Peripheral Pseudoaneurysms Research Articles

Clinical application of medical adhesive in endovascular embolization treatment of peripheral pseudoaneurysm.

This study explores the clinical application value of medical adhesive in endovascular embolization treatment of peripheral pseudoaneurysm. This was a retrospective review on 31 patients with peripheral pseudoaneurysm treated with medical adhesive endovascular embolization at the First Affiliated Hospital of Shihezi University from July 2021 to July 2023. Follow-up for 3-6 months was to observe the clinical efficacy and postoperative complications of medical adhesive embolization treatment. A total of 32 pseudoaneurysms were embolized in 31 patients with peripheral pseudoaneurysms. All pseudoaneurysms originated from visceral arteries. Among them, 29 pseudoaneurysms were embolized with medical adhesive alone, and three pseudoaneurysms were embolized with coil-assisted medical adhesive. After endovascular embolization with medical adhesive, all pseudoaneurysms were successfully embolized. Technical success was 100%. All patients experienced cessation of bleeding after endovascular embolization with medical adhesive, and there were no serious post-operative complications. Clinical success was 100%. During the follow-up period, two patients experienced recurrent bleeding but no pseudoaneurysm recurrence was observed. Endovascular medical adhesive embolization is a safe and effective method for treating pseudoaneurysm, with high hemostatic efficiency and permanent occlusion of the pseudoaneurysm after embolization, which is worthy of clinical promotion and application.

A 10‐year retrospective review of management and outcomes of pseudoaneurysms at a tertiary referral centre

Pseudoaneurysms are uncommon but potentially life-threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound-guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. Retrospective single-centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010-2020). There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm; 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound-guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was <9 h for visceral artery pseudoaneurysms and 24 h for peripheral artery pseudoaneurysms. There was no change in survival outcomes with respect to time from diagnosis and intervention. In this study, pseudoaneurysms were treated with a high degree of success by observation or by using an endovascular approach, and those requiring endovascular intervention did not need to be treated immediately in an emergent setting.

Management of Post-traumatic Peripheral Arterial Pseudoaneurysm in Antananarivo

Background: Pseudoaneurysm is the usual complication of arterial injury. The aim of this study is to describe the etiology and the management of post-traumatic peripheral arterial pseudoaneurysm in Antananarivo.&#x0D; Methods: This is a bicentric retrospective study for 10 years period (January 2010 to December 2019), performed in Cardiovascular Unit in Joseph Ravoahangy Andrianavalona Teaching Hospital and in Vascular Unit in Soavinandriana Hospital Center, including all patient who underwent a surgical procedure of post-traumatic peripheral arterial pseudoaneurysm.&#x0D; Results: 38 patients were recorded in 10 years period, which 26 patients recorded in JRA hospital and 12 patients in Soavinandriana Hospital. Patients were 33 males (86.84%) and 5 females (13.15%). Gunshots wounds (47.36%) and stabs wounds (34.21%) were the commonest circumstances of etiology. Pulsatile mass (84.21%), pain (60.52%) and palpable thrill (71.05%) were the usual of peripheral pseudoaneurysm. Doppler ultrasound (94.73%) and computed tomographic angiography (13.15%) performed the diagnosis of the pseudoaneurysm. Femoral artery (39.47%) and brachial artery (31.57%) were the most involved vessels. All patients underwent an open surgery. Surgical procedures were arterial repair in 26 patients (68.42%), reversed saphenous vein interposition in 5 patients (13.15%), PTFE graft in 2 patients (5.26%) and ligation excision in 5 patients (13.15%). There was no reoperation or mortality in early postoperative period.&#x0D; Conclusion: Trauma is the most common etiology of pseudoaneurysm in Antananarivo. Open surgical repair remains the procedure to treat the post-traumatic peripheral arterial pseudoaneurysm in our experience.

Usefulness of doppler techniques in the diagnosis of peripheral iatrogenic pseudoaneurysms secondary to minimally invasive interventional and surgical procedures: imaging findings and diagnostic performance study.

The pseudoaneurysm (PA) is a perfused sac directly connecting with the arterial lumen by an interruption of the vessel wall continuity, more commonly secondary to trauma or iatrogenic causes. Aim of our study was to determine the accuracy and usefulness of Doppler techniques in the diagnosis of peripheral iatrogenic PAs secondary to minimally invasive procedures. From a three year prospective research, 20 Duplex Ultrasound (DUS) studies in as many patients presenting with periarterial pulsating mass clinically suspected for PA secondary to minimally invasive procedures were selected. The PA final diagnosis was confirmed by angiography in 12 patients (60% cases), by computed tomography angiography in 5 patients (25%), by surgery in 2 patients (10%), and by magnetic resonance angiography in 1 patient (5%). The vessels involved by PA formation were: common femoral artery in 8 cases (40%); superficial femoral artery in 4 cases (20%); brachial artery in 3 cases (15%); popliteal artery in 2 cases (10%); superficial temporal artery (STA) in 2 cases (10%); dorsal medial digital artery of the foot in 1 case (5%). Our study confirmed the usefulness of doppler techniques in the diagnosis of peripheral iatrogenic PAs. Specifically, a sensitivity of 90-95%, a specificity of 100% and predictive values of 100% (VPP) and 83-90% (VPN) were reported. The radiologist must always suspect a PA in the differential diagnosis of lesions contiguous to an artery vessel. This is to prevent potential complications such as e.g. massive haemorrhage. In this order, DUS allows a careful selection of patients who require to undergo in-depth imaging methods or surgical therapy, thus contributing to a significant reduction of contrast medium and exposure to ionizing radiation.

Factors associated with pseudoaneurysm development and necessity for reintervention: a single centre study.

Evaluate the factors associated with pseudoaneurysm development and morphology. Measure ultrasound-guided thrombin injection (UGTI) and surgical treatment outcomes for pseudoaneurysms, and the necessity for post-primary intervention (reintervention). Retrospective analysis of ultrasound scans and CT angiography of peripheral pseudoaneurysm interventions from February 2011 to April 2017. 99 patients (61.6% female) were identified; median age 72 years (range 12-89). Multivariate analysis of patient demographics, including pre-intervention anticoagulant and antiplatelet medication was performed. Primary intervention for peripheral pseudoaneurysms (62.6% common femoral artery) included 93 UGTI and 6 surgical repairs; with 12 reinterventions (9 UGTI and 3 surgical). Pseudoaneurysm incidence for vascular interventional radiology (VIR) was 0.48% (31/6451) and cardiology was 0.24% (60/25,229). Rates for primary success, immediate complications, 30-day mortality and reintervention were measured respectively for UGTI (98.9%, 3.0%, 2.0%, and 11.8%) and surgical repair (100%, 0.0%, 22.2% and 16.7%). Reintervention risk factors included pre-intervention thrombocytopaenia (<150 × 109/L) ( p = 0.025) and pseudoaneurysms following vascular surgery (p = 0.033). Other positive associations for reintervention (non-significant) included use of a sheath size > 6 Fr ( p = 0.108) or arterial closure device ( p = 0.111) during the pseudoaneurysm causative procedure. The pre-intervention warfarin subgroup developed a larger mean pseudoaneurysm sac size (4.21 cm, range 0.9-7.6), compared to no treatment (p = 0.003), aspirin (p = 0.005) and clopidogrel (p = 0.026) subgroups. UGTI dosage for thrombosis had a positive correlation with incremental sac size increase (p < 0.001). The main reintervention risk factor was pre-intervention thrombocytopaenia, with additional positive associations including pseudoaneurysms caused by surgery, increased sheath size and arterial closure devices. Warfarinized patients developed larger sac-sized pseudoaneurysms compared with other pre-intervention regimens, with positive correlation of higher UGTI dosage required for thrombosis. Patients with pre-intervention thrombocytopaenia and pseudoaneurysms attributed to vascular surgery are subgroups that may benefit from post-intervention imaging surveillance due to significant reintervention risk.

Olağan Dışı Yerleşimli Yalancı Anevrizmalar: Yüzeyel Palmar Ark ve Yüzeyel Temporal Arter

Peripheral pseudoaneurysms mostly occur owing to diagnostic catheterization but rarely owing to blunt or penetrating trauma, infection, or recurrent microtrauma. They appear as a soft pulsatile mass. Complications may occur owing to rupture or distal embolization. Doppler ultrasound and computed tomography are the imaging techniques used in diagnosis. Endovascular interventions and surgery are among the treatment options. In this report, we present two unusually located pseudoaneurysms, one in the superficial palmar arch following penetrating trauma and another in the superficial temporal artery following blunt trauma.

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.

Endovascular stent graft implantation for treatment of peripheral pseudoaneurysms: Six-year results of a cardiovascular surgery center

Endovascular stent graft implantation for treatment of peripheral pseudoaneurysms: Six-year results of a cardiovascular surgery center

EPTFE stent graft in non-steno-occlusive arterial disease: 2 centers retrospective study.

We report our experience regarding use of Fluency stent graft (Bard, Murray Hill, NJ, USA) for the treatment of peripheral aneurysms, pseudoaneurysms, arteriovenous fistulae, dissections and arterial ruptures, lacerations or perforations. This two-center study included 59 patients (40M, 19F) with a mean age of 64.37years (range 20-91years). In total 61 lesions were treated, so subdivided: 10 true aneurysms, 26 pseudoaneurysms, 5 iatrogenic arteriovenous fistulae, 20 arterial ruptures, lacerations or perforations. Immediate technical success was obtained in 60 of 61 lesions (98.3%); in 1 case (pseudoaneurysm of hepatic artery) additional embolization of the gastroduodenal artery with microcoils was needed. Follow-up was available for 57 patients and 59 lesions; mean period was 23.52months (range 1-60months). At 1-year primary patency was 89.47%, whereas secondary patency was 96.4%. Endovascular application of Fluency stent graft seems to offer an effective, and durable less invasive alternative to standard surgical techniques for the treatment of peripheral aneurysms, pseudoaneurysms, iatrogenic arteriovenous fistulae and arterial ruptures, or penetrating injuries.

Treatment of peripheral vascular pseudoaneurysm

Objective To investigate the treatment of peripheral vascular pseudo-vascular aneurysm.Methods 45 cases with peripheral vascular pseudoaneurysm were admired in our hospital from March 2009 to February 2012.32 patients were implanted stent(6 cases of iliac artery,13 cases of femoral artery,three cases of axillary artery,two cases of carotid artery,three cases of popliteal artery,one case of brachial artery,three cases of anterior tibial artery,one case of radial artery).Four cases were treated by ultrasound-guided thrombin injection (one case of deep femoral artery,one case of brachial artery distal end,two case of femoral artery).Nine cases received surgical treatment (including one case of stent failure).One case of deep femoral pseudoaneurysm with coil embolization.Results 45 cases of pseudo-vascular aneurysms were closed after various methods of treatment.32 cases were placed sent implantation,31 cases of limb trunk artery pseudoaneurysm were completely isolated and the distal arterial pulse completely normal.One patient with iliac artery stent migration after stent implantation was diverted surgical resection of the aneurysm graft replacement.One case was followed up for 8 months after stent implantation found thrombosis.Four cases of patiensts with intratumoral thrombosis after thrombin injection,there was no recurrence.9 cases of surgery patients restored to good blood flow.One case of deep femoral pseudoaneurysm with the coil embolization had a good result.Conclusion The treatment of peripheral pseudoaneurysm should be based on the occurrence site and select the appropriate treatment in order to improve the therapeutic effect. Key words: Pseudoaneurysm; Bracket; Embolism; Surgery; Contained aneurysm

Traumatic Pseudoaneurysm of the Superficial Temporal Artery

Pseudoaneurysms of the superficial temporal artery (STA) are a relatively rare disease entity. Only less than 200 cases of STA pseudoaneurysm have been documented in the literature since Bartholin reported the first case of the STA pseudoaneurysm in 1740 . However, the authors encountered three cases during a 3-year span, which suggests that STA pseudoaneurysms may be more common than the previous literature shows. And the most frequent causes of peripheral traumatic pseudoaneurysm are closed head trauma(62%), penetrating wounds(27%), and iatrogenic trauma (11%). So any surgeon treating patients with head and facial trauma should be aware of this unusual lesion. Here, we report three cases of the STA pseudoaneurysm, which are caused by the head trauma.

Ultrasound-guided compression repair of peripheral artery pseudoaneurysm: 8 years’ experience of a single institute

BackgroundFemoral artery pseudoaneurysm is a rare complication but with increasing frequency nowadays due to the advances of endovascular intervention. Rare cases of brachial orpopliteal artery pseudoaneurysms had ever been reported and the predictive factors of failed ultrasound-guided compression repair (UGCR) are controversial. MethodsDuring the past 8 years, 21 patients (12 males and nine females; median age, 64 years) with peripheral pseudoaneurysms (femoral artery, n = 17; brachial artery, n = 3; popliteal artery, n = 1) were enrolled. A high frequency of 10–12 MHz color ultrasound was used to evaluate the presence of a pseudoaneurysm. The area of the pseudoaneurysm sac and the width and length of the pseudoaneurysm neck were recorded. Under real-time ultrasound guiding, gradual pressure was applied with the probe to obliterate flow in the pseudoaneurysm neck while still allowing flow through the supplying artery for approximately 10–15 minutes with at most three times (45 minutes’ compression). Follow-up color sonography was obtained at 24 hours to detect any recurrence. ResultsThe mean area and the largest dimension of the 21 pseudoaneurysms were 7.3 ± 6.5 cm2 and 3.6 ± 1.8 cm, respectively. The mean width and the mean length of the pseudoaneurysm neck were 2.1 ± 0.9 and 3.3 ± 2.0 mm, respectively. Successful thrombosis of the pseudoaneurysm was achieved in 19(90.5%) patients. The mean compression time of the 19 successful UGCR was 21.2 ± 11.0 minutes. Two patients failed the UGCR procedure after a 45-minute compression. Both of the two pseudoaneurysms were located in the femoral artery with a large width of the pseudoaneurysm neck (4 and 5 mm, respectively). ConclusionUGCR is a safe and cost-effective therapy for treating peripheral pseudoaneurysms of not only femoral artery, but also brachial artery and popliteal artery. We considered the width of the pseudoaneurysm neck to be the predictive factor of technical success.

Percutaneous Cyanoacrylate Glue Embolization for Peripheral Pseudoaneurysms: An Alternative Treatment

Post-traumatic pseudoaneurysms are rare in the peripheral arteries and usually occur as a late sequel of trauma. Surgery has traditionally been considered as the gold standard of therapy for traumatic peripheral pseudoaneurysms. We report 2 cases of post traumatic pseudoaneurysms successfully treated by percutaneous cyanoacrylate glue (N-Butyl 2 cyanoacrylate) embolization. This method offers complete exclusion of the pseudoaneurysm, at the same time avoiding the morbidity of open surgery.

Traumatic brachial artery pseudoaneurysm diagnosed in the emergency department with point-of-care bedside ultrasound

Abstract Case A 55-year-old gentleman was referred to the emergency department for penetrating trauma of his left upper arm. X-rays identified a metallic foreign body. Clinical examination revealed a swollen left upper arm with a pulsatile mass. Point-of-care bedside ultrasound in the ED confirmed a traumatic brachial artery pseudoaneurysm. Discussion The features of a peripheral pseudoaneurysm and its ultrasonographic appearance in both B-mode, and color Doppler imaging.

Easy Retrieval of Escaping Onyx Fragment with Percutaneous Manual Aspiration

The ability of embolization of arteriovenous malformations (AVMs) has increased with the use of Onyx liquid embolic material [1]. The application of the ethylene–vinyl alcohol copolymer (EVOH) in the endovascular treatment of intracranial AVMs was first described by Taki et al. and Terada et al. in the early 1990s [2, 3]. Onyx is an elastic polymer with a lavalike flow pattern that may be used within blood vessels and does not fragment during injection. Onyx is not absorbable and is capable of producing permanent vascular occlusion [4, 5]. Onyx can be used to embolize not only the intracranial AVMs but also the peripheral pseudoaneurysms and malformations [6]. A set of clinical complications that are related to the use of Onyx were described, including reflux of Onyx into the afferent artery peduncle, subarachnoid hemorrhage, and cerebral and pulmonary edema in part as a result of the dimethyl sulfoxide (DMSO) solvent used in Onyx [7, 8]. Extension of Onyx to the parent vessel is a rare complication that has been reported during treatment of AVMs. It has been shown that the Onyx substance can be retrieved with dedicated mechanical retrieval devices [9]. We encountered an escape of an Onyx fragment from the feeder artery into the parent superficial femoral artery while treating a peripheral AVM. We report successful removal of fragment that escaped from the feeder artery and a smaller fragment that embolized into the peroneal artery by simple manual aspiration.

Transcatheter embolization for peripheral pseudoaneurysms with n-butyl cyanoacrylate

The purpose of this study is to evaluate the clinical efficacy of transcatheter embolization for pseudoaneurysms of peripheral arteries with n-butyl cyanoacrylate (NBCA). From November 2000 to February 2008, 17 patients with 18 pseudoaneurysms were treated by transcatheter embolization at our affiliated hospitals. The locations of the pseudoaneurysms were right hepatic artery (n=3), renal artery (n=5), splenic artery (n=2), gastroduodenal artery (n=2), common hepatic artery (n=1), pancreatic arcade (n=1), external iliac artery (n=1), internal iliac artery (n=1), internal thoracic artery (n=1), and left gastric artery (n=1). We assessed technical success rate, embolization methods, and clinical course in this study. The technical success rate was 94.4% (17/18 cases). Embolization methods were isolation (n=17) and packing (n=1). Only NBCA was used in 14 cases, both coils and NBCA were used in four cases. Six patients were in shock prior to the procedure, but all patients recovered immediately after embolization procedure including transfusion. None of the patients died of procedure-related factors or had notable postoperative complications, but three patients died within a week of the procedure because of deterioration of the underlying disease. In conclusion, transcatheter embolization of pseudoaneurysms with NBCA is a safe and effective technique for treatment.

Transcatheter embolization for peripheral pseudoaneurysms with n-butyl cyanoacrylate

Transcatheter embolization for peripheral pseudoaneurysms with n-butyl cyanoacrylate

Extravasation during Aneurysm Embolization without Neurologic Consequences. Lessons learned from Complications of Pseudoaneurysm Coiling. Report of 2 Cases

Although endovascular intervention is the first-line treatment of intracranial aneurysm, intraprocedural rupture or extravasation is still an endangering event. We describe two interesting cases of extravasation during embolotherapy for ruptured peripheral cerebral pseudoaneurysms. Two male patients were admitted after development of sudden headache with presentation of intracerebral and subarachnoid hemorrhage, respectively. Initial angiographic assessment failed to uncover any aneurysmal dilatation in both patients. Two weeks afterwards, catheter angiography revealed aneurysms each in the peripheral middle cerebral artery and anterior inferior cerebellar artery. Under a general anesthesia, endovascular embolization was attempted without systemic heparinization. In each case, sudden extravasation was noted around the aneurysm during manual injection of contrast after microcatheter navigation. Immediate computed tomographic scan showed a large amount of contrast collection within the brain, but they tolerated and made an unremarkable recovery thereafter. Intraprocedural extravasation is an endangering event and needs prompt management, however proximal plugging with coil deployment can be sufficient alternative, if one confronts with peripheral pseudoaneurysm. Peculiar angiographic features are deemed attributable to extremely fragile, porous vascular wall of the pseudoaneurysm. Accordingly, it should be noted that extreme caution being needed to handle such a friable vascular lesion.

Onyx, a New Liquid Embolic Material for Peripheral Interventions: Preliminary Experience in Aneurysm, Pseudoaneurysm, and Pulmonary Arteriovenous Malformation Embolization

To describe our preliminary experience with a new liquid embolization agent, Onyx, in peripheral interventions. We successfully treated two peripheral aneurysms (one in an internal iliac artery, one in a thoracic collateral artery of an aortic coarctation), two peripheral pseudoaneurysms (one in a lumbar artery, one in a renal artery), and one pulmonary arteriovenous malformation. Onyx is a promising alternative embolic material for peripheral interventions. It can be combined with coils in selected cases, and balloon catheters can be effectively used during slow injection of embolic material to control flow and protect the aneurysm neck.

Complications Occurring During Conservative Management of Splenic Trauma in Children

Conservative management of splenic rupture in haemodynamically stable children is now generally accepted. However, during follow-up, many complications can occur. The aim of this study was to describe the complications we observed and to propose a standardised follow-up adapted to them. Between March 1992 and December 2002 we managed 65 children (aged between 3 and 15 years old) with accidental splenic rupture. Follow-up and treatment consisted of a 10-day bed rest with sonogram and Doppler controls on the 5th and 10th day and subsequently every month until complete healing. Complications included secondary haemorrhage in 3 cases, cystic evolution in 5 cases, and pseudo-aneurysm in 2 cases. All were treated by renewed bed rest. Three of the cysts resolved spontaneously, the other two underwent cystic resection and epiploplasty by laparotomy (n = 1) or laparoscopy (n = 1) and both pseudo-aneurysms were selectively embolised. There were no splenectomies. Complications essentially occurred in older children and were not related to gender, type of fracture, or extent of bleeding. Cystic evolution of the sub-capsular haematomas can appear up to 1 month after trauma. Peripheral pseudo-aneurysms which could be responsible for secondary haemorrhages were selectively embolised. We favour the use of the Doppler sonogram for follow-up until total recovery of these patients, even in low-grade traumas. Considering the number of complications encountered we do not believe the American evidence-based guidelines are suitable for our population.