Compression Of Pseudoaneurysms Research Articles

Median nerve injury after percutaneous catheterization of the brachial artery

Objective To discuss the pathological characteristics and treatment options of medial nerve injury after percutaneous brachial artery puncture. Methods From January 2015 to June 2016, 4 cases of median nerve injury were admitted in our department. The patients'age ranged from 57 to 76 years. Time from onset of symptoms to office visit ranged from 5 days to 1 year. Median nerve injury was identified with physical examination, ultrasound, angiography and electrophysiological examination. One case was treated conservatively. The other 3 cases were treated with surgical neurolysis. Results One case had hematoma compression. One case had hematoma compression and direct puncture of the nerve. One case had arteriovenous fistula compression. And pseudoaneurysm compression was identified in the last case. The outcomes were poor in all 4 cases. Conclusion Median nerve injury is one of the most serious complications of percutaneous brachial artery puncture. This procedure should be guided with ultrasound. Carefulness in the procedure and proper postoperative treatment may lead to fewer complications. Early recognition and surgical intervention is vital to the restoration of nerve function. Key words: Median nerve; Brachial artery; Punctures; Complications

Brachial Venous Pseudoaneurysm with High Median Nerve Palsy Following Cardiac Catheterization: A Case Report.

Cardiac catheterization is usually performed via the right common femoral artery. The brachial artery offers an alternative route when the femoral artery is diseased or when monitoring of aortic valve pressure is required1. Brachial artery catheterization can be complicated by direct damage to the median nerve or by an arterial or venous pseudoaneurysm, which can compress the nerve and result in indirect damage. While direct nerve trauma will present almost immediately, pseudoaneurysm compression of the median nerve may have an asymptomatic interval and present with late symptoms and gradual symptom progression2. We present a case of brachial venous pseudoaneurysm following cardiac catheterization. We discuss the relevant neurovascular anatomical relationships above the elbow and the most common potential local complications of brachial artery cannulation; we also highlight the need for periprocedural monitoring of local signs and distal neurovascular function. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A seventy-year-old right-handed woman presented to us two weeks after cardiac catheterization via the right brachial artery. Following the procedure, she developed swelling and superficial bruising of the cubital fossa and the proximal part of the forearm. Over the next two weeks, she developed pain and numbness of the right thumb and index finger as well as weakness of the right hand. She was unable to wield chopsticks or button her blouse. She had no history of bleeding diathesis, and recovery from previous laparoscopic cholecystectomy and appendectomy had been uneventful. Physical examination revealed a nonpulsatile 3-cm mass just proximal to the medial humeral epicondyle of the right upper limb. Arterial thrill and bruit were absent. There was weakness of the long flexor muscles of the thumb and index finger, thenar muscles, and wrist flexor muscles. There was mild atrophy of …

Issue Highlights

HomeCirculationVol. 111, No. 25Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published28 Jun 2005https://doi.org/10.1161/circ.111.25.3341Circulation. 2005;111:3341IS OBESITY A RISK FACTOR FOR MORTALITY IN CORONARY ARTERY BYPASS SURGERY? by Jin et al.This article investigates the role of body size on operative mortality after isolated coronary artery bypass graft surgery in 16 218 patients. Prior reports on body size (body mass index) have resulted in conflicting results. Body mass index in a logistic regression model was not found to be a statistically significant risk factor for mortality. The lowest mortality was observed in the high, normal, and overweight subgroups as compared with obese and underweight subgroups. However, obesity does remain a risk factor for sternal wound complications and negatively impacts late cardiovascular health. A little fat may be protective to get you through surgery, and being underweight increases the operative risk. See p 3359.EFFECTS OF EXERCISE AND ISCHEMIA ON MOBILIZATION AND FUNCTIONAL ACTIVATION OF BLOOD-DERIVED PROGENITOR CELLS IN PATIENTS WITH ISCHEMIC SYNDROMES: RESULTS OF 3 RANDOMIZED STUDIES, by Sandri et al.Exercise training reduces myocardial ischemia in patients with coronary artery disease and lower-limb ischemia in patients with peripheral arterial disease. Several mechanisms may account for these findings, including an improvement in regional perfusion. Previous studies have demonstrated that exercise training induces changes in vascular endothelial function and leads to enhanced vasodilation in local vascular beds. In this provocative study, Sandri and colleagues evaluated whether regular exercise may induce a regeneration of diseased endothelium by circulating progenitor cells or circulating progenitor cell-derived vasculogenesis, and whether ischemic stimuli are required to effect such changes. Their findings provide important new insights into this complex process. See p 3391.IMPROVED MYOCARDIAL β-ADRENERGIC RESPONSIVENESS AND SIGNALING WITH EXERCISE TRAINING IN HYPERTENSION, by MacDonnell et al.Myocardial β-adrenergic receptor responsiveness is depressed in pressure overload-induced cardiac hypertrophy, in association with multiple alterations in the signaling pathway that couples the β-adrenergic receptor to calcium handling and myocyte function. Exercise training is known to improve myocardial β-adrenergic responsiveness in this setting. MacDonnell et al examined the mechanism of this beneficial effect of exercise in spontaneously hypertensive rats. They found that levels of GRK2, a protein that desensitizes the β-adrenergic receptor, were reduced by exercise, in association with increased phosphorylation of two targets of β-adrenergic receptor-mediated phosphorylation, the ryanodine receptor and phospholamban. These findings suggest that biochemical alterations in the β-adrenergic receptor signaling cascade can have important functional consequences in both the pathophysiology of cardiac dysfunction and the response to therapeutic interventions such as exercise training. See p 3420.Visit http://www.circ.ahajournals.org:Images in Cardiovascular MedicineVentricular Septum Rupture After Myocardial Infarction Demonstrated by Multislice Computed Tomography. See p e449.Right Ventricular Lead Perforation Presenting as Left Chest Wall Muscle Stimulation. See p e451. Download figureDownload PowerPointPosterior Descending Artery Milking-Like Effect Caused by Ventricle Pseudoaneurysm Compression. See p e453.CorrespondenceSee p e455. Previous Back to top Next FiguresReferencesRelatedDetails June 28, 2005Vol 111, Issue 25 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.111.25.3341 Originally publishedJune 28, 2005 PDF download Advertisement

Anglographic Access Site Complications in the Era of Arterial Closure Devices

Coronary and peripheral angiography is associated with a low but significant risk of access site complications. While percutaneous devices have been shown to permit more rapid puncture site closure, previous reports have suggested the incidence and severity of complications associated with these devices are greater than with manual compression. This study compares access site complications with and without closure devices in the current era. The authors conducted a retrospective review of patients with access site complications after coronary or peripheral angiography between 1998 and 2000. Forty-five complications requiring vascular surgical consultation were identified in the 4,800 procedures performed during this time period. Fourteen complications occurred in 1,536 procedures (0.9%) using suture-mediated or collagen devices and 31 occurred in 3,264 procedures without devices (0.9%). The types of procedures and catheter sizes (mean 7 Fr) used were not different in the 2 groups. Other than complications involving a retained device, there was no difference between device and manual compression with respect to incidence or types of complication,requirement for operation, type of operation, or outcome. Access site complications identified included pseudoaneurysm (n = 22; 49%), bleeding or hematoma (n = 8;18%), arteriovenous fistula (n=5;11%), arterial thrombosis (n = 4;9%), infection (n = 4;9%), and retained device (n = 2;4%). Twenty-four patients (71% vs 45%; p = NS) required operative intervention including pseudoaneurysm repair, hematoma drainage, and thrombectomy. Eleven patients (26%) underwent successful ultra-sound-guided pseudoaneurysm compression and 9 patients (21%) required no intervention. These data demonstrate that closure devices facilitate arterial puncture site repair without an increase in access site complications. These devices can be safely utilized when rapid hemostasis is desired after coronary or peripheral angiography.

Masa pulsátil torácica como síntoma principal de seudoaneurisma gigante de aorta ascendente

The pseudoaneurysms of the ascending aorta are very infrequent but their diagnosis is important because of the associated high mortality. They usually appear in patients who have undergone aortic-related surgery, but the time that passes until they appear can be very prolonged and suspicious signs and symptoms can be quite anodyne. We present two cases of pseudoaneurysms of ascending aorta in two patients who underwent cardiovascular operations several months before, which were of such a considerable size that the first and practically the only symptoms were the sudden appearance of a pulsating thoracic mass because of pseudoaneurysm compression at this site.

Thromboembolism Complicating Thrombin Injection of Femoral Artery Pseudoaneurysm: Management with Intraarterial Thrombolysis

Ultrasound (US)-guided compression of pseudoaneurysms is being rapidly replaced by US-guided percutaneous treatment with thrombin injection because of the less intensive nature of this procedure. Thromboembolism after percutaneous treatment with thrombin injection is rare and has been described in brachial artery pseudoaneurysms. These were managed with intravenous administration of heparin and surgical thrombectomy. In this report, the authors describe thromboembolic complication of thrombin injection after treatment of a femoral artery pseudoaneurysm. This was managed by intraarterial thrombolysis with use of recombinant tissue plasminogen activator (rt-PA) with resolution of all major occlusive changes. A lower dose of thrombin injection and frequent postprocedural monitoring of distal pulses is recommended.

Sonographically guided compression repair of pseudoaneurysms: further experience from a single institution.

Our purpose was to perform a comprehensive review of our experience with compression of postcatheterization groin pseudoaneurysms. Two hundred eighty-one patients underwent 306 sonographically guided compression procedures on 297 groin pseudoaneurysms after femoral artery catheterization. The medical records, cardiac catheterization reports, and sonographic images were reviewed to determine patient demographics, type of catheterization procedure performed, sheath size, access site, interval from sheath removal to compression, anticoagulation status, pseudoaneurysm dimensions, complications, and follow-up information. Statistical analysis was performed using Pearson's chi-square and Kendall tau tests. The success rate for the initial compression attempt was 72.1%. Of the 83 failed compression attempts, 12 patients underwent a second attempt, of which seven attempts were successful. Therefore, counting both first and second attempts, the success rate was 74.4%. A strong negative correlation existed between anticoagulation status and success, with a 70% failure rate in patients with anticoagulated blood. Smaller pseudoaneurysm size was strongly correlated with success. Of the 83 failed cases, 49 ultimately underwent surgical repair. Eleven complications (3.6%) occurred, including three patients with rupture during compression. No deaths occurred as a result of compression repair. We conclude that sonographically guided pseudoaneurysm compression repair is an effective alternative to surgical repair, though nearly one third of compression attempts will fail and most of those patients will ultimately require surgery. The procedure is less effective when the patient's blood is anticoagulated and when the pseudoaneurysm is large. The procedure carries an overall complication rate of 3.6% and a risk for rupture of 1%.

Duplex-directed thrombin injection as a method to treat femoral artery pseudoaneurysms

Wixon, Christopher L. MDa, *; Philpott, Jonathan M. MDa; Bogey, William M. Jr MD, FACSa; Powell, Steven C. MD, FACSa Author Information

Ultrasound-guided compression of femoral pseudoaneurysm: an audit of practice

Objective. To audit the practice of ultrasound-guided compression of femoral pseudoaneurysm in a specialist cardiac hospital. Background. Femoral pseudoaneurysm is an important complication of invasive cardiac procedures. This may require surgical repair but more recently ultrasound-guided compression for ablating pseudoaneurysms has been described. We investigated the success of such a procedure. Methods and Results. In a 26-month period, 56 patients were referred for ultrasound scanning to exclude the formation of a femoral pseudoaneurysm following transfemoral cardiac procedures. During this period, 5756 diagnostic cardiac catherisations and 1165 coronary angioplasties were performed in our hospital (total of 6921 procedures). Of the 56 patients, 20 patients (0.3% of 6921) were found to have a pseudoaneurysm. Ultrasound-guided compression was attempted in 11 patients and was successful in 7 patients (64%). Of the patients who had failed ultrasound-guided compression, 2 proceeded to surgical closure and 2 were treated conservatively with compression stockings to facilitate thrombosis of the pseudoaneurysm. Of those who did not have an attempted ultrasound-guided compression of the pseudoaneurysm ( n=9), a conservative approach consisting of resting the leg was adopted to facilitate spontaneous thrombosis of the pseudoaneurysm; repeat ultrasound scanning was needed for follow-up and 1 patient required surgical closure in this group. Conclusions. In patients with a femoral pseudoaneurysm following an invasive cardiac procedure, ultrasound-guided compression may be useful as an immediate step to ablate the pseudoaneurysm. This avoids either prolonged leg rest and repeated ultrasound scanning or surgical intervention. However, ultrasound-guided compression is not always successful; in these patients, a period of conservative management with repeat ultrasound scanning is appropriate to allow for the possible spontaneous thrombosis of the pseudoaneurysm. Surgical closure is needed in those patients whose pseudoaneurysm is enlarging, painful or remain patent.

Ultrasound-guided pseudoaneurysm compression: Efficacy after coronary stenting and angioplasty

Purpose: Ultrasound-guided compression of femoral pseudoaneurysms has often obviated the need for open operative repair. Increasing use of percutaneous interventional cardiac procedures has created pseudoaneurysms with a large-caliber arterial defect, often in patients who are placed immediately on anticoagulation therapy. This report describes the prospectively collected information from our vascular laboratory regarding ultrasound-guided compression of these pseudoaneurysms after cardiac procedures, both interventional and diagnostic. Methods: Since March 1994 prospective data collection for patients who have undergone pseudoaneurysm compression in our vascular laboratory has recorded information including cardiac procedure, size of catheter or sheath, coagulation parameters, pseudoaneurysm size and location, and time to compression. Forty-one patients underwent attempted ultrasound-guided pseudoaneurysm compression after cardiac procedures: 19 after cardiac catheterization alone, seven after angioplasty, one after atherectomy, two after insertion and subsequent removal of an intraaortic balloon pump, and 12 after coronary stenting. Results: Compression was successful overall in 88% of the patients (36 of 41). Successful compression of the pseudoaneurysm was seen in 95% after catheterization alone, 100% after angioplasty, 100% after atherectomy, and 100% after intraaortic balloon pumping, as compared with 67% after stenting (eight of 12 vs 28 of 29; p = 0.02). A sheath size of 9F or greater was a significant factor in predicting unsuccessful compression (three of eight vs two of 33; p = 0.04). Abnormal coagulation parameters were present in 20 of the 41 patients and was not significantly different in patients who were successfully or unsuccessfully treated (four of five vs 16 of 36; p = 0.40). Conclusions: Pseudoaneurysms after cardiac procedures and interventions can often be successfully compressed with an ultrasound-guided technique. The presence of abnormal coagulation parameters was not identified as a risk factor for compression failure and should not dissuade attempted compression. Stent placement was more likely to result in unsuccessful compression, and this appeared to be a result of the larger size of the arterial defect. Even in this setting, compression achieved obliteration of the pseudoaneurysm in more than half of the patients. (J Vasc Surg;97;26;913-8.)

Technical report: An alternative mechanical technique of pseudoaneurysm compression therapy

Graded manual compression therapy under ultrasound guidance has become the standard first line treatment of post-catheterization femoral pseudoaneurysms. Although effective, this treatment is often poorly tolerated by both patient and operator. We describe a new mechanical technique which has proven successful in our department, and is well tolerated by both patients and staff.

Ultrasound-guided compression closure of postcatheterization pseudoaneurysms during concurrent anticoagulation: A review of seventy-seven patients

Data from our institution and elsewhere have demonstrated that ultrasound-guided compression closure (UGCC) is an effective method of treating postcatheterization pseudoaneurysms. Whereas patients receiving anticoagulation do not have as high a success rate as those not receiving anticoagulants, there have been no large series evaluating the factors associated with success or failure in patients receiving anticoagulation. The purpose of this study is to determine whether uninterrupted anticoagulation interferes with successful UGCC of pseudoaneurysms and to identify factors associated with success or failure. From May 1991 to September 1994, 238 cases of attempted UGCC of pseudoaneurysms were performed in our vascular laboratory. Only patients who received uninterrupted heparin, warfarin, or both at the time of pseudoaneurysm compression were eligible for inclusion into the study. Seventy-seven patients were identified who met the study criteria. Successful pseudoaneurysm compression was obtained in 56 (73%) patients, whereas 21 (27%) patients had a failed UGCC. In the successfully treated group, seven (12.5%) required between two to three compression attempts to induce sustained thrombosis. There was no statistical difference in age, sex, sheath size, days after procedure, location of pseudoaneurysm, or number of chambers in the pseudoaneurysm between those patients who had a successful repair and those who did not. If the pseudoaneurysm was less than 4 cm in diameter, 51 of 65 patients (78%) had a successful repair compared with 5 of 12 patients (42%) with a pseudoaneurysm of 4 cm or greater (p = 0.013). There was no statistical difference between success and failure in patients receiving warfarin alone (3.73 mean international normalized ratio, 72% success rate), heparin alone (mean activated partial thromboplastin time of 63 seconds, 92% success rate), or heparin and warfarin (mean activated partial thromboplastin time of 70 seconds, mean international normalized ratio of 4, success rate of 67%). No arterial or venous thrombosis occurred during pseudoaneurysm compression. Successful UGCC of pseudoaneurysms occurred in a large percentage of patients receiving full-dose, uninterrupted anticoagulation. The only factor influencing success was the size of the pseudoaneurysm.

Nonsurgical closure of femoral pseudoaneurysms complicating cardiac catheterization and percutaneous transluminal coronary angioplasty

Objectives. This study was performed to describe the initial experience and follow-up of ultrasound-guided compression of pseudoaneurysms in patients receiving systemic anticoagulant or antiplatelet therapy, or both, after recent cardiac catheterization or percutaneous transluminal coronary angioplasty.Background. Femoral artery pseudoaneurysm formation after an interventional procedure is becoming more common as larger caliber catheters and prolonged anticoagulant and antiplatelet therapy are being used. Traditional treatment of this complication has been surgical repair. This study describes a new method of closing femoral pseudoaneurysms by using external compression guided by Doppler color flow imaging.Methods. Fifteen patients, 3 undergoing cardiac catheterization and 12 undergoing coronary angioplasty, developed an expansile groin mass at the vascular access site diagnosed as a femoral artery pseudoaneurysm by Doppler ultrasound. Seven of the patients had undergone coronary stenting and were receiving postprocedural anticoagulant therapy. These patients underwent progressive graded mechanical (C-clamp) external compression guided by ultrasound. The mechanical compression was titrated to obliterate the vascular tracts to these aneurysms and maintain adequate flow in the femoral artery.Results. After an average compression time of 30 min (range 10 to 120), these tracts remained closed. Follow-up ultrasound examination at 24 h or later confirmed continued closure in all. Conclusions. This study suggests that nonsurgical closure of femoral pseudoaneurysms is feasible. This technique may be valuable in managing vascular access-related complications after diagnostic and interventional procedures, even in patients requiring prolonged anticoagulant therapy.