Iatrogenic Pseudoaneurysm Research Articles

Outcome Study of the Pipeline Embolization Device with Shield Technology in Unruptured Aneurysms (PEDSU).

The recently introduced Pipeline Flex Embolization Device with Shield Technology (Pipeline Shield) is the third generation of Pipeline flow-diverter devices. It has a new stent-surface modification, which reduces thrombogenicity. We aimed to evaluate clinical and radiographic (safety and efficacy) outcomes of the Pipeline Shield. The 30-day and 1-year mortality and morbidity rates and the 6- and 18-month radiographic aneurysm occlusion outcomes for procedures performed between March 2016 and January 2018 were analyzed. 3D-TOF-MRA was used for follow-up. Forty-four attempted Pipeline Shield procedures were performed for 41 patients with 44 target aneurysms (total of 52 aneurysms treated). A total of 88.5% of devices were inserted in the anterior circulation, and 11.5%, in the posterior circulation; 49/52 (94.2%) aneurysms were saccular; and 1/52 (1.9%) was fusiform. One (1.9%) aneurysm was an iatrogenic pseudoaneurysm, and 1 (1.9%) was a dissecting aneurysm. Seventy-one percent (35/49) of the saccular aneurysms were wide-neck (neck, >4 mm), 34.6% (18/52) were large (≥10 mm), and 3.8% (2/52) were giant (≥25 mm). The mean aneurysm sac maximal diameter was 9.0 mm, and the mean neck width was 5.0 mm. The cumulative mortality and morbidity rates were 2.3% and 6.8% at 1 year, respectively. The adequate occlusion rate was 78.8% at 6 months and 90.3% at 18 months. In this pragmatic and non-industry-sponsored study, the occlusion rates and safety outcomes were similar to those seen in previously published studies with flow-diverter devices and earlier generation Pipeline Embolization Devices.

Surgical treatment of iatrogenic pseudoaneurysms

Surgical treatment of iatrogenic pseudoaneurysms

Iatrogenic common carotid pseudoaneurysm in a neonate

Iatrogenic common carotid pseudoaneurysm in a neonate

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.

Aortic Pseudoaneurysm in an Unusual Site: Difficult Diagnosis by Echocardiography

A 54-year-old woman was admitted to our hospital with a fever of 1 week’s duration and a distal embolic event 4 days previously in the second and third digits of her right hand. She had a history of aortic valve replacement (STj#19) 2 months earlier as well as mitral valve replacement (STj#26) and tricuspid valve repair 10 years before. Lab data showed an increased white blood cell count and an elevated erythrocyte sedimentation rate. Blood culture was positive only in 1 round with Pseudomonas aeruginosa growth, which was not compatible with the patient’s good general condition. Transthoracic and transesophageal echocardiography, abdominal sonography, and computed tomography (CT) scan of the right hand were unremarkable. The patient was treated for infectious endocarditis with antibiotics for 6 weeks and then discharged. On follow-up transthoracic echocardiography, 1 month after discharge, an echo-free space in the posterolateral wall of the ascending aorta was detected. The second transesophageal echocardiography was highly suggestive of a pseudoaneurysm in the ascending aorta (Figure 1A & Video 1), which was subsequently confirmed by a CT angiography of the ascending aorta (Figure 2). For a better evaluation, aortography was done and it revealed a pseudoaneurysm in the posterolateral wall of the ascending aorta (Figure 3 & Video 2). A review of the previous transthoracic and transesophageal echocardiography images demonstrated that this pseudoaneurysm had been missed because it was filled with a thrombosis (Figure 1B & Video 3). The ascending aorta was normal in aortography before the second surgical operation. It appears that the most probable scenario was thrombosis formation in an iatrogenic aortic pseudoaneurysm at an unusual site, causing such presentations. The thrombosis was resolved with meticulous anticoagulation, leading to the clarification of the pseudoaneurysm. The administration of an anticoagulant was obligatory in this patient because of the presence of 2 mechanical valves. Nevertheless, this administration could lead to catastrophic events such as a ruptured ascending aorta, so the early detection of this complication may reduce the risk to the patient and confer an appropriate treatment. We repaired our patient’s pseudoaneurysm via surgery, and she was discharged in good physical condition. The development of an aortic pseudoaneurysm is an uncommon complication of open-heart surgery, and it usually forms in the anterior wall; nonetheless, its formation in the posterior wall is rare and can be due to the deep cannulation of the ascending aorta during surgery. The presence of this complication should, therefore, be kept in mind by any cardiologist who encounters a patient with an embolic event and previous cardiac surgery.

IP143. Massive Iatrogenic Posterior Tibial Artery Pseudoaneurysm After Total Ankle Reconstruction

IP143. Massive Iatrogenic Posterior Tibial Artery Pseudoaneurysm After Total Ankle Reconstruction

Huge Iatrogenic Pseudoaneurysm of the Profunda Femoris Artery

Huge Iatrogenic Pseudoaneurysm of the Profunda Femoris Artery

Jatrogenna przetoka tętniczo-żylna z workowatym poszerzeniem- opis przypadku

Iatrogenic pseudoaneurysm affects 2–8% of the population undergoing endovascular therapy. Arteriovenous fistula occurs in about 1–1.5% of patients. Ą very rare combination of the arteriovenous fistula with a large widening resembling a pseudoaneurysm is presented. An ultrasound examination performed at 2 months after an electrophysiological study revealed the presence of an abnormal sac over the right superficial femoral artery. Doppler mapping detected the presence of blood flowing into the sac. Simultaneously, a jet of enhanced blood flow was seen between the anomalous sac and the femoral vein. A contrast-enhanced CT angiography revealed the iatrogenic arteriovenous fistula between the right superficial femoral artery and the femoral vein with the saclike widening. Currently, there is no clear and consistent definition of the complication presented. The patient was referred for surgical management and his further recovery was uneventful.

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.

Pseudoaneurysms of the Peripheral Arteries.

Peripheral arterial pseudoaneurysm, while relatively rare, are encountered by most vascular specialists. This review evaluates the epidemiology, diagnosis, natural history, and treatment of pseudoaneurysm in the peripheral arteries. Most of this review concentrates on iatrogenic peripheral pseudoaneurysms, but pseudoaneurysms of other etiologies will also be discussed.

Iatrogenic giant left anterior descending coronary artery pseudoaneurysm with contained perforation following percutaneous coronary intervention

Giant iatrogenic coronary pseudoaneurysms are very rare. Left untreated, they may cause serious adverse outcome. We present a case of a male patient with recurrent NSTEMIs and coronary interventions who developed a large LAD artery pseudoaneurysm with contained rupture. He underwent excision of the large proximal LAD pseudoaneurysm, excision of the previous LAD stent, ligation of proximal LAD, and coronary artery bypass grafting with LIMA-LAD graft. He subsequently recovered and was stable on follow up. In conclusion, an aggressive surgical strategy, though difficult, is likely the best means of management for lasting benefit.

A case report of placing covered stent for bile duct by pull through technique for iatrogenic pseudoaneurysm of common carotid artery

A case report of placing covered stent for bile duct by pull through technique for iatrogenic pseudoaneurysm of common carotid artery

Case Report: Surgical Management of Iatrogenic Injury to Brachiocephalic Artery From Central Venous Cannulation

Background: Iatrogenic arterial injury of the brachiocephalic artery during central venous cannulation has rarely been reported [ [1] de Troia A. Tecchio T. Azzarone M. Biasi L. Piazza P. Franco Salcuni P. Endovascular treatment of an innominate artery iatrogenic pseudoaneurysm following subclavian vein catheterization. Vasc Endovascular Surg. 2011; 45: 78-82 Google Scholar ]. A multicentre retrospective study from 2008 estimated the incidence of large-bore catheter misplacement into an artery during central venous cannulation to be 1 in 1,800 [ [2] Guilbert M.-C. Elkouri S. Bracco D. et al. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg. 2008; 48: 918-925 Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar ]. The morbidities of this complication include arterial dissection, haemothorax, and arteriovenous fistula.

Percutaneous Thrombin Injection for the Treatment of Post-Procedural Iatrogenic Pseudoaneurysms

Percutaneous Thrombin Injection for the Treatment of Post-Procedural Iatrogenic Pseudoaneurysms

Three Cases of Coil Embolization for Iatrogenic Pseudoaneurysm Following Femoral vein Puncture During Radiofrequency Catheter Ablation

Three Cases of Coil Embolization for Iatrogenic Pseudoaneurysm Following Femoral vein Puncture During Radiofrequency Catheter Ablation

Pseudoaneurysm of peripheral arteries: Our experience in a community-based hospital

Introduction: Pseudoaneurysms are false aneurysm where disruption in the arterial wall forms a localized pulsatile hematoma connecting the artery. The common causes are intravenous drug abuse (IVDA), iatrogenic (vascular interventions and surgery), trauma, and infections. Aims: The aim of this study was to analyze the etiology, management, and outcome of patients with pseudoaneurysms of peripheral arteries. Materials and Methods: This is a retrospective analysis of prospectively maintained database of 32 patients with peripheral artery pseudoaneurysms over 45 months at a community-based hospital of Eastern Nepal. Results: The most common site involved was femoral artery (56.3%) followed by brachial (15.6%), radial (6.3%), anterior tibial (6.3%), and others (15.5%). The common etiologies were iatrogenic (46.9%), IVDA (31.3%), trauma (18.7%), and infection (3.1%). Operative intervention was performed in 29 (90.6%) patients as follows: ligation of artery and debridement (46.9%), primary repair (28.1%), and venous graft bypass (15.6%). Three patients (9.4%) with noninfected iatrogenic pseudoaneurysms of <3 cm were managed conservatively. Infected pseudoaneurysms were seen in 14 (43.7%) patients. Staphylococcus aureus was the most common isolate in the culture. There was no reoperation, amputation, or any in-hospital mortality. At follow-up, one patient developed leg claudication pain following a femoral artery ligation and one of the five patients developed a graft thrombosis after an autologous reversed saphenous vein bypass graft without any sequelae. Conclusion: Although repair with distal revascularization is an ideal approach, debridement and simple ligation of pseudoaneurysms is a safer alternative especially in IV drug abusers.

A Case of Percutaneous Coronary Intervention Using A Polytetrafluorethylene-Covered Stent For An Iatrogenic Pseudoaneurysm Of The Left Main Coronary Artery

A Case of Percutaneous Coronary Intervention Using A Polytetrafluorethylene-Covered Stent For An Iatrogenic Pseudoaneurysm Of The Left Main Coronary Artery

Diagnosis and treatment differences between iatrogenic and traumatic intracranial pseudoaneurysms

Objective To investigate the differences in the diagnosis and treatment between iatrogenic intracranial pseudoaneurysms (II-PSAN) and traumatic intracranial pseudoaneurysms (TI-PSAN). Methods In this retrospective study, 11 patients with intracranial PSAN admitted to the Department of Neurosurgery of Huashan Hospital Affiliated to Fudan University between January 2013 and December 2017 were enrolled. Among those 11 cases, TI-PSAN was diagnosed in 9 cases and II-PSAN in 2. In the 9 TI-PSAN cases, there were 11 PSAN including 7 undergoing embolization treatment (PSAN and parent artery), 2 receiving revascularization (stent and Guglielmi detachable coil placement in 1 and double stents placement in 1), 1 undergoing surgery and the other 1 receiving no treatment. For the 2 cases with II-PSAN, 1 received embolotherapy and 1 received revascularization using LVIS stent and GDC. At the follow-up, the DSA, CTA or MRI was performed to evaluate the recurrence and residue of PSAN and assess the outcomes by using the modified Rankin score (mRS). Results Among the 13 PSAN of 11 patients, 12 showed satisfactory outcomes after surgery. One TI-PSAN patient died from intracranial hemorrhage at 1 day post surgery and no postoperative hemorrhage was reported in the other 10 cases. The 10 cases were followed up for 1-36 months, with an average of 13 months. Among them, 6 received DSA in the follow-up and the other 4 received CTA or MRA in the follow-up. Among 8 cases with TI-PSAN, no revascularization or recurrence of PSAN was reported in the 6 cases undergoing embolization and the vascular compensation was satisfactory. In the other 2 cases undergoing revascularization, 1 showed no residual or recurrent PSAN and 1 showed residue in the aneurysm neck. In the 2 II-PSAN cases, there was no residual or recurrent PSAN. Eight TI-PSAN cases showed the mRS score of 0-2 and 2 cases with II-PSAN showed the mRS score of 0. The outcomes were all good. Conclusions Unlike TI-PSAN, the symptoms of II-PSAN are not typical. Thus, much attention should be paid to the diagnosis of II-PSAN. For the II-PSAN patients or TI-PSAN patients with mild vascular injury and good integrity, vascular reconstruction is preferred. For PSAN patients with poor vascular integrity and compliance to reconstruction, occlusion of PSAN combined with vascular bypass surgery should be considered in advance. Key words: Intracranial pseudoaneurysm; Iatrogenesis; Traumatism; Diagnosis; Endovascular treatment; Difference

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.

A novel technique for iatrogenic pseudoaneurysm obliteration with ultrasound-guided thrombin foam injection.

Iatrogenic pseudoaneurysms (IPA) are treated with ultrasound-guided thrombin injections (UGTI). We describe a novel technique for IPA repair that applies UGTI with thrombin foam (UGTFI). Successful obliteration of 6 IPAs (IPA without a neck, n = 5; with a neck, n = 1) in 6 patients (2 males, aged 68 ± 1 years, 4 females, aged 59 ± 11 years) was performed by using UGTFI. The dose of administered thrombin was 25-75 IU. No microembolization phenomenon and no serious clinical complications were observed. Treatment of IPA with UGTFI may reduce the embolization rate, risk of IPA cavity thrombin leakage, required drug dose. Use of the thrombin foam could be the next step in the development of the UGTI, particularly in the treatment of IPA without a neck.