Femoral Pseudoaneurysm Research Articles

Selection of an impedance- or magnetic field-based electro-anatomical mapping platform does not affect outcomes of outflow tract premature ventricular complex manual ablation

Comparative data are virtually missing about the performance of different electro-anatomical mapping (EAM) system platforms on outflow tract (OT) premature ventricular complex (PVC) ablation outcomes with manual ablation catheters. We aimed to compare the acute success-, complication-, and long-term recurrence rates of impedance-based (IMP) and magnetic field-based (MAG) EAM platforms in manual OT PVC ablation. Single-centre, propensity score matched data of 39–39 patients ablated for OT PVCs in 2015–17 with IMP or MAG platforms were analysed. Acute success rate, peri-procedural complications, post-ablation daily PVC burden, and long-term recurrence rates were compared on intention-to-treat basis. Acute success rate was similar in the IMP and MAG group (77 vs. 82%, p = 0.78). There was a single case of femoral pseudo-aneurysm and no cardiac tamponade occurred. PVC burden fell significantly from baseline 24.0% [15.0–30.0%] to 3.3% [0.25–10.5%] (p < 0.001) post-ablation, with no difference between EAM platforms (IMP: 2.6% [0.5–12.0%] vs. MAG: 4.0% [2.0–6.5%]; p = 0.60). There was no significant difference in recurrence-free survival of the intention-to-treat cohort of the IMP and MAG groups (54 vs. 60%, p = 0.82, respectively) during 12 months of follow-up. Ablation with the aid of both impedance- and magnetic field-based EAM platforms can considerably reduce OT PVC burden and give similar acute- and long-term freedom from arrhythmia.

Aortic-tibial transiliac wing extra-anatomic bypass with distal fistula for treatment of an infected deep femoral pseudoaneurysm.

Transiliac wing bypass has been reported to be a viable extra-anatomic alternative technique for patients presenting with a history of groin infection or irradiation.1Enzmann F.K. Nierlich P. Eder S.K. Aspalter M. Dabernig W. Aschacher T. et al.Trans-iliac bypass grafting for vascular groin complications.Eur J Vasc Endovasc Surg. 2019; 58: 930-935Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Of the 32 reported cases, only two patients had undergone transiliac aortic–tibial or iliotibial bypass.2Sekanina G. Lemminger F. Bruecher D. Iliaco-crural bypass through a borehole in the iliac fossa as extra-anatomic vascular bypass in infected inguinal canal and posterior aspect of the knee.Chirurg. 1995; 66: 142-145PubMed Google Scholar,3Heldenberg E. Lorber J. Cheyn D. Bass A. Transiliac wing alternate route bypass for infected groin vascular graft.J Vasc Surg. 2014; 60: 504-505Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar We report the case of a 72-year-old man with a complex history of multiple lower limb revascularizations, who had been admitted for a deep femoral infected anastomotic pseudoaneurysm (A) and left chronic limb threatening ischemia. Computed tomography showed chronic occlusions at the femoropopliteal level, with a previous thrombosed obturator canal bypass. The only patent lower leg artery was the posterior tibial artery (PTA) from its mid-third to the foot.A transiliac wing aortic–tibial prosthetic bypass was performed through a pararectal retroperitoneal approach (B/Cover). The infrarenal aorta and common iliac arteries were cross-clamped before implanting an 8-mm expanded polytetrafluoroethylene graft soaked in rifampicin at the terminal aorta level. It was tunneled into the retroperitoneal space, over the psoas muscle. A U-shape osteotomy was performed at the anterior left iliac wing border through a second lateral incision to guide the bypass. Another incision was made at the lateral side of the thigh to guide the graft route between the femoral condyles. It was associated with a distal arteriovenous bypass between the PTA and a fibular vein (C), before the distal anastomosis of the aortic–tibial bypass, to partially deviate the aortic blood flow from the PTA into the venous circulation.The second part of the procedure consisted of deep femoral pseudoaneurysm repair. It was developed at the distal anastomosis level of the thrombosed obturator canal bypass, which was removed to the obturator canal during the same procedure. The deep femoral artery was then ligated with 5-0 polypropylene suture. Transiliac wing bypass has been reported to be a viable extra-anatomic alternative technique for patients presenting with a history of groin infection or irradiation.1Enzmann F.K. Nierlich P. Eder S.K. Aspalter M. Dabernig W. Aschacher T. et al.Trans-iliac bypass grafting for vascular groin complications.Eur J Vasc Endovasc Surg. 2019; 58: 930-935Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Of the 32 reported cases, only two patients had undergone transiliac aortic–tibial or iliotibial bypass.2Sekanina G. Lemminger F. Bruecher D. Iliaco-crural bypass through a borehole in the iliac fossa as extra-anatomic vascular bypass in infected inguinal canal and posterior aspect of the knee.Chirurg. 1995; 66: 142-145PubMed Google Scholar,3Heldenberg E. Lorber J. Cheyn D. Bass A. Transiliac wing alternate route bypass for infected groin vascular graft.J Vasc Surg. 2014; 60: 504-505Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar We report the case of a 72-year-old man with a complex history of multiple lower limb revascularizations, who had been admitted for a deep femoral infected anastomotic pseudoaneurysm (A) and left chronic limb threatening ischemia. Computed tomography showed chronic occlusions at the femoropopliteal level, with a previous thrombosed obturator canal bypass. The only patent lower leg artery was the posterior tibial artery (PTA) from its mid-third to the foot. A transiliac wing aortic–tibial prosthetic bypass was performed through a pararectal retroperitoneal approach (B/Cover). The infrarenal aorta and common iliac arteries were cross-clamped before implanting an 8-mm expanded polytetrafluoroethylene graft soaked in rifampicin at the terminal aorta level. It was tunneled into the retroperitoneal space, over the psoas muscle. A U-shape osteotomy was performed at the anterior left iliac wing border through a second lateral incision to guide the bypass. Another incision was made at the lateral side of the thigh to guide the graft route between the femoral condyles. It was associated with a distal arteriovenous bypass between the PTA and a fibular vein (C), before the distal anastomosis of the aortic–tibial bypass, to partially deviate the aortic blood flow from the PTA into the venous circulation. The second part of the procedure consisted of deep femoral pseudoaneurysm repair. It was developed at the distal anastomosis level of the thrombosed obturator canal bypass, which was removed to the obturator canal during the same procedure. The deep femoral artery was then ligated with 5-0 polypropylene suture. Appendix

Femoral artery aneurysm with large hematoma from Pasteurella: case report and literature review

BackgroundPasteurella multocida is a well-known gram-negative facultative anaerobe well known for its ability to cause soft tissue infections following animal bite or scratch. Here we present a case with mycotic aneurysm of the superficial femoral artery due to P. multocida infection.Case presentationA 62 year old male patient presented with worsening right leg pain and swelling. On examination, he was found to have profound swelling and erythema of the right medial thigh and tenderness to palpation. Computerized tomography showed findings suggestive of right femoral pseudoaneurysm with a large right medial thigh hematoma. Blood cultures grew P. multocida. Patient underwent emergent open resection of the mycotic aneurysm and vascular bypass surgery. Intraoperatively, the site was noted to be grossly infected with multiple pockets of pus which were drained and pus cultures grew P. multocida. The diagnosis of P. multocida bacteremia with right femoral mycotic aneurysm and thigh abscess was made. Patient received 6 weeks of intravenous ceftriaxone and recovered.ConclusionOur case is the first report on infection of peripheral vessel with Pasteurella and highlights the importance of prompt surgical intervention and effective antibiotic treatment

Femoral Mycotic Pseudoaneurysm Rupture by Salmonella

Femoral Mycotic Pseudoaneurysm Rupture by Salmonella

A nomogram for predicting the risk of femoral pseudoaneurysm after neurointerventional procedures.

BackgroundBecause femoral pseudoaneurysm (FPA) is a dangerous complication of interventional procedures with a risk of life-threatening bleeding, our aim was to develop a predictive nomogram for FPA after neurointervention, and to suggest the best method for early identification of FPA.MethodsWe searched the PubMed database for literature addressing FPA after interventional procedures to analyze the risk factors, and we also reviewed the clinical data of patients from the Department of Neurosurgery who underwent neurointerventional procedures. Selected parameters were analyzed by univariate and multivariate logistic regression analysis. A nomogram was constructed using the independent risk factors by a multivariate regression model, and was validated by bootstrap resampling method, as well as receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and calibration curve. The influence on the detection rate of FPA with Doppler ultrasound was also analyzed with Fisher’s exact test.ResultsAccording to existing studies, female sex, diabetes and hypertension are major risk factors of FPA. Among 1,098 clinical patients, hypertension (P=0.044), higher body mass index (BMI) (P=0.020), larger sheath size (P=0.049), puncture site hematoma (P=0.011) and closure failure (P=0.003) were identified as independent risk factors. The nomogram including these factors showed robust discrimination [C-index, 0.916; 95% confidence interval (CI): 0.810–1.022] with an area under the curve of 0.916. DCA indicated clinical utility, and the calibration curves showed an acceptable consistency. A significant improvement in the detection rate occurred when Doppler ultrasound was utilized (P=0.031).ConclusionsThe presented nomogram showed favorable predictive accuracy for FPA after neurointervention. We recommend ultrasound examination for patients at high risk of FPA evaluated by the nomogram.

Infected Pseudoaneurysm with Necrotising Fasciitis Following Femoral Artery Catheterisation

Femoral pseudoaneurysm is the most common complication of femoral artery catheterisation usually diagnosed by colour doppler ultrasound. Ultrasound-guided compression has replaced surgery to be the mainstay of therapy due to its high success rate and low complications. The present case is about a 63-year-old female, who presented with pain and swelling in the right groin. She had undergone coronary angioplasty two weeks back. She developed fever, chills, wound induration and necrosis at the puncture site. A laboratory study revealed leucocytosis, elevated Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP). Ultrasound doppler showed a 4×2.8×2.7 cm pseudoaneurysm of the right superficial femoral artery with a to-and-fro flow pattern. Computed Tomography (CT) angiogram showed a large narrow neck pseudoaneurysm arising from the anterior wall of the proximal superficial femoral artery just distal to its origin. The right superficial femoral angiogram showed a pseudoaneurysm draining into a large cavity. She underwent an ultrasound-guided thrombin injection of the pseudoaneurysm. A thrombus was formed in the superficial femoral artery after thrombin injection and thrombosuction was done. The necrotic tissue was excised and skin grafting was done after the wound healed.

Outcomes of Covered Stents With Vacuum Sealing Drainage For Treatment of Infected Femoral Pseudoaneurysms in Intravenous Drug Addicts

For treatment of infected femoral artery pseudoaneurysms (IFAPs) with the covered stent, debridement technique is important but frequently ignored. Our study aims to review our experience and outcomes of patients undergoing covered stents placement and debridement with vacuum sealing drainage (VSD). This study retrospectively analyzed 41 intravenous drug addicts with IFAP who received covered stent implantation and debridement with VSD from January 2015 to December 2020. The diagnosis was based on the previous history of local injection and the presence of pulsatile mass at the injection site. All cases were confirmed by CT angiography (CTA), ultrasound, or digital subtraction angiography (DSA). Technical success, time of wound care, and clinical outcomes were evaluated. Technical success was achieved in all patients. The interval from diagnosis to treatment was 26 ± 11 hours. The time of continuous drainage with VSD was 18.79 ± 6.56 days. 38 patients (92.68%) with fresh granulation tissue were sutured and discharged from the hospital. Stents in 31(91.18%) of 34 cases were patent during follow-ups. Three patients had stent occlusion caused by thrombosis, and two of them were complicated with stent infection. The two infectious stents were removed and the femoral arteries were ligated. One of them received open-surgical reconstruction with the great saphenous because of claudication. Two patients were admitted to the hospital for rebleeding caused by drug abuse relapse. Covered stents placement is convenient and rapid to control massive hemorrhage in IFAPs of intravenous drug abuse. Early debridement of infected tissue with continued VSD may shorten the time of wound care and make the incidence of stent infection relatively low. Meanwhile, the patency in a short time follow-up is acceptable. These results indicate that covered stents implantation with VSD may be a safe, effective, and feasible measure for the treatment of IFAPs.

Coil Embolization of Iatrogenic Femoral Artery Pseudoaneurysm

<h3>Introduction and Objective</h3> Femoral pseudoaneurysms are not uncommon after cardiac catheterizations. Multiple methods are used to treat pseudoaneurysms including ultrasound guided thrombin injection, direct pressure, stent grafting, open surgical repair and endovascular coil embolization. We describe a patient with severe comorbidities with complicated femoral pseudoaneurysm treated with emergent coil embolization via radial access. <h3>Case Report</h3> An obese 77-year-old female with multiple comorbidities, who was deemed a prohibitive risk for cardiac surgery, was taken to the cardiac cath lab for percutaneous coronary intervention. She underwent balloon valvuloplasty of the aortic valve in addition to placement of drug-eluting stents in the left main, LAD, diagonal and circumflex arteries. This was accomplished through a 10 French sheath placed in the left common femoral artery. The groin was closed with two Perclose devices. An immediate hematoma developed in the left groin. Manual pressure was held until the patient was stable. She was then transported to the ICU. Shortly after arrival in the ICU, the patient developed hypotension. She was taken back to the cardiac cath lab where she underwent an arteriogram via the left radial artery. Contrast extravasation was noted from the left femoral artery. Several attempts to control hemorrhage with balloon occlusion were unsuccessful. Urgent vascular surgery consultation was obtained. Patient was emergently moved to the endovascular operating room. Left femoral arteriography via left radial access revealed active contrast extravasation from the femoral bifurcation into a large pseudoaneurysm cavity. A vertebral catheter was used to advance a glide wire into the pseudoaneurysm. A microcatheter was then advanced into the pseudoaneurysm cavity. The pseudoaneurysm was embolized with two detachable 6 × 12 Penumbra Ruby coils. Post embolization, there was minimal flow into the pseudoaneurysm. Duplex ultrasound performed the next day revealed minimal flow in the pseudoaneurysm cavity with a maximal flow lumen of 1 cm. This was observed and it spontaneously thrombosed. The patient ultimately recovered and returned to her baseline medical status. <h3>Discussion</h3> A variety of methods are available for the treatment of pseudoaneurysms. Traditional treatment options include ultrasound-guided manual compression, thrombin injection and open surgery. With the development and evolution of endovascular techniques, less invasive options such as stent graft coverage and coil embolization can be successfully utilized. There are few case reports of coil embolization of femoral pseudoaneurysms. In selected patients, coil embolization may be an effective alternative to surgical treatment and can be offered by the vascular surgeon.

SP5.2.4 Stent-graft endobypass for non-infected femoral pseudoaneurysms in high-risk surgical patients: acceptable short-to-mid-term results

Abstract Aim Stent-grafts are finding a place in the treatment of femoral pseudoaneurysms (FpsAs), having been described in the treatment of infected pseudoaneurysms. We present the results of endovascular treatment of non-infected FpsAs using stent-grafts. Methods Case series of patients who underwent stent-graft coverage of FpsAs from January 2016 to December 2020. Stent-graft fractures, occlusions and reinterventions, length of stay (LOS) and 30-day mortality were assessed. Results 11 patients (mean age 75±10.3 years, 7 males; all ASA 3 or 4) underwent stent-graft coverage of FpsAs. Original procedures linked to the formation of FpsA were iliofemoral bypass (n = 3), femorofemoral crossover (n = 3), percutaneous coronary interventions (n = 2), aortobifemoral bypass (n = 1), endovascular aneurysm repair (n = 1) and femoral endarterectomy (n = 1). 3 patients had previous open FpsA repair. Technical success of deployment was 100%. Stent-grafts used included Viabahn Endoprosthesis (WL Gore &amp; Associates, Flagstaff USA; n = 8), Viabahn VBX (WL Gore &amp; Associates; n = 1) and BeGraft (Bentley InnoMed GmbH, Hechingen, Germany; n = 2). All patients were maintained on either antiplatelets or anticoagulant. 10 patients were available for analysis (1 lost to follow-up); radiological follow-up included initial computed tomography angiography and later combined duplex ultrasonography/plain radiography. Median LOS was 4 days (IQR 4). 30-day mortality was 0%. Median survival was 12 months (IQR 17). There was one stent-graft occlusion requiring thrombectomy but no fractures were observed in this series. Conclusions This small series suggests that there may be a role for stent-grafts in treatment of FpsAs in carefully selected patients. Given lack of data on long-term outcomes, continued surveillance is recommended.

Extra-Anatomical Iliopopliteal Bypass

Introduction: Pseudoaneurysm of the femoral artery or an infected graft in the femoral region is a very serious disease with devastating complication. The aim of this study is to describe a novel technique for its management in the form of an extra-anatomic bypass between external iliac artery (EIA) and the popliteal/distal superficial femoral artery (SFA). Methods: This is a single-center retrospective study and includes eight consecutive patients with infection of previous femoral grafts and large femoral pseudoaneurysms, in which extra-anatomic bypass between EIA and popliteal or distal SFA was done. Results: The mean age of patients in the study was 43 years. There was one 30-day postoperative mortality (12.5%) due to sepsis. The patency rate in rest of the seven patients at the end of 3 months was 100% with no major complications. Conclusion: Our technique of extra-anatomic bypass from external iliac to femoral or popliteal artery, just medial to anterior superior iliac spine beneath the inguinal ligament in the subcutaneous plane is a simple and quick approach with no major neurological or bleeding risk.

Initial Results after the Implementation of an Edge-To-Edge Transcatheter Tricuspid Valve Repair Program.

Transcatheter tricuspid valve repair (TTVr) has emerged as an alternative for the treatment of severe tricuspid regurgitation (TR). We report our initial experience with an edge-to-edge TTVr system in a high-volume institution. Methods: We included consecutive patients who underwent edge-to-edge TTVr systems. The primary efficacy endpoint was a reduction in the TR of at least one grade. The primary safety endpoint was procedure-related clinical serious adverse events. Results: A total of 28 patients underwent TTVr with edge-to-edge systems. All patients presented with at least severe TR with a high impact on quality of life (82% of patients in NYHA class ≥ III). The Triclip system was the most used device (89%). The primary efficacy endpoint was met in all patients. Only one patient experienced a procedural complication (femoral pseudoaneurysm). At three-month follow-up, 83% of patients were in NYHA I or II (18% baseline vs. 83% 3 months follow-up; p < 0.001). Echocardiography follow-up showed residual TR ≤ 2 in 79% of patients (paired p < 0.001). At the maximum follow-up (median follow up = 372 days), no patients had died. Conclusions: Edge-to-edge TTVr systems seem to represent a very valid alternative to prevent morbidity and mortality associated with TR as depicted by the favorable efficacy and safety.

Femoral Artery Branch Pseudoaneurysm Resulting from Muscle Strain Injury for CME credit September 2021

Femoral Artery Branch Pseudoaneurysm Resulting from Muscle Strain Injury for CME credit September 2021

The prevention and management of approach-specific complications of abdominal aortic balloon occlusion in pelvic and sacral surgery

Objective: To investigate the causes,prevention and treatment of femoral artery puncture related complications caused by the application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in the resection of pelvic and sacral tumors. Methods: Clinical data of 23 patients with femoral artery puncture related complications who received REBOA in the resection of pelvic and sacral tumors from August 2010 to August 2018 at the Musculoskeletal Tumor Center,Peking University People's Hospital were retrospectively analyzed.There were 8 males and 15 females,with the an age of (37.0±16.2) years (range:15 to 65 years).Arterial access via the Seldinger technique for REBOA was obtained in the right common femoral artery of 18 cases,and in the left of 6 cases.An arterial sheath with a diameter of 11 to 12 F(1 F≈0.33 mm) was used for the patient.The occurrence and treatment of postoperative complications were analyzed. Results: Acute femoral arterial thrombosis occurred in 18 patients,which was managed by open repair 48 hours postoperatively.Among the 349 patients admitted before 2015 who received hemostasis by compression after femoral artery sheath removal,12 patients (3.4%) developed acute femoral artery thrombosis.While the 476 patients admitted after 2015 who used a vascular stapler to close the femoral artery wound,6 patients (1.3%) developed acute femoral artery thrombosis.One case of retroperitoneal hematoma and 1 case of femoral pseudoaneurysm were found and surgically fixed.Postoperative follow-up was (40±18) months (range:13 to 108 months).Three cases with chronic lower extremity ischemia were confirmed by Doppler ultrasonography during 1 to 5 years follow-up.Two of them had minimal symptoms and denied further treatment,while the other one received femoral-femoral artery bypass surgery to restore distal flow for pain and numbness relief. Conclusions: Acute femoral arterial thrombosis was the most common femoral artery puncture.Technique refinement of REBOA,the use of percutaneous suture device and close follow-up can reduce the approach-specific complications,and help to detect and treat the complications timely,which may popularize the clinical application of REBOA.

Femoral Artery Branch Pseudoaneurysm Resulting From Muscle Strain Injury

A 66 year old male presented with pain and swelling isolated to the right thigh after a bout of vigorous exercise on a step treadmill. We report a muscle strain injury resulting in formation of a pseudoaneurysm arising from a branch of the mid superficial femoral artery. The pseudoaneurysm was incidentally discovered during a venous ultrasound examination. Within two weeks of its finding, the pseudoaneurysm had resolved.

Evaluation of pseudoaneurysm management post multiple injections in drug abuser using endovascular approach by covered stent

Abstract: Background: Femoral pseudoaneurysm considered the common complication of repeated femoral puncture during drug addiction by self-trials injections. Pseudo aneurysms form at the different sites arterial entrance (femoral, brachial, radial…) if not sealed, leaking of blood and result in a well formed pulsatile hematoma. This is a very crucial problem by the exponential growth of drug addiction. Methods: A prospective clinical trial study over a period of 20 months, 22 patients were attended complaining of a local pulsatile swelling at different site of recurrent drug injection and involved in this study. Antegrade or retrograde approach used depending on the site of the pseudoaneurysm and feeding neck. Excluded from study any patient presented with signs of infection or bleeding or treated by other method. Results: 22 patients, 20 were males and 2 were females. Age was 31.2 + 9.2 in years. The incidence of traumatic pseudo aneurysm between 15 - 25 years old (45.5% of our cases ). the most common site forming pseudoaneurysm the groin (femoral artery), the antecubital region (brachial artery) and carotid artery (11) 44%, (8) 32% and 3 (12%) respectively. Management by endovascular covered stent may with different complications post intervention like 4.5% (one patient) thrombosis on brachial artery, endo-leak of the femoral artery ( one patient) and all managed with no residual complication and all patients passed well. Conclusion: endovascular intervention using covered stent to close the feeding neck, with less controllable complications and less hospitalization time. Key words: endovascular, pseudoaneurysm, covered stent and endo-leak.

Non Healing Venous Ulcer

Chronic leg ulceration affects 1–2% of the population and is associated with poor healing, frequent ulcer recurrence, and significant morbidity. Venous reflux can be identified in more than 70% of ulcerated legs. Coexistent arterial disease may be a factor in up to 20% of patients, but the clinical significance is poorly understood. We describe a patient who presented with a lower-limb ulcer, which was treated as a misdiagnosed case of venous ulcer for 12 years, following femoral pseudoaneurysm ligation.

Rotor Drivers in Induction and Maintenance of Atrial Fibrillation

Atrial fibrillation is the most common arrhythmia in clinical practice. It is associated with an increased risk of stroke, chronic heart failure, and sudden cardiac death. Our options of restoring and maintaining sinus rhythm have a very limited effect, both in the case of antiarrhythmic and catheter treatment. Catheter ablation has proven to be a more effective approach than antiarrhythmic therapy. The success rate of the procedure reaches 70%. However, radiofrequency ablation is associated with a risk of complications, with 4.5% of patients likely to develop major complications, including tamponade (1.31%), femoral pseudoaneurysm (0.71%), and death (0.15%). Given the generally recognized dominant role of the pulmonary veins in the induction of atrial fibrillation, their electrical isolation has become the recommended tactic of the catheter approach. In the case of patients with paroxysmal form of atrial fibrillation, the success rate of the procedure reaches 87%. Unfortunately, in the case of persistent forms of atrial fibrillation, the effectiveness of the primary procedure decreases to 28% and reaches 51% with repeated interventions. In addition to the anatomically oriented isolation of the pulmonary veins, a number of strategies have been proposed to reach the secondary zones of atrial fibrillation induction. The results of recent studies on the effectiveness of strategies for ablation of rotor regions and their role in the induction and maintenance of AF may lead to the further development of catheter ablation techniques and an individual radiofrequency ablation approach in a particular patient.

Girişimsel işlemlere bağlı gelişen femoral psödoanevrizmanın primer onarımı

Objective: This study aimed to report our clinical experience with the treatment of iatrogenic femoral pseudoaneurysms with the primary suture technique. Materials-methods: Thirty patients treated with the diagnosis of femoral pseudoaneurysm in the femoral artery between September 2015 and August 2020 participated in the Non-iatrogenic pseudoaneurysms, iatrogenic aneurysms smaller than 4 cm, and thrombosed aneurysms were excluded. All pseudoaneurysms were diagnosed by ultrasonography and computed tomography. Results: Peripheral arterial thrombosis developed in 1 (4%) patients. All femoral pseudoaneurysms were repaired with primary suture without clamping. No early postoperative deaths occurred. Conclusion: Although cross-clamp surgical treatment modalities have been described as standard surgical treatment, surgical repair with primary suture technique without clamping is a good method for iatrogenic peripheral arterial pseudoaneurysms.

Abstract No. 147 Retrograde recanalization of infrainguinal chronic total occlusions in an outpatient-based lab setting

Retrograde recanalization of chronic total occlusions (CTO) has become an essential technique when treating patients with critical limb ischemia. However, this technique has often been labeled a high-risk skill limiting utilization in the outpatient-based lab (OBL) setting. Here, we investigate the safety and efficacy of retrograde recanalization in treating Infrainguinal CTOs in the OBL setting. A retrospective chart review identified 53 patients over a 2-year period with Rutherford 3 (7.5%), 4 (7.5%), 5 (52.8%), 6 (32.1%) disease, who had undergone retrograde recanalization of infrainguinal CTOs after traditional techniques had failed. Mean age was 70.7 years and 75% were male. The majority of patients suffered from multifocal and/or long segment occlusions with 81% involving the infrageniculate arteries. Overall technical success was 100% and all patients were discharged home the same day. There were no major complications and only 2 minor complications (1 femoral pseudoaneurysm treated with a stent graft and 1 minimally flow limiting dissection not requiring treatment). No patients in the cohort subsequently underwent a distal bypass. No patients required subsequent major amputation and 9 patients required minor amputation (9 ray). Of those presenting with wounds, 85% of patients showed evidence of wound healing or had completely healed their wound at 3 months, while 46% had completely healed their wounds at 6 months. Retrograde recanalization of infrainguinal chronic total occlusions is a safe and effective treatment strategy that can be performed in an OBL setting. It has a high technical success rate and a low risk profile and should be considered in those patients who have failed traditional antegrade techniques and are not candidates for a below-the-knee arterial bypass.

Results of Obturator Foramen Bypass in Patients with Groin Infection and Arterial Involvement

Arterial bypass tunneling via the obturator foramen (OFB) can be performed to circumvent groin infections during lower extremity revascularization. The objective of this study is to report safety and efficacy outcomes of OFB in the setting of infected femoral pseudoaneurysms and infected prosthetic femoral bypass grafts. A multihospital, single-entity healthcare system retrospective review was conducted for all patients who underwent OFB between January 2014 through June 2020. Any patient >18 years of age who underwent OFB in the setting of groin infection with a minimum of 30 days follow-up was included in the trial. Demographic, operative, and clinical characteristics of patients were gathered during chart review. Statistical analysis was performed using Microsoft Excel and R studio. Seventeen patients underwent OFB during the defined time-period. Demographic data are presented in the first table (Demographic Characteristics). Mean American Society of Anesthesiologists score was 3.25. Mean estimated blood loss was 500 mL. Mean operative time was 307 min. Mean follow-up time was 8.5 months (range 0-35 months). In total, 41.2% patients underwent fluoroscopic-guided tunneling, and, when compared to blind tunneling, showed no difference in intraoperative complications or operative time (P value 0.3). In total, 52.9% of patients required ICU admission resulting in a mean number of 0.8 ICU days. The overall mean length of stay was 16.8 days. Two major amputations were reported during follow-up. Patient mortality within 30 days was 0%. Primary patency within 30 days was 100%. Intravenous drug use was not associated with an increased number of subsequent groin wound procedures (P value 0.3). Intravenous drug use was not associated with concomitant methicillin-resistant Staphylococcus aureus infection (P value 0.3). OFB is a safe and effective surgical option in patients who are unable to undergo anatomic tunneling during lower extremity bypass. OFB is associated with favorable rates of primary patency and amputation-free survival at midterm follow-up.