Postcatheterization Pseudoaneurysms Research Articles

Microvascular tissue perfusion after postcatheterization pseudoaneurysm treatment.

Femoral pseudoaneurysm (PSA) is a severe complication after endovascular procedures. Ultrasound-guided manual compression (MC) and percutaneous thrombin injection (TI) are frequently used treatments. MC is less effective, TI may cause thromboembolic events. Up to date, there is no data regarding impairment of microvascular tissue perfusion after PSA treatment. In this single-center, prospective study 22 patients with PSA were included. We compared macro- and microcirculatory perfusion in the treated and untreated leg at baseline before, after and one day after treatment. Leg perfusion was assessed with ultrasound and ankle-brachial index (ABI). Microcirculatory perfusion of the feet was measured with a near-infrared spectroscopy (NIRS) camera generating StO2-tissue-maps. Successful PSA thrombosis was achieved in 16 (100%) patients in TI group and in 4 (66.7%) patients in MC group. There was no evidence of arterial thrombi on ultrasound and the ABI did not differ between groups. NIRS StO2-tissue-maps of the feet showed no significant difference in both groups concerning the treated (p = 0.121) or the untreated (p = 0.198) leg during follow up. In this small exploratory study, there was no evidence of micro- and macrovascular tissue perfusion impairment after treatment of postcatheterization femoral pseudoaneurysm with thrombin injection underscoring the safety of this approach.

Ultrasound-Guided Thrombin Injection for Postcatheterization Pseudoaneurysms and Its Extended Indications.

Objective: Ultrasound-guided thrombin injection (UGTI) is an option for the treatment of postcatheterization pseudoaneurysms. This method is less invasive and less time-consuming compared with other procedures since it can be performed without general anesthesia, skin incision, or occlusion of the artery. Herein, we report on the efficacy of UGTI for postcatheterization bleeding complications.Methods: Postcatheterization bleeding complications include postcatheterization pseudoaneurysm and failed hemostasis. In this study, failed hemostasis was defined as cases in which hemostasis could not be accomplished by 30 min of manual compression following sheath removal. A retrospective study of eight cases in which we performed UGTI for postcatheterization bleeding complications between July 2016 and June 2019 at our institution was performed to evaluate technical success and recurrence of pseudoaneurysm or rebleeding events.Results: Among these eight cases, there were three cases of pseudoaneurysm and five cases of failed hemostasis. In all cases, technical success was achieved without any complications such as distal embolism or allergic reaction. There were no recurrences of pseudoaneurysm or rebleeding events during an average follow-up of 5.25 months.Conclusion: We believe that UGTI is effective not only for postcatheterization pseudoaneurysms but also for failed hemostasis.

Choosing a treatment method for post-catheterization pseudoaneurysms guided by the late to early velocity index

Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are also first 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. Previously, we have established that a late to early velocity index (LEVI) < 0.2 could be a predictor of an increased risk of psA recurrence after standard UGTI. In this paper, we report our first experiences when the choice of the first-line treatment method was based on LEVI assessment. From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI < 0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) with biological TG and 26 had LEVI > 0.2 and they underwent UGTI. The injection set containing human thrombin and fibrinogen was used for UGTGI. Bovine thrombin was used for UGTI. The success rate was 100% and no psA recurrence was detected during a 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 14 years of experience (0% vs. 13%, p = 0.01). All complications (10% in the UGTGI group and 15% in the UGTI group) were mild and transient and included clinical symptoms of paresthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. It may increase the success rate and avoid unnecessary repetition of the procedure, without increasing complication rate while keeping costs of the procedure reasonable.

Risk and prognostic factors of post-catheterization pseudoaneurysm.

PurposeTo evaluate the risk and prognostic factors of post-catheterization pseudoaneurysm (PPA).Material and methodsTo identify the risk factors for PPA occurrence, clinical findings were compared between 22 consecutive patients with radiologically confirmed PPAs (PPA group) and 300 randomly extracted patients without PPA, who underwent transarterial angiography or intervention (sample group) between 1 January 2015 and 31 March 2020. The PPA group was further divided into those treated successfully with mechanical compression (group A) and those requiring ultrasound-guided thrombin injection after compression failed (group B). Univariate and multivariate analyses were used to compare patient demographics, preoperative laboratory findings, procedure details, PPA diameter, and time interval between the procedure and compression between groups A and B to evaluate the prognostic factors of PPA.ResultsThe PPA group demonstrated significantly elevated prothrombin time international normalized ratios (PT/INR) (odds ratio [OR]: 6.27, 95% confidence interval [CI]: 2.020-19.5; p = 0.00151) and more frequent popliteal access (OR: 14.2, 95% CI: 1.040-195.0; p = 0.0467) compared to the sample group, and radial access decreased the risk of PPA (OR: 0.382, 95% CI: 0.0148-0.987; p = 0.0468). One of the 22 PPAs resolved spontaneously, and 11 others (52.4%) were successfully treated by mechanical compression. An interval exceeding 24 hours between the procedure and compression was the only significant prognostic factor (p = 0.0281) between groups A and B.ConclusionsElevated PT/INR and popliteal access may predispose patients to PPA; close consideration of the site of access may lower the risk of refractory PPA.

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

Experience of endovascular treatment of common femoral artery pseudoaneurysm with usage Angio-Seal Closure Device

One case of successful treatment of the common femoral artery pseudoaneurysm with usage of modified technique of pseudoaneurysm neck sealing with Angio-Seal with retrograde access percutaneously is presented.A 52-year-old man was admitted in the recovery period of ischemic stroke in the left carotid basin. A total subtraction cerebral angiography was performed, which revealed severe stenosis in the bulb of the left internal carotid artery with ulcerated contour and severe stenosis in the ostium of the left vertebral artery. Hemostasis was performed by compression. A pressure dressing was applied for a day. The puncture site was without any problems on the next day. The patient received double antiplatelet therapy 5 days before endovascular surgery. Before surgery, palpation in the right inguinal region determines a rounded painful compaction. Carotid stenting on the left side, stenting of the left vertebral artery and control angiography of arteries of the right lower limb were performed by left-side femoral access. Pseudoaneurysm in the bifurcation of the right common femoral artery with a narrow neck was verified. Attempts to cure it by manual compression under angiographic control and ultrasound control were unsuccessful.After 6 days, endovascular treatment of pseudoaneurysms of the right common femoral artery with closure of the pseudoaneurysm neck was performed. The right common femoral artery was catheterized with left radial access with diagnostic catheter on a hydrophilic wire 0.035ʺ. This wire was carefully advanced into pseudoaneurysm through a defect in the common femoral artery and subsequently served as a marker. The pseudoaneurysm was punctured with miniaccess needle, then the 0.018ʺ wire passed through the pseudoaneurysm neck into the femoral artery retrogradly, focusing on the “marker” wire. A 6F radial introducer is introduced along 0.018ʺ wire. Further, this access was used to close the pseudoaneurysm neck with the Angio-Seal Closure Device 6F according to the standard method. In a control angiograms, a pseudoaneurysm did not contrast, arteries are passable without stenosis and signs of dissection. Hemostasis at the site of puncture of the radial artery was performed with a hemostatic bracelet. The patient was discharged from the clinic to continue treatment in a rehabilitation neurological center.This technique of endovascular treatment of postcatheterization pseudoaneurysms of the common femoral artery is quite simple, causing minimal discomfort for the patient. The closure is immediate and angiographically controled. The use of radial access instead of contralateral femoral access for introducing of a “marker” wire and angiographic control reduces the risk of local complications at the access site.

Predictors of Groin Access Pseudoaneurysm Complication: A 10-Year Institutional Experience.

In clinical practice, the incidence of femoral pseudoaneurysms requiring repair is small, but at a tertiary care center, the repair rate is higher due to referrals. We sought to specifically study patients who suffered postcatheterization pseudoaneurysms requiring thrombin injection or operative repair and compare them to our routine transfemoral endovascular patients to identify predictors of clinically significant pseudoaneurysms. The underlying goal would be to identify what makes these patients that develop pseudoaneurysms different. A search of our billing records for Current Procedural Technology (CPT) codes of these 2 procedures between January 2008 and April 2018 was combined with our institution's Peripheral Vascular Intervention Vascular Quality Initiative database spanning from January 2013 to December 2017. A comparison was then performed between patients who had the outcome of operative intervention for a pseudoaneurysm complication and those who did not, with the goal of elucidating patient demographics and periprocedural factors that would predict pseudoaneurysm formation using univariate and multivariate analyses. There were 77 patients who required thrombin injection or open repair for access-related pseudoaneurysms and 324 patients who did not. Complications occurred more often in patients who were older than 75 (40.2% vs 21.9%; P = .0009), female (57.1% vs 38.6%; P = .003), obese (59.7% vs 33.3%; P < .001), hypertensive (96.1% vs 79.3%; P = .0005), who received a sheath >6F (32.4% vs 13%; P < .0001), intraoperative and postoperative anticoagulation (77.3% vs 32.7% and 52.1% vs 24.2%, respectively; P < .0001), and periprocedural P2Y12 inhibitors (48.7% vs 28%; P = .0005). Less complications were observed in patients who had a closure device used (42.9% vs 8.45%; P < .0001) and protamine reversal (26.5% vs 13.3%; P = .0163). Our findings validate published reports that incriminate a larger sheath size, perioperative anticoagulation, and female gender as increasing the rate of access site complications, with the use of a closure device being protective.

Development and treatment of two distinct pseudoaneurysms following transradial coronary catheterization in a patient with high bleeding risk: a case report

BackgroundA pseudoaneurysm is a rare but serious complication after transradial coronary catheterization. Although different treatment modalities have been proposed to treat post-catheterization pseudoaneurysm, only limited data are available to guide the treatment approach.Case presentationWe report a rare case of two distinct pseudoaneurysms complicating transradial percutaneous coronary intervention in a 75-year-old Hispanic woman being treated with dual antiplatelet agents for myocardial infarction and warfarin for atrial fibrillation. The pseudoaneurysms were diagnosed with ultrasound and were successfully treated with a series of Terumo Corporation (TR) band compressions.ConclusionsThis case demonstrates the efficacy of compression therapy in managing post-catheterization radial artery pseudoaneurysm in patients with high bleeding risk.

Retrospective analysis of coronary interventions in a single centre and comparison of specific differences between radial and femoral access

Objectives: The aim of this study was to analyse the consequence of radial or femoral access during coronary interventions to radiation dose, fluorography time and a number of pseudoaneurysms following each type of intervention.Background: According to the results of many recent studies (RIVAL, RIFLE-STEACS, STEMI RADIAL), current guidelines favour radial over femoral access during coronary intervention for safety, especially in cases of acute coronary syndromes. However, several papers have referred to problems in the design of these studies and the management of antithrombotic therapy. The influence of access site on radiation dose and fluorography time is also still unclear.Methods: We retrospectively analysed 4522 patients who underwent coronary angiography in 2012 and 2016 in a single centre in the Czech Republic. We compared the access site with the average radiation dose and mean effective dose that each patient received in Gy/cm2 or mSv, respectively. We also compared average fluorography time in minutes and the incidence of pseudoaneurysms.Results: The radiation dose was a body mass index (BMI)-dependent parameter since each five points of body mass index increased radiation dose approximately by 23%. Use of femoral access resulted in lower fluorography time in all subgroups (p < .001) and decreased radiation dose in patients with coronary artery bypass grafts (CABGs) by 26% (p = .044). On the other hand, there has been 16 times lower frequency (p < .001) of post-catheterisation pseudoaneurysms after radial access than after femoral access.Conclusions: Both the radiation dose and fluorography time were lower after femoral access compared to radial access in patients with CABGs. On the other hand, radial access led to significantly fewer periprocedural pseudoaneurysms. Radial access therefore should be considered as the preferred access site during coronary intervention in patients with a high risk of pseudoaneurysm development, and femoral access should be considered for patients with a high risk of contrast-induced nephropathy.

Treatment of post-catheterization pseudoaneurysms by ultrasound-guided thrombin injection: A single-center experience and practical guideline

Ultrasound-guided thrombin injection has been shown to be a safe and effective treatment for iatrogenic post-catheterization pseudoaneurysms, but still is underused in France. We report our single-center experience and propose a technical guideline for ultrasound-guided thrombin injection. Ultrasound-guided thrombin injection should be considered to be the first-line treatment of iatrogenic pseudoaneurysms.

Post-catheterization giant pseudoaneurysm of the femoral artery: an delayed clinical presentation

Post-catheterization pseudoaneurysm is most common vascular complication of cardiac and peripheral angiographic procedures. We report a 67-year-old female patient with giant (25 cmx25 cm) femoral artery pseudoaneurysm which gradually enlarged without rupture developed after catheterization in the periods of three years. She electively underwent to operation. Pseudoaneurysm pouch was evacuated and the bleeding focus from possible catheterization site was primarily repaired with polypropylene suture. Intraoperative or postoperative course was uncomplicated. The patient was discharged on postoperative day 5. The interesting aspect of the presented case is that despite a wide pseudoaneurysm, it remains unruptured for several years.

A case of a ruptured postcatheterization pseudoaneurysm in the brachial artery

A case of a ruptured postcatheterization pseudoaneurysm in the brachial artery

Ultrasound-Guided Percutaneous Thrombin Injection for Post-Catheterization Pseudoaneurysm

The efficacy and safety of ultrasound-guided thrombin injection (UGTI) for the treatment of post-catheterization femoral and brachial artery pseudoaneurysms (PSA) is unclear in Japan. A retrospective study of 32 consecutive patients undergoing percutaneous UGTI of post-catheterization PSA between February 2011 and February 2014 was performed. There were 23 femoral PSA and 9 brachial PSA treated with UGTI. The prevalence of CAD and smoking history were higher in the brachial PSA patients, but there were no statistically significant differences in other patient demographic factors or in the preprocedural antiplatelet therapy between the femoral and brachial PSA patients. The median dose of thrombin injected was 200 U (range, 100-600 U). The initial success rate, early recurrence rate and surgical conversion rate were 91%, 0% and 4% in the femoral PSA, and 89%, 11% and 11% in the brachial PSA, respectively. There were 2 cases of medial nerve compression in the brachial PSA group, but there were no complications in the femoral PSA group (P=0.0198). On outpatient clinical follow-up in the successfully treated patients, there were no recurrences after an average follow-up of 16 months. UGTI is a feasible, safe and effective less-invasive treatment for post-catheterization PSA. Brachial PSA, however, might require additional attention because of their tendency toward higher recurrence and complications.

A cost effective endovascular approach for management of post-catheterization profunda femoris artery pseudoaneurysm using thrombin

Post-catheterization PSA is one of the most commonly encountered vascular complications of cardiac and peripheral angiographic procedures. We report the case of patient who developed deep-seated profunda femoris artery pseudoaneurysm (PSA) following cardiac catheterization. Despite, repeated ultrasound guided compressions the PSA failed to close and instead produced local site pressure ulcers. The secondary infection followed which precluded use of percutaneous thrombin injection. The PSA was finally closed via a total endovascular technique combining intravascular thrombin injection and coil embolization, thus obviating the need for expensive measures like cover stents or invasive surgical repairs.

Noninvasive technique of preventing thrombin escape into the systemic circulation during ultrasound-guided thrombin injection (UGTI) of the postcatheterization pseudoaneurysms

Abstract Introduction Iatrogenic, postcatheterization pseudoaneurysms (PSA) of the femoral artery are a common complication after diagnostic and interventional procedures, with up to 7.7% incidence. Treatment includes surgical repair, ultrasound-guided compression (USGC) repair of the tract of the PSA, or recently ultrasound-guided thrombin injection (UGTI). Large (&gt;1.8 cm) PSA sac with short (&lt;3 mm) and/or wide (&gt;3 mm) tract has higher complication ratio such as thromboembolic events after UGTI. Those cases are considered for protective balloon inflation during thrombin injection. The aim of our study was to evaluate the success rate of preventing escape of the thrombin during UGTI with simultaneous manual compression on ipsilateral iliac artery. Methods and results We reported 46 patients, 17 males and 29 females, aged 53–74 years, with iatrogenic, postcatheterization femoral artery PSA. Out of 46 patients, 7 were successfully treated with USGC. The rest of the patients were treated with UGTI with simultaneous manual compression on ipsilateral iliac artery to stop the flow in PSA, and to avoid thrombin escape into the native circulation. Success rate of UGTI with manual compression of ipsilateral iliac artery was 97% with the complication rate of 2.6%. Conclusion Our study confirms that UGTI treatment of the PSA of the femoral artery combined with compression of the ipsilateral iliac artery could be a safe and reliable method of the thrombin escape prevention into the systemic circulation, as good as more invasive and demanding methods.

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

This study retrospectively evaluated ultrasonography-guided (US-guided) percutaneous thrombin injection for the treatment of postcatheterization femoral and brachial artery pseudoaneurysms. Fifty-five patients with postcatheterization femoral artery (n = 53) or brachial artery (n = 2) pseudoaneurysms were treated using US-guided human thrombin (500 IU/mL) injection. Pseudoaneurysm size, thrombin dose, therapy outcome, and complications were documented. Follow-up color Doppler US was performed 7 and 30 days after treatment. Short-duration supplemental compression was applied to six patients at the first week follow-up examination after a reinjection of thrombin had failed. Mean pseudoaneurysm volume was 20.3 ± 18.7 cm(3). The mean injected thrombin dose was 478 ± 238 IU. Thirty-eight (69.1%) of the 55 pseudoaneurysms were thrombosed with a single injection, and 11 of 17 pseudoaneurysms were thrombosed after a second injection. All (100%) of the 41 pseudoaneurysms that were diagnosed within the first two weeks of postcatheterization were successfully treated. The overall primary success rate was 89.1% (49 of 55 pseudoaneurysms). Supplemental compression promoted thrombosis in four of the six patients who had treatment failure with thrombin injection. The secondary success rate was 96.4% (53 of 55 pseudoaneurysms). There were no complications. US-guided thrombin injection was most successful within the first two weeks, and the supplemental compression might aid in the closure of partially thrombosed pseudoaneurysms.

E0470 Ultrasound guided thrombin injection for the treatment of iatrogenic postcatheterisation pseudoaneurysms in 76 cases

Ultrasound-Guided Thrombin Injection For The Treatment Of Iatrogenic Post-Catheterisation Pseudoaneurysms In 76 Cases Objective The purpose of this study was to evaluate the safety and efficacy of ultrasound-guided thrombin injection...

Color-Doppler-Ultrasound guided compression to repair common femoral artery pseudoaneurysm

Background The insurgence of post-catheterization pseudoaneurysms has dramatically increased among the elderly if compared to the past, due to the spreading of endovascular treatments, both of diagnostic and surgical nature. The case presented here shows the usefulness of eco Color Doppler in this kind of pathology.

Post-Catheterization External Iliac Artery Pseudoaneurysm, Use of Uncovered Stent in Emergency Endovascular Repair

Post-Catheterization External Iliac Artery Pseudoaneurysm, Use of Uncovered Stent in Emergency Endovascular Repair

Surgical Approach To A Giant Post Cardiac Catheterization Pseudoaneurysm After Unsuccessful Duplex Ultrasound-Guided Compression

Femoral artery pseudoaneurysm is a significant problem in patients undergoing diagnostic catheterization.In the study we present our surgical approach to a giant post cardiac catheterization pseudoaneurysm after unsuccessful Duplex ultrasoundguided compression.Surgical repair of pseudoaneurysms was the treatment of choice.