Iatrogenic Femoral Artery Pseudoaneurysm Research Articles

Area reduction of perforation with a small-size sheath technique for iatrogenic femoral artery pseudoaneurysm with a large perforation.

Open surgery for femoral artery pseudoaneurysms is invasive, and complications can be detrimental. Several cases of treatment of iatrogenic femoral artery pseudoaneurysms using percutaneous suture-mediated closure devices have been reported. However, it is difficult to properly deploy the foot of the device to the arterial wall when the perforation area is large. We developed a technique using a double guidewire to partially occupy the perforation with a small-size sheath, which reduces the area of the perforation. This AREPAS (area reduction of perforation with a small-sized sheath) technique might allow for minimally invasive closure of perforations even in patients with large perforation areas.

The Importance of Ultrasound-Guided Manual Compression in Iatrogenic Pseudoaneurysm Treatment: The Sooner the Better

Objective: Although ultrasound-guided manual compression is a safe and cost-effective method in the treatment of pseudoaneurysm, there are many factors affecting the success of the procedure. This study aimed to determine the factors affecting the success of ultrasound-guided manual compression. Methods: The records of patients who developed iatrogenic femoral artery pseudoaneurysm in the cardiology department between 2017 and 2020 were retrospectively analyzed. Data regarding patients, procedural and aneurysm-related factors were evaluated by univariate and multivariate logistic regression analysis. Results: Seventy-five patients who underwent ultrasound-guided manual compression were included in our study. In study population, the rate of successful ultrasound-guided manual compression is 72%. As a result of the univariate analysis, hypertension, diabetes mellitus, sheath size, the length of aneurysm sac, the width of aneurysm sac, compression duration, aneurysm detection time> 24 hours parameters were found to be significant predictors for failed ultrasound-guided manual compression. In the multivariate analysis, it was found that the independent predictors associated with failed ultrasound-guided manual compression were the aneurysm detection time longer than 24 hours and the length of aneurysm sac (odds ratio: 5.908; 95% CI 1.136-30.720; P=.035 and odds ratio: 1.042; 95% CI 1.008-1.100; P=.045). In receiver operating characteristic (ROC) curve analysis, the length of the pseudoaneurysm sac of 34 mm and above had 90% sensitivity and 57% specificity for failed ultrasoundguided manual compression. Conclusions: Ultrasound-guided manual compression is an effective method in the treatment of pseudoaneurysm. However, early detection and size of pseudoaneurysm are important for the success of this treatment. Checking the operation site within the first 24 hours after catheterization is important for early diagnosis and treatment of possible complications. In addition, it should be considered that treatment success is low in length of pseudoaneurysm sacs longer than 34 mm.

Non-Surgical treatment Versus Surgery for Iatrogenic Femoral Artery Pseudoaneurysms: Systematic Review and Meta-Analysis.

ObjectivesThis study compared results of non-surgical treatment (compression and ultrasound guided thrombin injection (UGTI)) and surgery to treat iatrogenic femoral artery pseudoaneurysms.MethodsPubMed and Embase databases were searched up to October 2021. Primary outcome measure was success rate, and other outcomes examined were complication rate, reintervention rate. Two authors independently reviewed and extracted data. Data were presented as the odds ratios (ORs) with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to appraise the quality of the body of evidence.ResultsEight studies were included. A total of 623 patients with pseudoaneurysm undergoing treatment were included, of which 163 subjects underwent surgery, 397 subjects underwent compression, and 63 subjects underwent UGTI. The success rate was significantly lower in the non-surgery group (OR 0.24, 95% CI, 0.08–0.69, I2 = 0%). The complication rate was significantly lower in the non-surgery group (OR 0.10, 95% CI, 0.03 –0.29, I2 = 0%). Patients in the non-surgery group tended to have a lower, but statistically insignificant, reintervention rate (OR 0.11, 95% CI, 0.01–1.06, I2 = 35%). Further, the GRADE assessment showed that these results (success rate, complication rate, and reintervention rate) were of very low quality.ConclusionsAvailable evidence shows that it is reasonable to regard non-surgical treatment as the primary treatment for iatrogenic femoral artery pseudoaneurysms, and surgery as a remedy after failure of non-surgical treatment in some cases.

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.

Late to early velocity index as a predictor of iatrogenic femoral artery pseudoaneurysm recurrence in patients treated with ultrasound-guided thrombin injection.

IntroductionUltrasound-guided thrombin injection (UGTI) is the preferred treatment of pseudoaneurysms (psA). The potential risk of complications increases with the number of UGTI treatments needed for complete psA obliteration. Identification of risk factors for recurrent psA is needed.Material and methodsIn total, 508 patients with femoral artery psA underwent UGTI, followed by ultrasound examination repeated twice, at 1-week intervals, to assess UGTI effectiveness. In cases of psA recurrence, the procedure was repeated. Clinical and ultrasound data were prospectively collected.ResultsThe psA recurrence occurred in 76 (15%) patients. UGTI was repeated twice in 49 (64%), three times in 15 (20%) and more than three times in 12 (16%) patients. The median thrombin dose was 150 IU (80–250 IU), and was lower in initial procedures than repeated UGTI (p = 0.025). The median psA volume was 2.26 ml (0.86–5.47 ml). The median length of the communicating channel was 4 mm (0–12 mm). A time interval between vessel catheterization and UGTI greater than 7 days (p < 0.001), a late to early velocity index (LEVI) of < 0.2 identified during the outflow phase (p < 0.001), a psA volume > 5 ml (p = 0.032), and a short communicating channel between the psA and the artery (p = 0.037) predicted psA recurrence. Antiplatelet and anticoagulant agents did not increase the risk.ConclusionsThe LEVI and time interval between artery cannulation and UGTI treatment are strong parameters identifying patients at risk of psA recurrence. The psA volume and communicating channel length are less substantial risks, but still significant. Concomitant antiplatelet and anticoagulant therapy do not affect the success rate of UGTI.

Effective treatment of iatrogenic femoral pseudoaneurysms by combined endovascular balloon inflation and percutaneous thrombin injection.

The increasing number of percutaneous endovascular procedures in highly anticoagulated patients has increased the possibility of iatrogenic femoral artery pseudoaneurysm (IFAP). Ultrasound (US)-guided percutaneous thrombin injection is one of the feasible treatments; however, there are concerns about complications such as peripheral embolization. This study was performed to examine the efficacy and safety of treatment of IFAPs using a combination of percutaneous thrombin injection and intravascular balloon inflation. In this retrospective, single-center study, we analyzed 11 patients who developed and were treated for IFAPs from January 2017 through April 2020. The patients were treated with endovascular therapy (EVT) with percutaneous thrombin injection. The technique utilized fluoroscopic guidance to place a balloon at the neck of the IFAP, and the balloon was then inflated to prevent the inflow of blood to the aneurysm. We then performed US-guided thrombin injection. The mean age was 72.36 ± 10.43years; mean body mass index (BMI) was 25.25 ± 3.18. All patients had hypertension, 72.7% were undergoing hemodialysis, and 54.5% used oral anticoagulant drugs. The mean aneurysm size was 24.34 ± 13.54mm. The approach was transfemoral in ten patients and transradial in one patient. All procedures were successful, and there were no complications. The mean thrombin dose was 677.3 ± 410.7IU; the total hemostatic time was 45.4 ± 24.9min. In conclusion, the combination of percutaneous thrombin injection and endovascular balloon inflation was feasible and safe for the treatment of IFAPs. This technique may contribute to the treatment of IFAPs.

Comparison of two simple treatment algorithms for iatrogenic femoral artery pseudoaneurysm: ultrasound guided manual compression vs. ultrasound guided thrombin injection

Abstract Background Postcatheterization femoral pseudoaneurysm (PSA) is a common access site related complication after endovascular procedures with potentially deleterious effect on patient outcome. There is still lack of consensus about the optimal treatment. Objective We analyze the incidence of PSA in a large cohort of patients undergoing state of the art procedures in current cardiology, identify independent risk factors for PSA formation and assess our experience in PSA treatment comparing two simple treatment algorithms: ultrasound guided manual compression vs. ultrasound guided thrombin injection as a first line treatment. Methods and results In this single-centre, retrospective study 29.802 patients from January 2013 to May 2018 underwent femoral artery catheterization. Sheath removal was carried out according to standard operating procedures of the clinic. In 228 patients, a PSA was diagnosed. Thus, overall incidence of PSA amounted to 0.8%. Of 228 patients with a PSA, 117 (51%) patients were primarily treated with ultrasound guided manual compression with an overall success rate of 34% at next day follow up. All other patients (n=111, 49%) were primarily treated with ultrasound guided thrombin injection with an overall success rate of 99% at next day follow up. Low rates of periprocedural complications were noted with either hemostasis technique. Analysis of laboratory characteristics revealed that efficacy of ultrasound guided manual compression is dependent on INR whereas efficacy of ultrasound guided thrombin injection is independent of INR (p=0.0253). There was also a higher rate of significant hemoglobin drop with ultrasound guided manual compression versus ultrasound guided thrombin injection (0.78 mg/dl ± 0.09 vs 0.26 mg/dl ± 0.08, p=0.038). Time to mobilization was significantly shorter after ultrasound guided thrombin injection (UGTI: mean time 23.4 h ± 3.1 h, UGMC: mean time 27.1 h ± 10.2 h, p=0.0002). Multivariate logistic regression analysis revealed that female gender, age (&amp;gt;75 years), oral anticoagulation and anemia are independent risk factors for PSA formation. Conclusions Almost 0.8% of patients undergoing cardiac catheterization via femoral access acquire PSA, for which independent risk factors could be identified. Interventional cardiologist operated ultrasound guided thrombin injection is highly effective and safe as a first line treatment and reduces blood loss compared to ultrasound guided manual compression. Funding Acknowledgement Type of funding source: None

Ultrasound-guided thrombin injection for treatment of iatrogenic femoral artery pseudoaneurysms compared with open surgery: first experiences from a single institution.

PurposeThe frequency of iatrogenic femoral artery pseudoaneurysm (FAP) diagnoses has recently increased due to the growing use of diagnostic and interventional procedures involving large diameter sheaths, as well as more potent anticoagulation procedures. In this study, we aimed to present our experience with ultrasound-guided thrombin injection (UGTI) in patients with iatrogenic FAP.MethodsWe studied patients with FAP who were under anticoagulant or antiplatelet therapies preoperatively, or who had received a loading dose during an interventional procedure. The outcomes of patients with FAP treated with UGTI were compared with those of patients who underwent open surgical repair for pseudoaneurysms.ResultsAmong the 55 patients included in this study, 24 had UGTI while 31 had open surgery. The success rate was 95.8% when taking into consideration primary and secondary attempts. The mean duration of the procedure was shorter in patients with UGTI (10.1 ± 3.54 minutes) when compared with those who underwent open surgery (76.55 ± 26.74 minutes, P ≤ 0.001). In addition, the total complication frequency was significantly higher in the open surgery group (P = 0.005), as was their length of hospital stay (P < 0.001). Cost analysis showed significant differences between UGTI ($227.50 ± $82.90) and open surgery ($471.20 ± $437.60, P = 0.01).ConclusionWe have found that UGTI is the safer and more effective choice of treatment in appropriate patients with FAP, as opposed to surgery.

LEA 39. Surgical Management of Complex Femoral Artery Pseudoaneurysms in the Era of a Minimally Invasive Intervention

The objective of this study was to identify the etiology, clinical presentation, and surgical morbidity and mortality of femoral artery pseudoaneurysms (FAPs) requiring surgery at our institute. We also proposed a classification of FAPs and an algorithm for systematic stepwise surgical decision-making of FAPs based on intraoperative findings. Patients with FAPs requiring surgical intervention at our institution between January 2016 and April 2019 were included. Data in this study were collected prospectively. A total of 54 (male, 42; female, 12) patients with FAPs who underwent surgical intervention at our institute were included in the study. The mean age of the population was 50.1 years. Most of the FAPs were iatrogenic (83.3%), whereas 13% were seen in intravenous drug abusers and 3.7% were traumatic. In iatrogenic FAPs, percutaneous coronary intervention was the most common cause (33.3%), followed by dialysis access (31.5%) and surgery (13%). Common femoral artery was the most commonly involved artery (51.9%) in FAPs in our study. Right-side pseudoaneurysms were more common than left-side pseudoaneurysms (72.2% vs 27.8%). Pseudoaneurysm clot culture was positive in 63%. Staphylococcus aureus (29.6%) was the most common organism isolated. There was a significant correlation between the cause of the pseudoaneurysm and surgery done, even though our surgical decision was based on intraoperative findings. Post-dialysis pseudoaneurysms underwent primary rent closure (P = .014); post-percutaneous coronary intervention pseudoaneurysms underwent patch repair (P = .04); and postsurgical pseudoaneurysms (P = .001) and intravenous drug abuse pseudoaneurysms (P = .041) underwent bipolar ligation. There was a significant difference (P = .04) in the age of patients who required amputation after bipolar ligation compared with those who did not (55 years vs 41 years). Mortality in our study was 3.7%; morbidity was mostly wound related, seen in 24% of patients. Re-exploration was needed in 11.1% of patients. Even in the era of increasing minimally invasive approaches for various surgical problems, including FAPs, there is still a role for open surgical pseudoaneurysm repair if indicated, and it can be done with acceptable morbidity and mortality.

Ultrasound-Guided Percutaneous Thrombin Injection in Iatrogenic Femoral Artery Pseudoaneurysms: A Single Center Experience

Amaç: Bu çalışmada, iyatrojenik femoral arter psödoanevrizmalarında ultrason eşliğinde perkütan trombin enjeksiyonu tedavisi hakkında tecrübemizi aktarmak ve bu minimal invaziv tedavinin etkinliği ile güvenilirliğinin sunulması amaçlandı.Gereç ve Yöntemler: Bu çalışmada Haziran 2012 ile Ağustos 2017 arasında ultrason eşliğinde perkütan trombin enjeksiyonu ile tedavi edilmiş iyatrojenik femoral arter psödoanevrizmalı 42 hasta (26 kadın, 16 erkek) retrospektif olarak değerlendirildi. Doppler ultrason ile psödoanevrizma kesesi sayısı, çapı, psödoanevrizma şekli ve yapısı, orijin aldığı arter tanımlandı ve sonrasında 21 G iğne ile trombin enjeksiyonu gerçekleştirildi. İşlem sonrası kontrol, ilk gün ve birinci hafta sonrası Doppler ultrason ile yapıldı.Bulgular: Çalışmaya dahil edilen hastların ortalama yaşı 66 idi (46-88 yaş). Psödoanevrizmalar hastaların %33’ünde yüzeyel femoral arterden, %67’sinde ana femoral arterden köken almaktaydı. Ortalama psödoanevrizma çapı 36.7 mm (19-55 mm), ortalama psödoanevrizma uzunluğu 21 mm, ortalama boyun çapı 3.2 mm olarak ölçüldü. Psödoanevrizmalar hastaların %50’sinde parsiyel tromboze, 8 hastada aynı zamanda iki veya daha fazla sayıda ve 8 hastada multilobuleydi. Hastaların %83’ünde psödoanevrizma kesesi tek enjeksiyonda total tromboze oldu. İki hastanın psödoanevrizma kesesi ilk prosedür esnasında trombin enjeksiyonuna ek olarak hafif kompresyon ile tromboze edildi. Dört hastada ilk hafta içinde gelişen rekürrens nedeniyle ikinci bir enjeksiyon ile total tromboz sağlandı. Bir hastada psödoanevrizma boyutunun artması sonucu yüzeyel femoral artere bası yapması ve akımı engellemesi nedeniyle psödoanevrizma stent-greft ile tedavi edildi. Teknik, primer ve sekonder başarı oranları ise sırasıyla %100, %93 ve %98 olarak hesaplandı. İşlemler esnasında komplikasyon gelişmedi. Sonuç: İyatrojenik femoral arter psödoanevrizmalarının tedavisinde uygulanan ultrason eşliğinde perkütan trombin enjeksiyonu; güvenilir, etkin ve çok sayıda, multilobule psödoanevrizmalarda bile kolay uygulanabilir bir yöntemdir.

Imaging-guided percutaneous thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms

To evaluate factors that may affect successful ultrasound-guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms (PSA). This was an IRB-approved, HIPAA-compliant retrospective study of 326 consecutive subjects (138 males, 188 females; mean age 68years, range 18-95) who underwent thrombin injection for treatment of femoral PSA; follow-up ultrasound was available in 145 subjects. The number of PSA lobes and dimensions, pre-procedure laboratory values (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count), and concomitant anticoagulation therapy were recorded. Technical success was achieved in 98.2% (320/326) of subjects. Primary effectiveness (complete thrombosis at 24h) was achieved in 74.5% (108/145). Twenty-five subjects underwent repeat thrombin injection, successful in 21 subjects, for a total effectiveness rate of 97.0% (129/133). No imaging factor was associated with technique failure, including number of lobes (p = 0.898), largest dimension (p = 0.344), or volume (p = 0.697). No statistically significant difference in pre-procedure INR, aPTT, or platelet count was found between subjects with CT and those with IT (p > 0.138). Anticoagulation therapy was associated with incomplete thrombosis (35.5% [38/107] for CT vs. 63.9% [23/26] for IT; p = 0.002). Imaging-guided percutaneous thrombin injection has high technical success and effectiveness rates for the treatment of iatrogenic femoral artery PSA. Anticoagulation therapy was the only factor associated with incomplete thrombosis.

LEA 12. Percutaneous Suture Technique With ProGlide: A Novel Method for Management of Vascular Access Pseudoaneurysm After Percutaneous Coronary Intervention Procedure

Iatrogenic femoral artery pseudoaneurysm (IFAP) is a common complication of endovascular procedures in the femoral artery for therapeutic intervention. It is reported that the incidence of IFAP is 2% to 7.7% involving peripheral intervention because of the frequent use of anticoagulant therapy and use of larger sheaths. We use the ProGlide (Abbott Vascular, Santa Clara, Calif), a percutaneous suture device, at the pseudoaneurysm neck under fluoroscopy to seal the pseudoaneurysm sac. The study was retrospective and noncomparative. We analyzed 16 patients with IFAP, treating with ProGlide, from October 2016 to May 2018. The diameter of the pseudoaneurysm sac, operating time, complications, and blood loss were collected. All 16 patients were operated on with ProGlide. One case failed because of the short neck of the pseudoaneurysm. In 93.8% (15/16) of patients, the sac diameter was reduced. The average operating time was 27 minutes; the average blood loss was 14 mL. No major surgical complication was found. A percutaneous suture device can be used to treat pseudoaneurysm. It is a convenient, safe, and effective technique and can be recommended as a safe alternative method for pseudoaneurysm.

Percutaneous ultrasound-guided balloon-assisted embolization of iatrogenic femoral artery pseudoaneurysms with Glubran®2 cyanoacrylate glue: safety, efficacy and outcomes.

Femoral pseudoaneurysm (PA) is a frequent complication of arterial access for endovascular procedures. Surgery has traditionally been considered as the gold standard of therapy. We aimed to report our experience of percutaneous ultrasound (US)-guided balloon-assisted embolization with cyanoacrylate glue for the treatment of iatrogenic femoral PAs. Retrospective two-center study of patients with femoral iatrogenic PAs treated by N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran®2 glue embolization between July 2013 and November 2017. All patients underwent contralateral arterial access with balloon placement of an appropriate size in front of the PA neck before glue/lipiodol embolization in a 1:1 ratio by percutaneous US-guided puncture of the aneurysmal sac under fluoroscopy control. Twenty-three patients (12 females, 11 males; median age, 79 years; range, 18-93 years) were included. Median PA size was 34 mm (range, 17-60 mm). The median time to treatment was 5 days (range, 1-30 days). Twenty patients (86.9%) were successfully treated by glue injection alone. The three remaining patients (13.1%) with persistent PA or associated arterial-venous fistula were immediately treated during the same procedure by additional stent-graft. Then, overall immediate and 1-month clinical success rates were 100%. No surgical conversion was necessary. No recurrence was reported during the median follow-up of 11 months (range, 2-73 months). Two (8.7%) puncture-related complications occurred at the contralateral arterial access site, which spontaneously resolved. No non-target glue embolization occurred. US-guided balloon-assisted glue embolization is safe and effective to treat iatrogenic femoral PAs in most cases, offering complete exclusion of the PA and avoiding the morbidity of open surgery.

Ultrasound-guided percutaneous thrombin injection following iatrogenic femoral artery pseudoaneurysm: patient selection and perspectives

Ultrasound-guided percutaneous thrombin injection following iatrogenic femoral artery pseudoaneurysm: patient selection and perspectives

A Rare Case of Axillary Artery Pseudoaneurysm Due to Shoulder Dislocation Treated With Percutaneous Thrombin Injection

The incidence of combined neurovascular injuries among patients with high-energy shoulder trauma ranges from 27% to 44%. However, the presentation of an axillary artery pseudoaneurysm (PSA) due to shoulder dislocation without an associated osseous fracture is a very rare condition. Moreover, treatment of combined neurologic and vascular injuries of the shoulder remains controversial. Additionally, minimally invasive treatments such as thrombin injection have been mainly evaluated in patients with iatrogenic femoral artery PSAs. Therefore, we aim to report a rare case of axillary artery PSA associated with brachial plexus injury after shoulder dislocation treated with percutaneous thrombin injection.

A novel minimally invasive method of successful tissue glue injection in patients with iatrogenic pseudoaneurysm.

To investigate the efficacy and safety of ultrasound-guided tissue glue injection for the treatment of iatrogenic femoral artery pseudoaneurysm. The study comprised of nine patients with unsuccessful ultrasound-guided thrombin injection and one patient with rapidly progressing anemia. All patients had undergone recanalization procedures at least twice, including two subjects with a very rapidly enlarging pseudoaneurysm lobe or significant anemia. Tissue glue at a dose of 0.9 ± 0.53 ml was injected under ultrasound guidance in each patient. Complete embolization was achieved in all patients. Follow-up ultrasound performed 24 h later as well as at 1 and 2 weeks did not show recurrent reperfusion of the pseudoaneurysm. Embolization of iatrogenic pseudoaneurysm using tissue glue seems to be an effective technique for the treatment of this complication. It might be considered as a treatment option in case of unsuccessful primary repair by means of thrombin injection orhemorrhagic shock due to rapid aneurysm progression. Advances in knowledge: Patients with multiple recanalizations and those with dynamically enlarging pseudoaneurysm or rapidly progressing anemia are at risk of life-threatening bleeding. An ultrasound-guided tissue glue injection, a novel method for the treatment of femoral artery pseudoaneurysm, might be considered as a treatment option especially in case of primary thrombin injection failure.

Percutaneous closure of iatrogenic femoral pseudoaneurysms with thrombin injection

Iatrogenic femoral artery pseudoaneurysm (IFP) is a tedious complication of percutanous coronary and peripheral interventions which prolong the in-hospital stay. It's overall incidence may increases to 8% in the therapeutic complex procedures. Surgical correction is a traditional approach which is still preferred as a first resort in the many cardiovascular centers in the Turkey. Herein, we aimed to demonstrate the feasibility of percutaneous closure of IFP with thrombin injection.

Surgical Treatment Strategies of Iatrogenic Giant Femoral Artery Pseudoaneurysms

Background: The aim of this study was to evaluate the technical and clinical results, following surgical treatment of iatrogenic giant femoral artery pseudoaneurysms. Methods and findings: Among 1850 patients 60 (3.25%) of them diagnosed with an iatrogenic giant femoral artery pseudoaneurysms. All patients underwent surgical repair and were followed up for one month, three month and six month respectively using Duplex ultrasound sound and/or CT angiography. There were 40 male and 20 female, aged 30-70 years (Mean age 49.06 years ± 11.03). There were 66.7% n=40 patients presented with groin pain, pulsatile mass associated with lower extremity ischemia, infected pseudoaneurysm in 16.7% (n=10), pending ruptured pseudoaneurysm in 8.3% (n=5), and large wide pseudoaneurysm neck confirmed by Doppler ultrasound (8.3%) n=5. Primary repair was done for 30 patients; repair with vein batch angioplasty for 15 patients, interposition reversed saphenous vein graft for 10 patients, and interposition synthetic Dacron graft for 5 patients. Technical success was achieved in 100% of cases. There is neither limb loss nor intra-operative or postoperative mortality. Distal extremity ischemia was completely resolved after surgical repair. Postoperative complications included one groin wound infection, which was controlled by antibiotic treatment and debridement. Conclusion: Open surgical repair of femoral pseudoaneurysms is technically feasible, first-line treatment for iatrogenic giant femoral artery pseudoaneurysmsassociated complications.

Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms.

Arterial pseudoaneurysms are well known iatrogenic complication of percutaneous angiographic or interventional vascular procedures. In the past, the definitive treatment option was open surgical repair which is a relatively invasive procedure. In the last few years, Ultrasound (US) guided percutaneous thrombin injection has been gaining popularity as definitive treatment of pseudoaneurysms. To evaluate efficacy and safety of US guided percutaneous injection of thrombin for treatment of iatrogenic femoral pseudoanurysms at a tertiary care interventional radiological and cardiology centre. A retrospective analysis was conducted on 38 consecutive patients, diagnosed to have iatrogenic femoral artery pseudoaneurysms by Doppler study, in the period from Jan 2013 to Jun 2016. All these patients were treated by US guided percutaneous injection of thrombin solution inside the pseudoaneurysm sac till contents became echogenic and flow inside the pseudoaneurysm stopped completely. One month further follow up in all these patients was done. The dose of thrombin injected varied from 200-1000 IU (mean 300 IU). Immediate thrombosis was seen in all the pseusdoaneurysms. Follow up at 24-48 hours showed complete thrombosis and regression of pseudoaneurysm in all the patients except one in whom a small residual sac was seen which thrombosed completely on second thrombin injection. Further follow up at one month showed regression of aneurysms in all the cases. No significant post procedural clinically significant complications were seen in any of the patients. US guided percutaneous thrombin injection is a highly successful and safe procedure for the treatment of iatrogenic femoral pseudoaneurysms.

Two cases of an acute arterial embolic occlusion following ultrasound guided thrombin injection of iatrogenic femoral artery pseudoaneurysm

Two cases of an acute arterial embolic occlusion following ultrasound guided thrombin injection of iatrogenic femoral artery pseudoaneurysm