Femoral Pseudoaneurysm Research Articles

Peri-interventional combined anticoagulation and antithrombotic therapy in atrial fibrillation ablation: A retrospective safety analysis.

Catheter ablation (CA) of atrial fibrillation (AF) requires an intensified peri-inter-ventional anticoagulation scheme to avoid thromboembolic complications. In patients with cardiac or extracardiac artery disease, an additional antiplatelet treatment (AAT) is at least temporally necessary especially after a percutaneous intervention with stent implantation. This raises the question whether these patients have a higher peri-interventional bleeding risk during CA of AF. The data of 1235 patients with CA of AF were retrospectively analyzed in terms of bleeding events, ablation type, antithrombotic medication and comorbidities such as coronary artery disease and components of the HAS- BLED score. Peri-interventional bleeding events were classified in accordance with the BARC classification. Differentiations were made between slight femoral bleeding (based on type 1), severe femoral bleeding and pericardial effusion without pericardiocentesis (based on type 2) with the need of further hospitalization, the need of transfusion (based on type 3a) and pericardial tamponades requiring pericardiocentesis (based on type 3b). 1131/1235 (91.6%) patients were exclusively under anticoagulation and 187 (15.3%) patients were also on AAT. There were no statistically significant differences in type 1 and 3b bleeding complica-tions or the occurrence of femoral pseudoaneurysms between both groups. However, type 2/3a bleeding complications, mostly femoral bleedings, were significantly more frequent in the patient group with AAT (3.2% vs. 7.5%, p = 0.006). An additional antiplatelet therapy increases the risk of severe femoral bleeding events during CA of AF. It appears reasonable to perform the elective procedure of AF ablation after the dis-continuation of AAT.

Comparison of controlled pressure belt -allowing mobility- to sandbags after percutaneous coronary intervention: pilot study

We aimed to investigate the efficacy and safety of a belt mechanism (anjiobelt), which we developed recently and patented, which allows mobility after coronary operations and the application of adjustable pressure to the femoral artery. Between October 2012 and April 2013, 189 consecutive patients undergoing percutaneous coronary intervention electively or due to acute coronary syndrome were enrolled. There were 96 patients in the sandbag group and 93 patients in anjiobelt group. Manual compression was applied to the femoral artery until reaching primary homeostasis. Then, a 4-5 kilogram sandbag or anjiobelt was placed. Mobilization was allowed in case of need in the anjiobelt group. Twenty-four hours after the procedure, superficial bruising in the femoral region, hematoma, pseudo-aneurysm, and arteriovenous fistula, as femoral artery complications, were noted using Doppler ultrasound. Hematoma occurred more frequently in the sandbag group. Hematoma of <1 cm developed in 52 patients with sandbag and in 25 patients with anjiobelt (p<0.0001), while hematoma of 1-5 cm developed in 5 patients with sandbag and in 3 patients with anjiobelt (p<0.0001). Femoral artery pseudoaneurysm was seen in 4 patients (2 with anjiobelt, 2 with sandbag; p=0.975). Anjiobelt significantly reduces the incidence of hematoma in comparison to conventional sandbag in patients undergoing percutaneous coronary intervention. Other complications of the femoral region in terms of efficiency and safety appear to be similar to those observed with sandbag. The main problems occurring in these patients due to absolute immobilization have been eliminated with the anjiobelt.

Life-Threatening Rupture of a False Aneurysm after Femoral Arterial Catheterization: Unexpected Delay after a Common Procedure

We report the case of a 79-year-old patient who presented with a femoral iatrogenic pseudoaneurysm of delayed and unusual onset with immediately life-threatening massive bleeding. Ultrasound is the method of choice for the diagnosis of pseudo aneurysm. If there is not spontaneous closure, ultrasound-guided compression repair, minimally invasive percutaneous treatments, and surgical repair are the three therapeutic options.

New risk scoring system for femoral pseudoaneurysm formation after cardiac catheterization (Ateş Scoring System)

To create a new scoring system for femoral pseudoaneurysm (FPA) formation after diagnostic or interventional cardiac catheterization. Materials and methods: We evaluated 41,322 transfemoral catheterization procedures performed in our center within 7 years. Among all procedures, 630 FPAs developed that required surgical repair. Eighty-five cases were managed by compression with duplex guidance. As a case-control group, 1260 patients were selected from the patients who had been catheterized during the same time period but did not develop FPA. We created the risk scoring system according to body mass index, hypertension, diabetes mellitus, catheter diameter, coronary artery disease, atherosclerosis, and number of patients treated per day in a particular room. Results: FPA required operative repair in 1.1% of patients who underwent cardiac catheterization for diagnosis and in 4.7% of cardiac interventional procedures. We determined that if the risk score is greater than 15, the probability of formation of a FPA is 7 times greater than normal. Conclusion: This study confirms that FPA is a morbid situation, and high risk scores are important because FPA formation is 7 times greater than normal. This novel method of calculating risk score allows for the stratification of patients into 4 levels of risk.

Ruptured pseudo-aneurysm of a femoral artery in a drug abuser revealed by post-mortem CT angiography

A 35-year-old drug addict was found dead in a public toilet with a ruptured groin, which was later diagnosed to be a leaking pseudo-aneurysm. Investigation at the scene revealed impressive external hemorrhage related to a groin wound. Post-mortem computed tomography angiography demonstrated an aneurysm of the right femoral artery with leak of contrast liquid. Signs of blood loss were evident at autopsy, and histological examination revealed necrosis and rupture of the pseudo-aneurysm. Toxicological analyses were positive for methadone, cocaine, citalopram, and benzodiazepines. This is the first case report in the literature of a ruptured femoral pseudo-aneurysm with a post-mortem radiological diagnosis.

Computational fluid dynamic modeling of femoral artery pseudoaneurysm

Abnormal dilations of arteries or veins are called aneurysm. There is a pseudoaneurysm which does not have the structure of arterial wall. The patient with a pseusoaneurysm should be treated as soon as possible to avoid potential dangers from it. Here, we made a model of a femoral pseudoaneurysm to study its hemodynamics, which help to develop new treatment methods that reduce a recurrence and side effects from treatments. We interpreted hemodynamics in a femoral pseudoaneurysm and found that there is continous and repetitive pressure to the pseudoaneurysm wall and that the pressure is bigger in the 90° model than in the 45° model.

Spontaneous External Rupture of Femoral Pseudoaneurysm

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

TCT-403 Percutaneous Ultrasound-Guided Thrombin Injection as a Safe and Efficacious Primary Treatment of Iatrogenic Femoral Pseudoaneurysms for the Interventional Cardiologist

TCT-403 Percutaneous Ultrasound-Guided Thrombin Injection as a Safe and Efficacious Primary Treatment of Iatrogenic Femoral Pseudoaneurysms for the Interventional Cardiologist

E-012 Urgent intra-arterial thrombectomy for stroke: technical complications

IntroductionSince April 2010, a pilot experience has been set for offering intra-arterial treatment for stroke to a 3.5 million people population. We aim to share our experience from the standpoint...

Mycotic Pseudoaneurysms Due to Injection Drug Use: A Ten-Year Experience

Arterial injury and infection due to repetitive injection drug use can result in mycotic pseudoaneurysm predisposing to hemorrhage, distal embolism, limb loss, and death. We hypothesized that debridement of the infected artery, followed by immediate vascular reconstruction, results in successful limb salvage in these patients. The setting was a county hospital. A retrospective review of all patients diagnosed with lower extremity pseudoaneurysms by the Departments of Surgery and Radiology between 2000 and 2009 was conducted. Outcome measures were patient characteristics, site(s) of lesion, type and results of imaging, type of operation, length of hospital stay, and complications. Sixteen patients had 17 pseudoaneurysms. One of the patients had two mycotic pseudoaneurysms in the same region separated by a period of 10 months. Culture of the wall of the first pseudoaneurysm was not performed. The second pseudoaneurysm was culture positive. The 15 remaining mycotic pseudoaneurysms were all culture positive. Nine patients were men, and the median age of the patient group was 37 years. Common femoral pseudoaneurysms were the most frequent (76%). Symptoms included swelling (94%), pain (82%), and erythema (75.6%). A rapidly expanding pulsatile expansile mass was present in four of the patients. Computed tomography and percutaneous angiography were done in seven and four of the patients, respectively, and were diagnostic in all cases studied. Resection and reconstruction with autologous vein was the most common procedure (seven), followed by cadaveric grafting (four), synthetic grafting (two), ligation (two), and primary repair (two). Muscle flaps were used in 76.5% of the cases. Complications included anastomotic dehiscence (n = 3), acute thrombosis (n = 1), ischemia (n = 1), abscess (n = 1), and compartment syndrome (n = 1). Three of these patients required a second vascular reconstruction. One patient ultimately required an amputation. No postoperative deaths occurred. Methicillin-resistant Staphylococcus aureus was cultured from 13 of the 16 arterial walls. Methicillin-resistant Staphylococcus aureus is the predominant organism causing mycotic aneurysms of the common and superficial femoral arteries owing to injection drug use at San Francisco General Hospital. Wide debridement of the infected artery and reconstruction with an in-line reversed saphenous vein or cryopreserved vascular allograft is a safe and effective method of treatment. Long-term follow-up studies are needed to determine the durability of this method of treatment.

Safety of pulmonary vein isolation and left atrial complex fractionated atrial electrograms ablation for atrial fibrillation with phased radiofrequency energy and multi-electrode catheters

Recently, a multi-electrode catheter system using phased radiofrequency (RF) energy was developed specifically for atrial fibrillation (AF) ablation: the pulmonary vein ablation catheter (PVAC), the multi-array septal catheter (MASC), and the multi-array ablation catheter (MAAC). Initial results of small trials have been promising: shorter procedure times and low adverse event rates. In a large single-centre registry, we evaluated the adverse events associated with multi-electrode ablation catheter procedures with PVAC alone, or combined with MASC and MAAC. In all, 634 consecutive patients with AF had 663 procedures with multi-electrode ablation catheters, 502 patients with the PVAC alone, 128 patients with PVAC/MASC/MAAC, 29 redo procedures with the PVAC or PVAC/MASC/MAAC, and 4 patients had a complicated transseptal puncture. Major and minor adverse events during 6 month follow-up were registered. In 15 cases (2.3%), major adverse events were seen within the first month after the procedure. These included complicated transseptal puncture (4), stroke (2), transient ischaemic attack (5), acute coronary syndrome (2), femoral pseudoaneurysm (1), and arteriovenous fistulae (1). Minor adverse events were seen in 10.7% at 6 months, mostly due to femoral haematoma (3.9%), and non-significant PV stenosis (5.2%). There was no difference in the occurrence of major adverse events between PVAC alone, or PVAC/MASC/MAAC ablation. Ablation with phased RF and multi-electrode catheters is accompanied by a major adverse event rate of 2.3% within 1 month and a minor event rate of 10.7% at 6 months.

Ultrasound-guided compression repair for iatrogenic femoral artery pseudoaneurysm

To evaluate relative factors affecting the efficiency of ultrasound-guided compression repair in iatrogenic femoral artery pseudoaneurysm. Ultrasound-guided manual compression was performed in 42 patients of iatrogenic femoral artery pseudoaneurysm from June 2004 to June 2010. There were 28 male and 14 female patients, with a mean age of (52 ± 5) years. These patients were presented with femoral artery pseudoaneurysm after catheterisation procedure by percutaneous femoral artery puncture and confirmed by color doppler flow image. Ultrasound-guided manual persistent compression with probe was performed at the puncture site between femoral artery and pseudoaneurysm, until completely thrombosis of pseudoaneurysm, whereas the pseudoaneurysm failed to complete closure required surgical repair. Out of 42 patients, 34 patients (81.0%) were successfully treated by compression resulted in completely thrombosis. There were 8 (19.0%) failures conversion to surgery. Factors associated with success were size of pseudoaneurysm (< 25 mm, 25 - 40 mm, > 40 mm; χ(2) = 13.956, P = 0.001), anti-coagulation status (χ(2) = 5.578, P = 0.010), depth of artery break (< 50 mm, 50 - 80 mm, > 80 mm; χ(2) = 14.055, P = 0.001), pseudoaneurysm communicated with common femoral artery, superficial femoral artery and profunda femoral artery (χ(2) = 8.968, P = 0.011), as well as days to presented with pseudoaneurysm (< 3 d, ≥ 3 d; χ(2) = 5.733, P = 0.012). In multivariate Logistic regression analysis, success by compression was associated with size of pseudoaneurysm (WALD = 5.34, P = 0.021) and with depth of artery break (WALD = 4.84, P = 0.028). The ultrasound-guided compression repair of iatrogenic femoral artery pseudoaneurysm is safe, convenient, inexpensive and reliable treatment.

An undiagnosed pseudoaneurysm found during arterial catheterization in a Takayasu arteritis patient

An undiagnosed pseudoaneurysm found during arterial catheterization in a Takayasu arteritis patient

Aorta-Bifemoral Baypas Sonrası Oluşan Femoral Psödoanevrizmanın İçerisinde Serbest Greftin Cerahi Tamiri

Aorta-Bifemoral Baypas Sonrası Oluşan Femoral Psödoanevrizmanın İçerisinde Serbest Greftin Cerahi Tamiri

Deep Femoral Artery Branch Pseudoaneurysm After Orthopedic Procedure Requiring Surgical Treatment: A Case Report

Pseudoaneurysms (PSA) of deep femoral artery (DFA) have been reported following penetrating and blunt trauma to the thigh and orthopedic procedures of the proximal femur. We describe a case of pseudoaneurysm of DFA as a late complication of limb trauma which was confirmed by exploration in an urgent surgery. After two operations successful surgical repair was performed.

Femoral pseudoaneurysms requiring surgical treatment.

Background:Despite use of arterial closure devices (APCDs) and thrombin injection , surgery is needed at times to repair femoral pseudoaneurysms (FPA) in patients undergoing endovascular interventions. We analysed the indications and results of surgical repair in a tertiary referral center performing more than 6.000 angiographies and/or interventions annually.Objectives:The aim of this retrospective observational study was to identify local and clinical factors related to the need of surgical repair.Patients and Methods:In this retrospective study, 122 (0.06%) FPAs treated among 21060 patients over a period of five years were assessed. Patient characteristics and therapeutic procedures were analyzed through hospital records.Results:There were 15.163 (72%) coronary and 5.897 (27%) peripheral interventions, respectively. In 89 (73%) patients, FPA was successfully treated by ultrasound guided compression (USGC) alone.Thirty-three (28%) patients underwent open surgical repair. Indication for operative treatment was hemodynamic instability in 9 (7%) patients, rapidly expanding haematoma unsuitable for USGC or after unsuccessful USGC in 23 (19%). One (0.8%) patient had an arterio-venous fistula. Intraoperative findings suggest that atypical endovascular access (e.g. deep femoral artery, lateral or medial puncture) and multiple puncture sites and/or laceration of the vessel wall were related to the need for surgery in 22 (67%) cases. Most patients had active antithrombotic therapy. Gender or the nature of procedure (diagnostic vs. intervention) did not increase risk for open repair. One (0.8%) patient died. No amputations were performed. Mean hospital stay of patients undergoing open surgical repair was 11 (range 4-36) days.Conclusions:Technical puncture problems were identified in 2/3 of patients requiring open surgery.

Management of Femoral pseudoaneurysms in intravenous drugs users - A bubble trouble

Introduction: Femoral pseudoaneurysm in the intravenous drug users is a challenge to the treating surgeon. Surgical options range from ligation with excision to reconstruction using various kinds of grafts. However there is no generalized consensus on the optimal surgical treatment and the controversy persists.&#x0D; Methods: Medical charts of 10 consecutive patients presenting with infected femoral pseudoaneurysm of the lower limbs in emergency department,who underwent surgery in Bir Hospital from Jan 2008 to Dec 2010 were retrospectively analyzed. The patients were divided into two groups randomly based on the surgical management they had received. First was the reconstructive group and the second group underwent simple ligation of the femoral artery and excision of the pseudoaneurysm &#x0D; Results: All cases underwent emergency surgery. Extra anatomical Iliofemoral bypass was done in total of 7 cases, of which polytetrafluroethylenePTFE graft in 5 and Vein graft in 2 cases. Ligation of the femoral artery and excision of the pseudoaneurysm was done in 3 cases. In the reconstructive group 2 cases had to be operated twice for bleeding, 1 with PTFE graft and other with vein graft whereas 2 cases had late graft infection and was attributed to reinjection of drugs through the graft. All 4 cases underwent reoperation with ligation. In the second group with simple ligation and excision except for mild claudication, there were no other major complications. There was no mortality in both the groups.&#x0D; Conclusion: Intravenous drug users have high tendency to reuse femoral site for reinjection and thus arterial reconstruction maybe in jeopardy of recurrent infection and reoperation. Simple ligation with debridement and excision may prove to be a better option in cases of emergency surgery followed by delayed reconstruction if needed.

Iatrogenic femoral pseudoaneurysms - a simple solution of inconvenient problem?

A femoral artery pseudoaneurysm - is the most common complication associated with invasive coronary interventions. The aim of the study was to analyze the effectiveness of various methods used for femoral pseudoaneurysm treatment and to assess how routine use of radial approach leads to reduction of these site complications. The study comprised 1854 consecutive patients who were hospitalized in years 2005-2008 and underwent coronary angiography (with or without angioplasty) via femoral artery access. Since 2009 routine radial approach has been introduced for both coronary angiography and angioplasty. In patients with symptoms suggesting entry site complications Doppler ultrasound was performed. Femoral access site complications requiring additional procedures were observed in 63 patients (3.4%): in 56 femoral pseudoaneurysms (88.8%) and in 7 arteriovenous fistulas (11.1%) were diagnosed (all appeared after coronary angioplasty). The patients were treated in following ways: standard compression with an elastic bandage prolonged to 12 hours - in 14 cases (25%), ultrasound guided compression - in 13 patients (23.2%), finger compression followed by standard compression with an elastic bandage prolonged to 12 hours or ice compress - in 10 patients (17.8%), surgical treatment - in 3 patients (5.3%). Only 2 patients required thrombin injection (3.6%). Since the time routine radial approach was introduced extreme reduction in the rate of local complications was registered. Although iatrogenic femoral pseudoaneurysms following invasive percutaneous coronary interventions are still important complications, most of them can be treated conservatively. It seems that radial access completely eliminates the risk of this complication.

Percutaneous embolization of coronary fistulas: A single-center experience

IntroductionA coronary fistula is a connection between one of the coronary arteries and a cardiac chamber or great artery. It is a rare defect and usually occurs in isolation. Two-dimensional echocardiography has an important role in diagnosis but coronary or CT angiography is essential to delineate the anatomy. Surgery is the traditional therapeutic approach but percutaneous closure is now the recommended method, with excellent results and few complications in experienced centers. MethodsWe describe our experience with percutaneous treatment of 15 coronary fistulas in 12 patients between 1996 and 2011. Eight (67%) were males and the median age was 25 years. The most frequent symptoms were murmur and/or fatigue. All fistulas were congenital. Five patients (42%) had concomitant cardiac disease: pulmonary atresia with intact ventricular septum (1), patent ductus arteriosus (1), ostium secundum atrial septal defect (1), stenotic bicuspid aortic valve (1), and critical pulmonary stenosis operated in the neonatal period (1). Three patients had two fistulas, while the others had a single lesion. All fistulas were hemodynamically significant. They originated in the territory of the right coronary (10), left coronary (3) and circumflex (2), draining into the right ventricle (5), pulmonary artery (6), right atrium (2) coronary sinus (1) and left ventricle (1). Embolization materials included standard coils, controlled-release coils, microcoils (standard, GDC or IDC) and an Amplatzer® duct occluder. ResultsEmbolization was achieved in all patients. There was no mortality. One patient with a large fistula and a very small right coronary artery distally to the origin of the fistula had a right ventricular infarction. In three patients there were minor complications: inadvertent coil embolization, recovered in the same procedure (1), transient arrhythmia (1) and femoral pseudo-aneurysm (1). In a mean follow-up of 4.9 years (1 month to 14 years), there were no procedure-related complications. Echocardiographic and/or angiographic control showed complete and permanent occlusion in ten patients and minimal residual flow in two patients through small collaterals with no hemodynamic significance. ConclusionPercutaneous embolization represents an effective form of treatment for selected coronary fistulas. A wide range of embolization devices must be available to ensure the best therapeutic approach.

Embolização percutânea de fístulas coronárias – Experiência de um centro

Introduction A coronary fistula is a connection between one of the coronary arteries and a cardiac chamber or great artery. It is a rare defect and usually occurs in isolation. Two-dimensional echocardiography has an important role in diagnosis but coronary or CT angiography is essential to delineate the anatomy. Surgery is the traditional therapeutic approach but percutaneous closure is now the recommended method, with excellent results and few complications in experienced centers. Methods We describe our experience with percutaneous treatment of 15 coronary fistulas in 12 patients between 1996 and 2011. Eight (67%) were male and median age was 25 years. The most frequent symptoms were murmur and/or fatigue. All fistulas were congenital. Five patients (42%) had concomitant cardiac disease: pulmonary atresia with intact ventricular septum (1), patent ductus arteriosus (1), ostium secundum atrial septal defect (1), stenotic bicuspid aortic valve (1), and critical pulmonary stenosis operated in the neonatal period (1). Three patients had two fistulas, while the others had a single lesion. All fistulas were hemodynamically significant. They originated in the territory of the right coronary (10), left coronary (3) and circumflex (2), draining into the right ventricle (5), pulmonary artery (6), right atrium (2) coronary sinus (1) and left ventricle (1). Embolization materials included standard coils, controlled-release coils, microcoils (standard, GDC or IDC) and an Amplatzer ® duct occluder. Results Embolization was achieved in all patients. There was no mortality. One patient with a large fistula and a very small right coronary artery distally to the origin of the fistula had a right ventricular infarction. In three patients there were minor complications: inadvertent coil embolization, recovered in the same procedure (1), transient arrhythmia (1) and femoral pseudo-aneurysm (1). In a mean follow-up of 4.9 years (one month to 14 years), there were no procedure-related complications. Echocardiographic and/or angiographic control showed complete and permanent occlusion in ten patients and minimal residual flow in two patients through small collaterals with no hemodynamic significance. Conclusion Percutaneous embolization represents an effective form of treatment for selected coronary fistulas. A wide range of embolization devices must be available to ensure the best therapeutic approach.