Iatrogenic Pseudoaneurysm Research Articles

Percutaneous closure of latent iatrogenic left ventricular pseudoaneurysm: role of patient-specific imaging planning.

Percutaneous closure of latent iatrogenic left ventricular pseudoaneurysm: role of patient-specific imaging planning.

Iatrogenic Ulnar Artery Pseudoaneurysm

We present a patient with a rare vascular emergency of iatrogenic right ulnar artery pseudoaneurysm presented as an expanding hematoma with right forearm compartment syndrome following a percutaneous coronary intervention done to place stent in the left anterior descending artery through right transulnar approach (radial nondominant). A 71-year-old female was referred with a mass on the flexor aspect of the right forearm associated with severe localized pain, tenderness, and weakness of distal forearm and hand. Investigations had revealed a right ulnar artery pseudoaneurysm. Ultrasonography of the right forearm demonstrated a pseudoaneurysm with thrombus formation arising from the right ulnar artery and using a hand Doppler, no blood flow detected distal to the swelling. Surgical repair by an open approach was done to remove the hematoma and the ulnar artery puncture site was repaired. The postoperative period was uneventful.

Successful management of iatrogenic arterial pseudoaneurysm caused by rotational atherectomy.

Successful management of iatrogenic arterial pseudoaneurysm caused by rotational atherectomy.

Percutaneous Trans-Hepatic Embolization of an Iatrogenic Extra-Hepatic Pseudoaneurysm of the Right Hepatic Artery in a Patient With Previous Occlusion of the Proper Hepatic Artery: An Endovascular Procedure to Avoid a Difficult Surgical Repair

We report a case of successful percutaneous transhepatic, embolization of an iatrogenic extra-hepatic pseudoaneurysm (PsA) of the right hepatic artery (RHA) under combined fluoroscopic and ultrasonographic guidance. A 73-year-old man underwent percutaneous transhepatic biliary drainage placement in another hospital, complicated by haemobilia and development of a RHA PsA. Endovascular embolization was attempted, resulting in coil embolization of the proper hepatic artery, and persistence of the PsA. At this point, the patient was referred to our hospital. Computed tomography and direct angiography confirmed the iatrogenic extra-hepatic PsA of the RHA, refilled by small collaterals from the accessory left hepatic artery (LHA) and coil occlusion of the proper hepatic artery. Attempted selective catheterization of these vessels was unsuccessful due to the tortuosity and very small caliber of the intra-hepatic collaterals, the latter precluding endovascular treatment of the PsA. Percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA was performed with Lipiodol® and cyanoacrylate-based glue (Glubran®2). Real time fluoroscopic images and computed tomography confirmed complete occlusion of the pseudoaneurysm. Surgical repair, although feasible, was considered at high risk. In our patient, we decided to perform a percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA using a mix of Lipiodol® and Glubran®2 because of the fast polymerization time of the glue allowing the complete occlusion of the PsA in few seconds, thus eliminating the risk of coil migration, reducing the risk of PsA rupture and avoid a difficult surgical repair.

The efficacy and clinical outcomes of transarterial embolization in acute massive upper gastrointestinal bleeding: a single-center experience

Objective: To evaluate the efficacy of transarterial embolization (TAE) in the treatment of acute upper gastrointestinal bleeding (UGIB) and identify potential factors affecting the treatment outcome. Patients and Methods: Eighteen patients with UGIB treated with TAE were included in the study. The demographic data, causes of bleeding, angiography findings, treatments applied, and clinical outcomes were retrospectively analyzed. Results: Thirteen (72.2%) patients were male, five (27.8%) were female, and the mean age was 55 years (range: 33-68 years). A pseudoaneurysm (n = 7; 38.9%) was the most common finding, followed by tumor staining (n = 4; 22.2%). The most common pathology causing bleeding was peptic ulcer disease (n = 9; 50%). The most commonly embolized artery was the gastroduodenal artery (n = 11; 61.1%). There were three (16.7%) patients with hemobilia due to iatrogenic hepatic artery pseudoaneurysm. In most cases (n = 9; 50%), coils and polyvinyl alcohol particles were used in combination. Technical success was achieved in all patients. The clinical success rate was 78.5% (11/14 patients) after the exclusion of patients who died for non-UGIB causes (n = 4; 22.2%). Conclusion: Transarterial embolizati

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.

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.

Pseudoaneurysm following Surgical Resection of Craniopharyngioma: What Is the Best Management?

AbstractCraniopharyngiomas are benign tumors of the sellar and parasellar region for which surgical resection remains the treatment of choice. There are many publications on the most frequent postoperative complications, but few reports on subclinical lesions affecting the arteries of the circle of Willis, despite their high morbidity and mortality rate. Trauma-induced aneurysms are infrequent, representing less than 1% of intracranial aneurysms. Iatrogenic intracranial pseudoaneurysms are a subtype of surgically induced aneurysms developed as a result of direct injury to the arterial wall or after dissection of tumors adherent to the vessel adventitia. The natural history of these lesions is not well known because their incidence is extremely low. We report two cases of postoperative aneurysms of the internal carotid artery after craniopharyngioma resection and a brief review on the management of such lesions.

PICA injury secondary to anterior odontoid screw fixation: Case report of an exceptional complication

BackgroundOdontoid fracture is a common injury in the upper cervical spine that can sometimes be managed by anterior odontoid screw fixation. Case descriptionWe report the first case of iatrogenic postero-inferior cerebellar artery (PICA) injury while performing anterior odontoid screw fixation for a type II odontoid fracture in a 22-year-old man. Fisher grade 4 subarachnoid hemorrhage secondary to iatrogenic pseudoaneurysm formation was managed by the endovascular neuroradiologist. Odontoid fracture was then managed posteriorly using Harm's technique. Postoperative 12-month follow-up revealed good clinical and radiological results. CT scan showed fusion. Complete exclusion of the pseudo aneurysm with a mild stroke in the inferior left cerebellar hemisphere were noted on the MRI. There were no cerebellar ataxia or swallowing disorders. ConclusionTo the best of our knowledge, this is the first case report of iatrogenic PICA injury in anterior odontoid screw fixation. The patient was well managed in our institution within a multidisciplinary team. We recommend that surgical management of odontoid fractures should be performed in expert centres.

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.

Basilar Artery Injury During Endonasal Surgery: Stepwise to Control Bleeding.

Intraoperative injury during endoscopic endonasal surgery of the carotid artery has been previously described in the literature. However, the accidental damage of the basilar artery in such scenario is not defined. To define the protocol of action for massive bleeding from an artery in the posterior fossa. The reported patient was diagnosed with a partially calcified clival chordoma featured by a huge intradural component. An endoscopic endonasal transpterygoid transclival approach was selected for the treatment of this tumor. During the surgical procedure, the basilar artery injury was injured, causing intense bleeding. We present and discuss the surgical maneuvers that could save a patient's life after this dramatic complication. Different techniques were performed in order to control the massive bleeding, including injection of hemotastic matrix with thrombin (Floseal©), bipolar coagulation, and vessel reconstruction by means of a vascular clip. Finally, an autologous muscle graft reinforced with an overlying fibrin sealant patch (Tachosil©) was chosen and was an effective technique. Afterwards, the patient was treated with a flow diverter device to occlude an iatrogenic pseudoaneurysm. A monoplegia of the right upper limb was the only remarkable sequel 6 mo after surgery. The muscle graft together with the coordinated action with interventional neuroradiology for the reconstruction of the vessel are possibly the best options to try to preserve the neurological function. In such a scenario, the assumption of potential ischemic events prevails over the intraoperative death of the patient.

Ultrasound-guided thrombin injection as a preferable method of treatment for iatrogenic pseudoaneurysms after invasive cardiovascular procedures - a single-center experience.

IntroductionArterial cannulation is inherently associated with a risk of vascular complications including pseudoaneurysm (psA) that are encountered in both radial and femoral artery access. Among various methods of treatment of pseudoaneurysm the most popular are: watchful waiting for a spontaneous resolution, ultrasound-guided compression, ultrasound-guided thrombin injection (UGTI) and surgical treatment. In many previous reports nonsurgical methods appeared to be effective in most cases.AimTo evaluate the incidence, characteristics as well as treatment scheme of iatrogenic pseudoaneurysms in a single high-volume cardiovascular intervention center.Material and methodsThe study is a prospective analysis of femoral artery and radial artery pseudoaneurysm cases in a 6-year period (2015–2020) in Świętokrzyskie Cardiology Centre in Kielce, Poland. Analysis of baseline characteristics, treatment and outcomes of all pseudoaneurysm cases was performed.ResultsAmong a total number of 7268 cardiovascular procedures, with 49.2% being of the radial approach, we diagnosed 113 cases of psA. Global prevalence of femoral artery pseudoaneurysm was 1.29% and that of radial artery pseudoaneurysm was 0.30%. Only 2 patients with femoral puncture were primarily qualified for surgical treatment due to large size of the pseudoaneurysm. The vast majority of patients underwent successful nonsurgical therapy with the major predominance of the UGTI procedure. Effectiveness of the first thrombin injection was as high as 90% in RPA and 85% in FPA, whereas all of the consecutive attempts were successful.ConclusionsUGTI is nowadays a very effective and safe method of iatrogenic pseudoaneurysm treatment that prevents further necessary surgical procedures.

Iatrogenic Pseudoaneurysm after Laparoscopic Bilateral Inguinal Hernia Surgery: Treatment with Endovascular Coil Embolization

Although laparoscopic interventions have provided significant achievements in hernia surgery, they may cause complications such as pain, hematoma, intestinal injuries, testicular complications, and sometimes arterial pseudoaneurysms. Arterial pseudoaneurysms are a very rare complication of laparoscopic inguinal hernia surgery. Pseudoaneurysms have serious various causes such as inflammation, trauma, and iatrogenic injury. The patient was diagnosed with bilateral inguinal hernia and a laparoscopic total extra-peritoneal repair was completed. Pelvic bleeding developed on the first postoperative day. A pseudoaneurysm that was 80x70x50 cm was detected in an abdominal computer tomography angiography. In this case because of having high rate morbidity and mortality of open surgery, we selected endovascular angioembolization instead of open surgery in the treatment of pseudoaneurysm which occurred after laparoscopic inguinal hernia surgery

Pseudoaneurysm of the popliteal artery. Complication of knee arthroscopic procedures. Case raport

A pseudoaneurysm refers to a defect in an arterial wall, which allows the communication of arterial blood with the ad­ja­cent extraluminal space. Blood extravasates out of the ar­te­ry, but is contained by surrounding soft tissue which forms a cavity or sac. Pseudoaneurysms are typically the result of traumatic arterial injury. With the increasing uti­li­sa­tion of percutaneous arterial interventions worldwide, iatrogenic arterial injury has become the predominant cause of pseudoaneurysm formation. The highest inci­dence of iatrogenic pseudoaneurysm formation is observed in the common femoral artery as a result of inadequate hae­mo­sta­sis of the arterial puncture site following catheterisation pro­cedures, followed by the popliteal artery. Patients with popliteal pseudoaneurysms typically present with pain and swelling of the affected area (calf), along with a palpable mass which may be pulsatile with a thrill or bruit. Small pseu­do­­aneurysms can resolve spontaneously without in­ter­ven­tion. Persistent pseudoaneurysms may increase and lead to complications related to compression of the vein, nerve and overlying tissues. This can lead to swelling of the legs, deep vein thrombosis, compressive neuropathy and skin necrosis. Although rare, pseudoaneurysms can spread and eventually rupture. Imaging is a mandatory part of the di­ag­nostic protocol for popliteal artery pseudoaneurysms. Dop­pler ultrasound, CT or MRI examinations performed with contrast and angiography are useful in determining pseudoaneurysmal masses. Doppler ultrasound is the most commonly chosen method for diagnosing pseu­do­aneu­rysms, with a sensitivity of 94% and a specificity of 97% in the detection of pseudoaneurysms. On Doppler ul­tra­sound, a pseudoaneurysm appears as a hypoechoic sac adjacent to the affected artery, with the color flux ob­served inside it. Computed tomography angiography is another effective way of diagnosis, especially in centers with­out easy access to vascular ultrasound services. It is also useful in cases where Doppler ultrasound findings are ambiguous or the anatomy is not well defined. Open sur­gi­cal treatment has been considered the gold standard for ia­tro­genic pseu­do­aneu­rysms because the arterial defect is per­ma­nent­ly repaired.

Endovascular management of internal carotid artery pseudoaneurysms: Retrospective observational study

Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) are caused by multiple etiological factors and can involve any segment. There are no clear guidelines to select treatment options in managing these cases. A retrospective review of all patients treated for ICA PSAs by endovascular treatment was conducted. Details of clinical presentations, imaging modalities, angiographic findings and endovascular treatment were noted. Four male (57%) and three female (43%) patients were treated. Their ages ranged from ten months to 52 years old. Five patients had cervical ICA PSAs, and one patient each had PSA of petrous and paraclinoid ICA segment. Five patients had traumatic etiology, one patient had post-infective mycotic and one patient had iatrogenic PSA. The most common presentation was pulsatile neck swelling (n = 5). Two patients (n = 2) presented with massive bleeding, one patient had stroke with aphasia and transient limb weakness, while the patient with petrous PSA had tinnitus and ear pain. Parent artery occlusion (PAO) was performed in six patients (n = 6). In three patients (n = 3), we used stent grafts to trap the ICA. Two patients (n = 2) underwent PAO with coils. In one patient, we used liquid embolic agent (Histoacryl) for PAO. An aneugraft pericardium covered stent was used in one patient. All patients experienced good angiographic results, without any neurological complication. There was no re-canalization of the aneurysm on follow ups. Endovascular approach is a feasible treatment option, with multiple alternative occlusion techniques and a low complication rate. PAO still remains a simple, safe, effective treatment in selective patients.

Iatrogenic Pseudoaneurysm of the Dorsalis Pedis Artery

Iatrogenic pseudoaneurysm of the dorsalis pedis artery is an extremely rare complication of ankle arthroscopy. This case is of a 26-year-old female who developed a pseudoaneurysm after ankle arthroscopy. This case study follows her through diagnosis, surgical repair, and postoperative follow-up.

A new approach to the treatment of post-catheterization pseudoaneurysms by ultrasound-guided tissue glue injection or ultrasound-guided thrombin injection depending on a late to early velocity index

Abstract Background Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are reports of the use of biologically-derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. TG are more potent procoagulants and may increase the procedure success rates at the cost of higher risk of complications in case too much substance escape into the patient's circulation during the procedure. TG are also more expensive than thrombin so they are often reserved for selected patients. We have previously identified a late to early velocity index (LEVI) &amp;lt;0.2 as a predictor of an increased risk of psA recurrence after standard UGTI. In the current paper we report our first experiences when the choice of the first-line treatment method was based on LEVI. Methods From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI &amp;lt;0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) and 26 had LEVI &amp;gt;0.2 and underwent UGTI. The injection set (containing human thrombin and fibrinogen) was used for UGTGI. Bovine thrombin was used for UGTI. Results The success rate was 100% and no psA recurrence was detected during 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 15 years of experience (0% vs. 13%, p=0.02). All complications were mild and transient and included clinical symptoms of paraesthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. Conclusion The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. Two examples of LEVI calculations Funding Acknowledgement Type of funding source: None

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

Iatrogenic Ascending Aortic Pseudoaneurysm: A Scarcy Bomb After Coronary Artery Bypass Surgery

Pseudoaneurysma aorty je vzacnou, avsak život ohrožujici komplikaci, s niž se lze setkat několik měsiců nebo i let po operaci na aortě. I když je kardiochirurgický výkon nejcastějsi přicinou, může k vzniku pseudoaneurysmatu vzacně dojit i po urazu a infekci. Klinicke projevy se mohou pohybovat v rozmezi žadne symptomy až katastrofalni výsledek. Průměr a velikost pseudoaneurysmatu aorty se mohou postupem let zvětsovat, což tak může zvysovat riziko jeho nahle ruptury a krvaceni. Popisujeme připad pseudoaneurysmatu vzestupne aorty, vznikleho 13 měsiců po koronarnim bypassu a uspěsně řeseneho chirurgicky. Diagnozu aneurysmatu je nutno stanovit v perioperacnim i pooperacnim obdobi vcas, protože jeho ruptura by měla katastrofalni důsledky.

Application of interventional embolization in the treatment of iatrogenic pseudoaneurysms.

The present study aimed to investigate the clinical effectiveness and safety of endovascular embolization for the treatment of pseudoaneurysm secondary to previous abdominal and pelvic surgery or radiological percutaneous abdominal procedure. A retrospective review was performed on all patients with abdominal and pelvic pseudoaneurysm confirmed by CT angiography or digital subtraction angiography and treated with endovascular embolization. Different techniques of embolization with coils were applied and the outcomes, including clinical effectiveness and safety, were assessed. A total of 31 patients with a total of 32 pseudoaneurysms were included in the present study. Of these pseudoaneurysms, 23 were from the main trunks and branches of the gastroduodenal artery, 5 were from the splenic artery, 2 were from the common hepatic artery, 1 was from the right hepatic artery and 1 was from the right internal iliac artery. There were no serious complications observed and there was no occurrence of re-bleeding following embolization. The embolization of the pseudoaneurysms was successful in all patients. In conclusion, endovascular embolization is a safe and effective method for the treatment of secondary iatrogenic pseudoaneurysm in the abdomen and pelvis.