with one deep vein thrombosis and one infection observed in the UGC group. UGCI demonstrated to be a safe, efficient, and faster alternative for treating iatrogenic FAPs with a higher success rate, reduced LOS, and similar low complication rates compared to UGC. This study suggests that UGCI could be considered a preferred method for the management of FAP post-femoral artery catheterization.

Post-catheterization Common Femoral Artery Pseudoaneurysm in a Patient with a Mechanical Mitral Valve Requiring Anticoagulation: A Case Report

Iatrogenic femoral pseudoaneurysms are a rare complication of transfemoral vascular access. We present a case of a 65-year-old woman with a mechanical mitral valve requiring warfarin, who developed a femoral pseudoaneurysm four days after cardiac catheterization with femoral access. The patient developed a 17 x 10 x 17 cm rectus sheath hematoma and was treated with ultrasound-guided thrombin injection. Anticoagulation was held for three days while the patient was monitored for further bleeding and later restarted based on shared decision-making, given the risk of valve thrombosis. There are few guidelines regarding the re-initiation of anticoagulation in high-risk bleeding patients with mechanical mitral valves. Non-invasive coronary computed tomography angiography should be considered in patients on anticoagulation who require non-emergent cardiac ischemic evaluation.

The Ablate-by-LAWT multicentre prospective study: Personalized paroxysmal atrial fibrillation ablation with ablation index adapted to local left atrial wall thickness.

Personalized radiofrequency (RF) ablation for paroxysmal atrial fibrillation (PAF), adapting the ablation index (AI) to local left atrial wall thickness (LAWT), proved to be highly efficient maintaining high arrhythmia-free survival rates. However, multicentre data are lacking. This multicentre, prospective, non-randomized study was conducted at 5 tertiary hospitals and sought to assess the safety, efficacy, and reproducibility of the LAWT-guided ablation for PAF. Consecutive patients referred for first-time PAF were prospectively enrolled. The LAWT maps were obtained from preprocedural multidetector computed tomography and integrated into the navigation system. AI was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the pulmonary veins (PVs). A total 109 patients (60.1 ± 9.4years, 64.2% male) were enrolled. Median procedure time was 61.7min (48.4-83.8), fluoroscopy time was 1.0min (0.4-3.3), and RF time was 13.9min (12.3-16.8). Median AI tailored to the local LAWT was 393 (374-412) for the anterior wall and 340 (315-378) for the posterior wall. Right and left PVs first-pass isolation was achieved in 89% and 91.7% of the patients, respectively. At 12-month follow-up, freedom from any atrial arrhythmia was 93.4% (95% CI 88.7-98.1), without differences across centres (P = 0.169). One patient experienced femoral artery pseudoaneurysm, with no other serious procedural-related complication. The Ablate-by-LAWT study proved that LAWT-guided PV isolation for PAF is safe, effective, and efficient in a multicentre setting. Twelve-month recurrence-free survival exceeded 90% (NCT04218604).

Superficial femoral artery pseudoaneurysm at implantation site of drug eluting stent discovered due to bacteremia: A case report

BACKGROUND Drug-eluting stents (DES) are used to treat lower extremity arterial disease. During DES treatment, aneurysmal degeneration occasionally occurs, especially with fluoropolymer-based DES. However, the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region, although there have been several reports on pseudoaneurysm formation after DES pla-cement in the coronary artery region. CASE SUMMARY We report the case of a 64-year-old man who presented with fever and pain in his left hand after dialysis. Bacteremia was diagnosed by blood culture, and after admission, he developed pain on the medial side of the right thigh. A pseudoaneurysm was observed in the right superficial femoral artery (SFA) at the proximal end of a previously placed DES. The bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery, and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic treatment. The pseudoaneurysm of the right SFA rapidly expanded after admission, but the expansion rate was reduced after infection control. Seven months after the first admission, the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron graft. CONCLUSION Although pseudoaneurysm after DES placement in the lower extremity region is rare, it must be considered in patients with bacteremia.

Femoral artery Pseudo-aneurysm: Presentation, Causation and Outcome in Cardiothoracic Vascular and Transplant Centre of a Tertiary Level Hospital in Nepal

Background: Peripheral arterial pseudo-aneurysms are of varied etiology and are quite common presenting from simple swelling to life threatening hemorrhage and sepsis. Our study aimed at evaluating our Institute’s experience with femoral artery pseudo-aneurysm over a span of 2 years with particular focus on the various range of presentations, causative factors and management outcomes. Methods: Retrospective analysis of medical records of patients with diagnosis of femoral arterial pseudo-aneurysm who underwent surgery was done. Data was collected retrospectively from Anesthesia and vascular surgery records as well as administrative records. Results: Over the duration of 2 years we found a total of 135 cases of femoral artery pseudo-aneurysm treated in our center. Intravenous drug abuse (112) followed by catheter induced (11) was the commonest etiology. Demographics showed a propensity towards the youth with most cases in the 20-30 age group (78, 58%) followed by 30-40 (35, 25%). A painful swelling with tenderness (91) was the commonest presentation. All patients underwent surgical treatment with 62 (45 %) patients undergoing ligation and the same numbers undergoing pseudo-aneurysm repair, 62 (45%). 78 (58%) patients had an uneventful recovery. However 18 cases had to undergo limb amputation and 7 patients lost their lives due to various complications. Conclusion: Our study found that femoral artery pseudo-aneurysms present with various etiology and presentation, poses a huge challenge to the clinicians for surgery and management of its complications.

Accuracy and feasibility in building a personalized 3D printed femoral pseudoaneurysm model for endovascular training.

The use of three-dimensional(3D) printing is broadly across many medical specialties. It is an innovative, and rapidly growing technology to produce custom anatomical models and medical conditions models for medical teaching, surgical planning, and patient education. This study aimed to evaluate the accuracy and feasibility of 3D printing in creating a superficial femoral artery pseudoaneurysm model based on CT scans for endovascular training. A case of a left superficial femoral artery pseudoaneurysm was selected, and the 3D model was created using DICOM files imported into Materialise Mimics 22.0 and Materialise 3-Matic software, then printed using vat polymerization technology. Two 3D-printed models were created, and a series of comparisons were conducted between the 3D segmented images from CT scans and these two 3D-printed models. Ten comparisons involving internal diameters and angles of the specific anatomical location were measured. The study found that the absolute mean difference in diameter between the 3D segmented images and the 3D printed models was 0.179±0.145 mm and 0.216±0.143mm, respectively, with no significant difference between the two sets of models. Additionally, the absolute mean difference in angle was 0.99±0.65° and 1.00±0.91°, respectively, and the absolute mean difference in angle between the two sets of data was not significant. Bland-Altman analysis confirmed a high correlation in dimension measurements between the 3D-printed models and segmented images. Furthermore, the accuracy of a 3D-printed femoral pseudoaneurysm model was further tested through the simulation of a superficial femoral artery pseudoaneurysm coiling procedure using the Philips Azurion7 in the angiography room. 3D printing is a reliable technique for producing a high accuracy 3D anatomical model that closely resemble a patient's anatomy based on CT images. Additionally, 3D printing is a feasible and viable option for use in endovascular training and medical education. In general, 3D printing is an encouraging technology with diverse possibilities in medicine, including surgical planning, medical education, and medical device advancement.

The multicenter ablate-by-LAW study: personalized paroxysmal atrial fibrillation ablation according to the local left atrial wall thickness

Abstract Background Personalized radiofrequency (RF) catheter ablation for paroxysmal atrial fibrillation (PAF), tailoring the ablation index (AI) to the local left atrial wall thickness (LAWT), has proven to be an efficient procedure with high arrhythmia-free survival rates. However, to date, only monocentric experiences have been reported in the literature. Purpose The present study sought to report a multicenter experience in order to assess the safety, efficacy, and efficiency, of a LAWT-guided personalized pulmonary vein isolation (PVI) approach for PAF ablation (ClinicalTrials.gov, NCT04218604). Methods We conducted an international multicenter prospective study at five tertiary hospitals (two in Spain, one in Italy, one in Germany, and one in the United States). Consecutive patients referred for first-time RF catheter ablation of PAF were prospectively enrolled from November 2020 to September 2022. In all patients a three-dimensional map of LAWT were obtained from preprocedural multidetector computed tomography (MDCT)-derived data postprocessing. LAWT was categorized into 1 mm layers and AI was titrated according to the LAWT. All procedures were performed under general anesthesia, utilizing high-rate low-tidal volume (HR-LTV) ventilation (Figure 1). All antiarrhythmic drugs were discontinued following the 3-month blanking period. The primary endpoint was freedom from any documented sustained atrial arrhythmia at 12-month follow-up, regardless of symptoms. Results One hundred and nine patients (60.1±9.4 years, 64.2% male) were prospectively enrolled. The mean LA diameter was 38.7±5.8 mm and the mean left ventricular ejection fraction was 60.7±4.7%. The median procedure time was 61.7 minutes (IQR 48.4–83.8), and the median RF application time was 13.9 minutes (IQR 12.3–16.8). The mean number of VisiTags was 63.2 ± 18. First-pass PVI was achieved in the 83.5% of patients. The median fluoroscopy time was 61.5 seconds (IQR 22.5–197.5). In 94 (86.2%) patients, ablation was performed with a single femoral venous puncture. At 12-month follow-up, the rate of freedom from any documented atrial arrhythmia was 93.4% (Figure 1). Two (1.8%) patients died during follow-up, one from unknown cause three months after the procedure, and another from complications following multiple trauma after falling from a ladder. One patient (0.9%) developed femoral artery pseudoaneurysm, with no other serious procedure-related complications. Conclusion The Ablate-by-LAW multicenter study proved that a personalized PAF ablation protocol, tailoring the AI to the local LAWT is highly efficient and achieved a high acute first-pass PVI rates. The study reported a high 12-month survival-free from any documented sustained atrial arrhythmias, exceeding 90%, and an exceptionally low incidence of serious procedure-related complications.

ASSESSMENT OF SURGICAL TREATMENT STRATEGIES OF IATROGENIC GIANT FEMORAL ARTERY PSEUDOANEURYSMS

Iatrogenic giant femoral artery pseudoaneurysms pose significant clinical challenges, necessitating prompt intervention to prevent complications. Despite advancements in endovascular techniques, optimal surgical strategies remain unclear. This study aimed to evaluate surgical treatment's technical and clinical outcomes for these pseudoaneurysms. Objective: To assess the technical success and clinical outcomes following surgical repair of iatrogenic giant femoral artery pseudoaneurysms. Methods: This retrospective cohort study was conducted at a tertiary care hospital in Lahore, Pakistan between July 2022 and July 2023. A total of 60 patients diagnosed with iatrogenic giant femoral artery pseudoaneurysms underwent surgical repair. It was followed up for one, three, and six months using Duplex ultrasound and CT angiography. Data were analyzed to evaluate surgical techniques, technical success rates, and postoperative outcomes. Statistical analysis was performed using descriptive statistics and chi-square tests. Results: All patients (n=60) underwent successful surgical repair with various techniques: primary repair (n=30), repair with vein patch angioplasty (n=15), interposition reversed saphenous vein graft (n=10), and interposition synthetic Dacron graft (n=5). Technical success was achieved in 100% of cases, with no limb loss or intraoperative/postoperative mortality. The presenting symptoms were resolved in all patients, with one case of postoperative groin wound infection being effectively managed with antibiotics and debridement. Conclusion: Open surgical repair of femoral pseudoaneurysms demonstrates excellent technical feasibility and serves as a first-line treatment for iatrogenic giant femoral artery pseudoaneurysm-associated complications. These findings support surgical intervention as a practical approach to managing these challenging cases.

Complications of femoral access for hemodialysis: A surgical perspective

Background: Vascular access, especially arteriovenous fistula (AVF), is critical for patients requiring haemodialysis. Due to delayed diagnosis, late referral, poverty and limited availability of competent access surgeons, many patients commence haemodialysis without an AVF, hence the frequent use of venous catheters. Objectives: To assess the pattern of complications associated with repeated femoral punctures for haemodialysis. Materials and Methods: This is a multicentre prospective study conducted at the Cardiovascular units of the University of Port Harcourt Teaching Hospital, Port Harcourt and Federal Medical Centre, Umuahia between January 2017 and December 2022. 66 patients were recruited for the study. Data obtained were patients’ demography, complications of femoral access, surgical approach and outcome. Results: 15 patients presented with severe lower limb pains and inability to walk, 10 with fibrosis/ hardening of the skin of both groins, 8 with skin infection at the repeated puncture sites, 12 had Pseudoaneurysm of the superficial femoral artery (SFA), 6 had iatrogenic femoro-femoral Arteriovenous Fistula (AVF) of the SFA and superficial femoral vein (SFV), 5 had groin abscess. All the patients had internal jugular venous catheters inserted. Some patients had Fogarty catheter thrombectomies and interposition Great Saphenous Vein (GSV) graft repairs, while some others had successful takedown of the AVF, Fogarty thrombectomy and direct prolene 6/0 repair of the vein & arterial wall defects. All those that underwent surgical treatment had successful recovery. Conclusion: Femoral vein cannulation, apparently easy to perform, should not be used as the vascular access of choice for chronic haemodialysis.

Iatrogenic bilocular femoral artery pseudoaneurysm in a patient with end-stage renal disease undergoing regular hemodialysis: An unexpected occurrence after a common procedure and surgical cure

Introduction: Pseudoaneurysms of the femoral artery can develop as an uncommon complication following penetrating trauma or arterial catheterization for cardiovascular procedures or hemodialysis. It is commonly diagnosed with color duplex imaging and usually a single pseudoaneurysm is present. Case Report: We present a 62-year-old woman with end-stage renal disease who developed a very rare bilocular pseudoaneurysm of the femoral artery caused by inadvertent puncture of the artery during elective hemodialysis which remained uneventful and undiagnosed until the pseudoaneurysm was itself punctured by the dialysis catheter iatrogenically and another large connecting pseudoaneurysm was formed above the initial one. Typical unilocular pseudoaneurysm presents as Yin-Yang sign on color duplex imaging but here bidirectional turbulent flow was seen as double Yin-Yang sign suggestive of bilocular pseudoaneurysm mimicking the shape of a snowman, hence Yin-Yang Snowman sign. The patient presented with signs and symptoms of rapid progression of the pseudoaneurysm resulting in femoral nerve compression with compromised skin viability. Therefore, surgical management was planned and the bilocular pseudoaneurysms were excised with repair of the femoral artery and then covered with vascularized rectus femoris muscle flap. Conclusion: An arterial pseudoaneurysm should be included in the differential diagnosis for a groin mass after femoral catheterization or other vascular procedures. A non-invasive imaging approach using color flow duplex sonography can be used with confidence and safety. But in complicated cases or cases with impending complications, surgical exploration and excision remains the mainstay of treatment.

Spontaneous superficial femoral artery pseudoaneurysm: a rare case report

Spontaneous femoral artery pseudoaneurysm (PSA) is a rare disease and there are few reported cases. We report a case of a 45 year-old male with painless, non-pulsatile swelling in the medial aspect of left lower thigh, which is gradually increasing in size for a period of 2 months. He had no history of trauma or surgery. CT Angiography confirmed a large pseudoaneurysm of the left distal superficial femoral artery (SFA). Then patient had sudden rupture of the pseudoaneurysm and it was treated surgically by ligation of SFA proximal and distal to pseudoaneurysm with excision of large surrounding hematoma.

Evaluation of Surgical Management of Infected Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers

Evaluation of Surgical Management of Infected Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers

Efficacy and safety of 3D reconstruction and basket multi-electrode renal denervation (RDN) for refractory hypertensive patients with chronic kidney disease.

Renal Artery Sympathetic Denervation (RDN) can lower blood pressure. Different ablation catheters (single electrode, multi-electrode) have different scopes of ablation (renal artery main stem and branches). Few studies have compared the advantages and disadvantages of different ablation catheters and different procedures in terms of antihypertensive efficacy. To compare the efficacy and safety of 3D reconstruction radiofrequency ablation (3DRA) and basket multi-electrode radiofrequency ablation (BMRA) in Renal Artery Sympathetic Denervation. Fifty-three patients with Refractory hypertension (RHT) were divided into BMRA, (n=28) and 3DRA(n=25). BMRA group used a stereobasket multi-electrode ablation catheter with a controlled ablation temperature of 60°C and an ablation time of 120s per site. 3DRA group used a NavStar pressure-monitored perfusion monopolar ablation catheter with a controlled ablation temperature of 40°C, an ablation time of 40s per site, and an ablation energy of 12W. Baseline and RDN parameters and complications were compared in both groups. Home and 24h ambulatory blood pressure, type of anti-hypertensive medication taken, and serum creatinine were followed up at 1, 3, 6, 12, and 24 months after the RDN. There were no differences in baseline characteristics between the two groups. (23.14±2.00)months of follow-up in the BMRA group resulted in a total of (25.86±8.61) loci ablation. (19.28±7.40)months of follow-up in the 3DRA group resulted in a total of (21.04±6.47)loci ablation. Home SBP was significantly lower in both groups at 1 month after RDN treatment compared to baseline(H-SBP/mmHg: BMRA 149.9±10.59vs. baseline 168.36±12.76; 3DRA 152.6±14.91vs. 164.89±12.96, both p<.05). The proportion of people with 24h ambulatory SBP attainment was significantly higher in both groups and was maintained for 24 months. At each follow-up time point, there were no differences in home and 24-h flow SBP, DBP, or Scr between the two groups. There were two cases of severe renal artery complications from implanted vascular stents and one case of femoral artery pseudoaneurysm in the 3DRA group. At follow-up, 1 (1.9%) patient in the 3DRA group died of unexplained death and 1 (1.9%) patient developed heart failure, and 1 (1.9%) patient in the BMRA group died of unexplained death. Basket multi-electrode radiofrequency ablation and 3D reconstruction radiofrequency ablation of the renal artery applied to RDN have comparable efficacy in reducing systolic blood pressure.

Percutaneous balloon-assisted ultrasound-guided direct thrombin embolization of superficial femoral artery pseudoaneurysm: a case series and literature review

BackgroundSuperficial femoral artery (SFA) pseudoaneurysms, a rare but potentially life-threatening complication, that can arise after vascular interventions or trauma. This case series explores the efficacy and safety of a minimally invasive treatment modality, percutaneous ultrasound-guided thrombin injection (PUGTI) combined with balloon occlusion, in three patients with SFA pseudoaneurysms.Case presentationThree patients (age: 71–82 years; 3 female) with SFA pseudoaneurysms underwent PUGTI with balloon occlusion. The procedure involved direct thrombin injection under ultrasound guidance while occluding the parent artery using a balloon catheter. Follow-up was conducted at 1 week and 1 month post-procedure to assess technical success, complications, and recurrence.ConclusionPUGTI combined with balloon occlusion appears to be a safe and effective treatment for SFA pseudoaneurysms, particularly for larger pseudoaneurysms. The procedure is associated with a high technical success rate. Balloon occlusion may offer a safer alternative to direct thrombin injection without occlusion, as it potentially minimizes the risk of complications such as distal thromboembolism.

Total Basilar Artery Thrombosis Presenting with Recurrent Transient Ischemic Attacks (TIAs): A Case Report

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Managing acute ischemic stroke in patients with significant comorbidities, such as hypertension, heart failure, and substance abuse, presents unique challenges. Timely intervention is critical, but the risk of complications and poor prognosis is high.&lt;br /&gt;&lt;strong&gt;Case Presentation&lt;/strong&gt;: A 46-year-old male with a history of smoking, drug abuse, poorly controlled hypertension, and dilated cardiomyopathy with an ejection fraction of 25%-30% presented with sudden left-sided weakness, facial droop, and dysarthria. The initial National Institutes of Health Stroke Scal score was 6. Computed tomography (CT) brain showed no acute infarctions but revealed chronic lacunar infarctions and atrophy. CT angiography identified significant vascular abnormalities, including right internal carotid artery attenuation and non-visualization of both intracranial vertebral and basilar arteries. Intravenous thrombolysis (tPA) led to initial improvement, but recurrent strokes or transient ischemic attacks (TIAs) followed, leading to intubation and mechanical ventilation. Magnetic resonance imaging revealed evolving infarctions in the pons and cerebellum. A basilar artery thrombectomy was successfully performed, but postoperative complications included spontaneous pneumothorax and femoral artery pseudoaneurysm, requiring further interventions. Due to extensive posterior circulation infarction, the patient had a poor neurological prognosis and was placed on do not resuscitate status.&lt;br /&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: This case highlights the complexities of treating acute ischemic stroke in patients with substantial comorbidities. While interventions such as thrombolysis and thrombectomy are critical, they carry risks. A multidisciplinary approach is necessary to balance immediate treatment with considerations of long-term prognosis and quality of life.&amp;nbsp;&lt;/p&gt;