Treatment Of Femoral Artery Pseudoaneurysm Research Articles

Evaluation of the Pressure and Wall Shear Stress on the Aneurysm Wall According to the Growth Position of a Femoral Artery Pseudoaneurysm by Numerical Analysis

In this study, the effect of the angle change between the neck region and the aneurysm region of a femoral artery pseudoaneurysm (β) on the pressure and shear stresses on the aneurysm wall was investigated with the computational fluid dynamics (CFD) method. The CFD method is an important tool in observing the direction and velocity of blood flow. With the numerical analysis results, it was aimed to evaluate the growth rate and rupture risk of the aneurysm. Findings obtained as a result of the change of β angle between 0˚ and 15˚ for a certain value of the angle between the femoral artery and the aneurysm neck region (α=45˚) were presented in graphs containing velocity vectors inside the aneurysm, pressure, and wall shear stresses on the aneurysm wall. When all the analysis results were evaluated, it was understood that for a pseudoaneurysm formed in the femoral artery, the highest growth rate and risk of rupture could occur at the β =0˚ angle. It was predicted that the obtained findings will be beneficial in determining the treatment method and time in the treatment of femoral artery pseudoaneurysm.

Ultrasound-guided thrombin injection for treatment of femoral artery pseudoaneurysm with concomitant AV-fistula - a retrospective single centre experience.

Increasing volume of complex percutaneous endovascular procedures in highly anticoagulated patients generate a not negligible percentage of femoral pseudoaneurysms (PSA) with concomitant arteriovenous fistulas (AVF). While ultrasound-guided thrombin injection (UGTI) is the therapy of choice for PSA, concomitant AVF is regarded as a contraindication for UGTI, as venous thromboembolism is feared. In this retrospective, register-based cohort study, we report on and evaluate the use of UGTI for the treatment of PSA with AFV. All patients (n = 523), who underwent UGTI for femoral PSA at the German Heart Centre Munich from January 2011 until January 2018, were retrospectively reviewed for the presence of a concomitant AVF and outcomes were recorded. Forty femoral PSA/AVFs treated by UGTI were identified. The mean enddiastolic arterial-flow-velocity above the AVF, an estimate of the AVF size, was 14.61 ± 1.7 cm/sec. The Majority of patients exhibited flow-velocities < 25 cm/sec (n = 31; 77.5 %) and were on either uninterrupted oral anticoagulation (n = 32; 80 %) or dual antiplatelet therapy (n = 8). Twenty-eight (70 %) PSA/AVFs could be successfully closed by UGTI. In eight multicompartmental PSAs, partial obliteration necessitated combined treatment with manual compression, while one partial occlusion was treated by observation. There were three failures, of which two underwent covered-stent-graft-implantation and one surgical repair. One DVT (2.5 %) occurred two days after UGTI in the by far largest AVF (60 cm/sec) included in the study. Besides two late PSA recurrences treated by surgery, no other complications were observed. AVF persisted in 65 %, all of them asymptomatic. The mean follow-up was 6 ± 15.5 months. UGTI appears to be a treatment option in femoral PSA/AVF, at least under oral anticoagulation in small fistulas with enddiastolic arterial-flow-velocities ≤ 25 cm/sec. However, caution is necessary in larger AVFs, which should remain a contraindication for UGTI.

A novel minimally invasive method of successful tissue glue injection in patients with iatrogenic pseudoaneurysm.

To investigate the efficacy and safety of ultrasound-guided tissue glue injection for the treatment of iatrogenic femoral artery pseudoaneurysm. The study comprised of nine patients with unsuccessful ultrasound-guided thrombin injection and one patient with rapidly progressing anemia. All patients had undergone recanalization procedures at least twice, including two subjects with a very rapidly enlarging pseudoaneurysm lobe or significant anemia. Tissue glue at a dose of 0.9 ± 0.53 ml was injected under ultrasound guidance in each patient. Complete embolization was achieved in all patients. Follow-up ultrasound performed 24 h later as well as at 1 and 2 weeks did not show recurrent reperfusion of the pseudoaneurysm. Embolization of iatrogenic pseudoaneurysm using tissue glue seems to be an effective technique for the treatment of this complication. It might be considered as a treatment option in case of unsuccessful primary repair by means of thrombin injection orhemorrhagic shock due to rapid aneurysm progression. Advances in knowledge: Patients with multiple recanalizations and those with dynamically enlarging pseudoaneurysm or rapidly progressing anemia are at risk of life-threatening bleeding. An ultrasound-guided tissue glue injection, a novel method for the treatment of femoral artery pseudoaneurysm, might be considered as a treatment option especially in case of primary thrombin injection failure.

Combining Percutaneous Ultrasound-Guided Hematoma Aspiration and Compression Repair to Treat Femoral Artery Pseudoaneurysm after Cardiac Catheterization.

This study aimed to prospectively evaluate the safety and efficacy of a new developed method that uses percutaneous ultrasound-guided hematoma aspiration followed by targeted localized manual compression for treatment of femoral artery pseudoaneurysm after cardiac catheterization, which obviates thrombin use, surgery, and long-time compression.From January 2007 to July 2014, 32 patients (17 women; mean age, 55.3 ± 11.5 years) out of 8,725 consecutive cases undergoing cardiac catheterization via femoral access developed one pseudoaneurysm each ranging in size from 21 × 11 mm to 72 × 39 mm. Under ultrasound guidance, blood within the pseudoaneurysm was aspirated percutaneously using an 18-gauge needle, while the pseudoaneurysm neck and a nearby site over the pseudoaneurysm were manually compressed for 15 min. All patients underwent repeat ultrasound examination 24 hours later.Of the 32 pseudoaneurysms, 31 were successfully occluded, and 1 recurred in a patient with coexisting arteriovenous fistula, yielding an overall success rate of 96.9% (31/32). No further recurrence or procedure related complications were observed. The treatment approach is unlike open surgical repair with hematoma evacuation and arterial defect suturing, in that it entails hematoma aspiration and feeding flow blockage at the pseudoaneurismal neck.In this preliminary experience, combining percutaneous ultrasound-guided hematoma aspiration and manual compression appears safe and effective in treating femoral artery pseudoaneurysms after catheterization and avoids thrombin use, long-time compression, and surgery.

Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese.

Ultrasound-guided thrombin injection (UGTI) is a well-established practice for the treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure. We aim to evaluate the safety and efficacy of UGTI to treat femoral artery pseudoaneurysm in the morbidly obese. This is a retrospective cohort study in which all patients who underwent UGTI at The Ohio State University Ross Heart Hospital from 2009 to 2014 were analyzed for patient characteristics and stratified by body mass index (BMI). Patients with BMI ≥ 35 were considered morbidly obese and were compared to patients with a BMI < 35. Outcome was failed treatment resulting in residual pseudoaneurysm. Our cohort consisted of 54 patients who underwent thrombin injection. There were 41 nonmorbidly obese and 13 morbidly obese patients. Mean age was 64.5 years. The cohort was 44.4% male. There were 6 failures, of which 1 underwent successful repeat injection and 5 underwent open surgical repair. There was no statistically significant difference in failure between nonmorbidly obese and morbidly obese patients (9.8% vs 15.4%, P = .45). There were no embolic/thrombotic complications. Ultrasound-guided thrombin injection is a safe and effective therapy in the morbidly obese for the treatment of femoral artery pseudoaneurysm. In the hands of experienced sonographers and surgeons with adequate visualization of the pseudoaneurysm sac, UGTI should remain a standard therapy in the morbidly obese.

Common Femoral Artery Pseudoaneurysm Associated with Arteriovenous Fistula

Background Thrombin injection (TI) is a common modality for the treatment of femoral artery pseudoaneurysm (PSA) of arterial access sites. It has decreased the need for open repair in this cohort of patients who often have increased surgical risk. Deep venous thrombosis and venous thromboembolism (VTE) have been reported after TI for PSA in the presence of an arteriovenous fistula (AVF). A combined treatment modality using ultrasound-guided TI with concomitant balloon occlusion of the AVF is described. Patient A high cardiac risk patient presented with a large pulsatile right groin mass after cardiac catheterization. Ultrasound identified a PSA arising from the right common femoral artery. The anatomy was suitable for TI; however, a large AVF also was present. The patient was a poor surgical candidate because of cardiac morbidity and body habitus. Methods The patient was taken to the hybrid vascular operative suite. Conscious sedation was administered. Venous access was obtained via the right internal jugular vein. Venography identified the AVF in the right common femoral vein. Thrombin was injected into the right groin PSA using direct ultrasound visualization. Simultaneous fluoroscopic-guided balloon inflation was used to occlude the common femoral vein and prevent flow through the AVF. Postinjection venography and Doppler examination of the femoral vessels were performed. Results The PSA was successfully occluded. There was no identifiable venous thrombus. Doppler examination also showed resolution of the AVF. There were no clinical signs or symptoms of pulmonary embolism. Conclusion TI of femoral artery PSA associated with AVF has increased risk of VTE. Concomitant venous occlusion during TI of a PSA may decrease the risk of VTE in the setting of a large AVF. This has the potential to expand the indications for TI in the high-risk surgical patient.

Comparison Between Ultrasound-Guided Compression and Para-Aneurysmal Saline Injection in the Treatment of Postcatheterization Femoral Artery Pseudoaneurysms

Management of postcatheterization femoral artery pseudoaneurysm (FAP) is problematic. Ultrasound-guided compression (UGC) is painful and cumbersome. Thrombin injection is costly and may cause thromboembolism. Ultrasound-guided para-aneurysmal saline injection (PASI) has been described but was never compared against other treatment methods of FAP. We aimed at comparing the success rate and complications of PASI versus UGC. We randomly assigned 80 patients with postcatheterization FAPs to either UGC (40 patients) or PASI (40 patients). We compared the 2 procedures regarding successful obliteration of the FAP, incidence of vasovagal attacks, procedure time, discontinuation of antiplatelet and/or anticoagulants, and the Doppler waveform in the ipsilateral pedal arteries at the end of the procedure. There was no significant difference between patients in both groups regarding clinical and vascular duplex data. The mean durations of UGC and PASI procedures were 58.14 ± 28.45 and 30.33 ± 8.56 minutes, respectively (p = 0.045). Vasovagal attacks were reported in 10 (25%) and 2 patients (5%) treated with UGC and PASI, respectively (p = 0.05). All patients in both groups had triphasic Doppler waveform in the infrapopliteal arteries before and after the procedure. The primary and final success rates were 75%, 92.5%, 87.5%, and 95% for UGC and PASI, respectively (p = 0.43). In successfully treated patients, there was no reperfusion of the FAP in the follow-up studies (days 1 and 7) in both groups. In conclusion, ultrasound-guided PASI is an effective method for the treatment of FAP. Compared with UGC, PASI is faster, less likely to cause vasovagal reactions, and can be more convenient to patients and physicians.

Injeção de trombina guiada por ultrassom no tratamento de pseudoaneurisma da artéria femoral após procedimento percutâneo em pacientes com síndrome coronária aguda

INTRODUÇÃO: A injeção de trombina guiada por ultrassom (IT) é uma opção para o tratamento de pseudoaneurisma da artéria femoral. No entanto, o resultado dessa técnica em pacientes com síndrome coronária aguda (SCA) pode ser comprometido pelo uso de medicações antitrombóticas. Também, o extravasamento de trombina para a circulação sistêmica pode causar aumento de eventos tromboembólicos. MÉTODOS: Foram selecionados todos os pacientes admitidos com SCA que apresentaram pseudoaneurisma da artéria femoral após procedimento percutâneo, tratados com IT, entre janeiro de 2007 e julho de 2011. Características clínicas e laboratoriais, resultado do tratamento e complicações foram avaliados. RESULTADOS: Analisamos 23 pacientes, com idade de 67,1 ± 14,2 anos, 60,9% eram do sexo feminino, com índice de massa corporal de 28,4 ± 4,7 kg/m², e 52,2% eram diabéticos. À apresentação, 87% tinham SCA sem supradesnivelamento do segmento ST e o restante, infarto do miocárdio com supradesnivelamento do segmento ST. Entre os pacientes avaliados, 70% foram submetidos a intervenção coronária percutânea. Todos os pacientes estavam em uso de ácido acetilsalicílico, 78,3% utilizaram inibidores da P2Y12 e 39,1%, inibidores da glicoproteína IIb/IIIa. A IT foi eficaz em ocluir o pseudoaneurisma em 100% dos casos (96,7% após a primeira injeção), sem embolia distal, infecção local ou necessidade de correção cirúrgica em nenhum caso. Não houve infarto, acidente vascular cerebral ou revascularização não-programada. Houve um óbito por choque cardiogênico, 22 dias após a IT, no segundo dia após cirurgia eletiva de revascularização miocárdica. CONCLUSÕES: O tratamento de pseudoaneurisma da artéria femoral com IT é um método seguro e eficaz em pacientes com SCA.

Ultrasound-Guided Thrombin Injection in the Treatment of Femoral Artery Pseudoaneurysm after Percutaneous Procedures in Patients with Acute Coronary Syndrome

Ultrasound-guided thrombin injection (TI) is an option for the treatment of femoral artery pseudoaneurysm. Nevertheless, the result of this technique in patients with acute coronary syndrome (ACS) may be compromised by the use of antithrombotic drugs. In addition, thrombin extravasation to systemic circulation could potentially cause an increase in thromboembolic events. Patients admitted with ACS who developed femoral artery pseudoaneurysm after a percutaneous procedure and treated by TI between January 2007 and July 2011 were included. Clinical and laboratory characteristics, treatment results and complications were evaluated. We evaluated 23 patients with mean age of 67.1 ± 14.2 years, 60.9% were women, with body mass index of 28.4 ± 4.7 kg/m 2 and 52.2% were diabetics. At presentation, 87% had non-ST elevation ACS and the remaining had ST elevation myocardial infarction. Of the evaluated patients, 70% were submitted to percutaneous coronary intervention. All patients were receiving aspirin, 78.3% used P2Y12 inhibitors and 39.1% used glycoprotein IIb/IIIa inhibitors. TI was successful in occluding the pseudoaneurysm in 100% of cases (96.7% after the first injection), without distal embolization, local infection or need of surgical correction. There were no cases of myocardial infarction, stroke or unscheduled revascularization. There was one death due to cardiogenic shock 22 days after TI, on the second post-operative day after an elective coronary artery bypass graft surgery. Treatment of femoral artery pseudoaneurysm by TI is a safe and effective procedure in patients with ACS. Injeção de Trombina Guiada por Ultrassom no Tratamento de Pseudoaneurisma da Artéria Femoral após Procedimento Percutâneo em Pacientes com Síndrome Coronária Aguda A injeção de trombina guiada por ultrassom (IT) é uma opção para o tratamento de pseudoaneurisma da artéria femoral. No entanto, o resultado dessa técnica em pacientes com síndrome coronária aguda (SCA) pode ser comprometido pelo uso de medicações antitrombóticas. Também, o extravasamento de trombina para a circulação sistêmica pode causar aumento de eventos tromboembólicos. Foram selecionados todos os pacientes admitidos com SCA que apresentaram pseudoaneurisma da artéria femoral após procedimento percutâneo, tratados com IT, entre janeiro de 2007 e julho de 2011. Características clínicas e laboratoriais, resultado do tratamento e complicações foram avaliados. Analisamos 23 pacientes, com idade de 67,1 ± 14,2 anos, 60,9% eram do sexo feminino, com índice de massa corporal de 28,4 ± 4,7 kg/m 2 , e 52,2% eram diabéticos. À apresentação, 87% tinham SCA sem supradesnivelamento do segmento ST e o restante, infarto do miocárdio com supradesnivelamento do segmento ST. Entre os pacientes avaliados, 70% foram submetidos a intervenção coronária percutânea. Todos os pacientes estavam em uso de ácido acetilsalicílico, 78,3% utilizaram inibidores da P2Y 12 e 39,1%, inibidores da glicoproteína IIb/IIIa. A IT foi eficaz em ocluir o pseudoaneurisma em 100% dos casos (96,7% após a primeira injeção), sem embolia distal, infecção local ou necessidade de correção cirúrgica em nenhum caso. Não houve infarto, acidente vascular cerebral ou revascularização não-programada. Houve um óbito por choque cardiogênico, 22 dias após a IT, no segundo dia após cirurgia eletiva de revascularização miocárdica. O tratamento de pseudoaneurisma da artéria femoral com IT é um método seguro e eficaz em pacientes com SCA.

Ultrasound-Guided Thrombin Injection in the Treatment of Femoral Artery Pseudoaneurysm after Percutaneous Procedures in Patients with Acute Coronary Syndrome

Ultrasound-guided thrombin injection (TI) is an option for the treatment of femoral artery pseudoaneurysm. Nevertheless, the result of this technique in patients with acute coronary syndrome (ACS) may be compromised by the use of antithrombotic drugs. In addition, thrombin extravasation to systemic circulation could potentially cause an increase in thromboembolic events. Patients admitted with ACS who developed femoral artery pseudoaneurysm after a percutaneous procedure and treated by TI between January 2007 and July 2011 were included. Clinical and laboratory characteristics, treatment results and complications were evaluated. We evaluated 23 patients with mean age of 67.1 ± 14.2 years, 60.9% were women, with body mass index of 28.4 ± 4.7 kg/m2 and 52.2% were diabetics. At presentation, 87% had non-ST elevation ACS and the remaining had ST elevation myocardial infarction. Of the evaluated patients, 70% were submitted to percutaneous coronary intervention. All patients were receiving aspirin, 78.3% used P2Y12 inhibitors and 39.1% used glycoprotein IIb/IIIa inhibitors. TI was successful in occluding the pseudoaneurysm in 100% of cases (96.7% after the first injection), without distal embolization, local infection or need of surgical correction. There were no cases of myocardial infarction, stroke or unscheduled revascularization. There was one death due to cardiogenic shock 22 days after TI, on the second post-operative day after an elective coronary artery bypass graft surgery. Treatment of femoral artery pseudoaneurysm by TI is a safe and effective procedure in patients with ACS. Injeção de Trombina Guiada por Ultrassom no Tratamento de Pseudoaneurisma da Artéria Femoral após Procedimento Percutâneo em Pacientes com Síndrome Coronária Aguda A injeção de trombina guiada por ultrassom (IT) é uma opção para o tratamento de pseudoaneurisma da artéria femoral. No entanto, o resultado dessa técnica em pacientes com síndrome coronária aguda (SCA) pode ser comprometido pelo uso de medicações antitrombóticas. Também, o extravasamento de trombina para a circulação sistêmica pode causar aumento de eventos tromboembólicos. Foram selecionados todos os pacientes admitidos com SCA que apresentaram pseudoaneurisma da artéria femoral após procedimento percutâneo, tratados com IT, entre janeiro de 2007 e julho de 2011. Características clínicas e laboratoriais, resultado do tratamento e complicações foram avaliados. Analisamos 23 pacientes, com idade de 67,1 ± 14,2 anos, 60,9% eram do sexo feminino, com índice de massa corporal de 28,4 ± 4,7 kg/m2, e 52,2% eram diabéticos. À apresentação, 87% tinham SCA sem supradesnivelamento do segmento ST e o restante, infarto do miocárdio com supradesnivelamento do segmento ST. Entre os pacientes avaliados, 70% foram submetidos a intervenção coronária percutânea. Todos os pacientes estavam em uso de ácido acetilsalicílico, 78,3% utilizaram inibidores da P2Y12 e 39,1%, inibidores da glicoproteína IIb/IIIa. A IT foi eficaz em ocluir o pseudoaneurisma em 100% dos casos (96,7% após a primeira injeção), sem embolia distal, infecção local ou necessidade de correção cirúrgica em nenhum caso. Não houve infarto, acidente vascular cerebral ou revascularização não-programada. Houve um óbito por choque cardiogênico, 22 dias após a IT, no segundo dia após cirurgia eletiva de revascularização miocárdica. O tratamento de pseudoaneurisma da artéria femoral com IT é um método seguro e eficaz em pacientes com SCA.

Sonographically Guided Hand Kneading and Compression for Treatment of Femoral Artery Pseudoaneurysms

The purpose of this study was to evaluate the effectiveness of sonographically guided hand kneading and compression for the treatment of femoral artery pseudoaneurysms after percutaneous intervention. Twenty-four patients who had post-percutaneous intervention femoral artery pseudoaneurysms treated with sonographically guided compression from 2001 to 2004 and 2008 to 2009 were compared with 25 patients who had postintervention pseudoaneurysms treated with sonographically guided hand kneading and compression from 2005 to 2009. All 25 patients (100%) treated with 1-stage sonographically guided hand kneading and compression had pseudoaneurysm occlusion; the median treatment time was 10 minutes. Twenty-two of the 24 patients (91.7%) treated with conventional sonographically guided compression had pseudoaneurysm occlusion. One-stage compression was successful in 10 patients; 9 and 3 patients had pseudoaneurysm occlusion after 2 and 3 compression treatments, respectively. Two other patients who underwent compression treatment 3 and 4 times did not have pseudoaneurysm occlusion and required surgery. The median treatment time for sonographically guided compression was 30 minutes. The treatment time was significantly shorter for the hand-kneading and compression technique (P < .001), and significantly fewer procedures were needed (P < .001). Sonographically guided hand kneading and compression is as effective as sonographically guided compression alone for pseudoaneurysm occlusion after femoral artery percutaneous intervention and requires significantly less time to perform.

Ultrasound‐guided thrombin–gelatin injection is effective for the treatment of iatrogenic femoral artery pseudoaneurysms: Initial results

To describe the technique of ultrasound (US)-guided percutaneous thrombin-gelatin injection for the treatment of femoral artery pseudoaneurysms (FAPs). FAPs are a possible complication from percutaneous angiographic procedures. US-guided thrombin injection is currently the preferential therapeutic option, limited by a low risk of potentially catastrophic femoral thrombosis; transluminal injection of collagen is another effective and safe option, although a more invasive one; surgical repair is associated with significant comorbidity. We hypothesized that US-guided combined thrombin and gelatin injection (UG-TGI) would also be effective while minimizing the risk of limb thrombosis. Review of the results, complications and length of hospital admission after the injection into the FAP sac of combined human-origin thrombin and bovine-origin gelatin matrix (FloSeal(®), Baxter), under direct US-guidance. We treated 13 patients (mean age 64 ± 9.46 years, 38% male), who developed a FAP following a percutaneous procedure: isolated coronariography in five (38%); angioplasty in four (31%); other cardiac procedures in four (31%). Immediate success was obtained in all (100%) patients, assessed by US; no allergic reactions, local infection, or embolic events occurred on 30-day follow-up. Median (interquartile range) admission time after the UG-TGI was 2 days (1.25-2.0); median time of total admission was 8 days (6.5-16.25). In this small study, UG-TGI for the treatment of FAP was feasible and had short-term effectiveness, without a learning curve effect. Despite the need for further experience, a trial comparing different therapies for FAP should include this procedure.

Fatal Complication after Thrombin Injection for Post-Catheterization Femoral Pseudoaneurysm

Femoral artery pseudoaneurysm (FAP) is one of the most common vascular complications after cardiac and peripheral angiographic procedures. Ultrasound-guided thrombin injection is the standard procedure for the treatment of FAP. Complications such as thrombotic events with leg ischemia after thrombin leakage into the femoral artery or immunogenic consequences are rare. Our experience indicates the need for caution when treating FAP, as severe complications can occur after thrombin injection in a femoral pseudoaneurysm, leading to a fatal event.

Postprocedural management of patients after transcatheter aortic valve implantation procedure with self‐expanding bioprosthesis

Transcatheter aortic valve implantation (TAVI) carries higher risk of post-procedural adverse events than conventional percutaneous cardiovascular interventions. We report our experience about postoperative management protocol adopted in our Division. One hundred and ten patients underwent TAVI and 108 were transferred to the cardiac intensive care unit (CICU) after procedure. During the first 48 hours, vital parameters were monitored continuously. Close attention was given to rhythm and atrio-ventricular conduction disturbances, systemic blood pressure, fluid balance and vascular accesses. The most common complications were renal impairment (21.3%), femoral artery pseudo-aneurysms (FAP) (11%), new complete atrioventricular block (20.3 %), cerebral vascular accident (4.5%) and cardiac perforation due to temporary pacemaker lead (1.8%). Ultrasound-guided compression repair was considered the first line treatment for FAP, but in 6 cases surgical treatment was immediately performed due to the rapid expansion of FAP. Complete atrio-ventricular block occurred in 22 patients (20.3 %) within the first 24 hours after TAVI and a permanent pacemaker was implanted in 21 patients (19.1%). Acute kidney injury occurred in 18 patients (35%) with pre-procedural chronic renal failure and in 5 patients (9%) without preoperative renal dysfunction. After TAVI, cardiovascular complications are common and therefore accurate standardized management of patients in CICU during the first 48 hours is mandatory to early detect and manage complications and to decrease the rate of adverse events and the length of in-hospital stay. © 2010 Wiley-Liss, Inc.

A Case of Successful Treatment of Femoral Artery Pseudoaneurysm Using Thrombin Injection

A seventy years-old female complained of a pulsating mass in right inguinal area after elective percutaneous coronary intervention. The size of mass was about 3 cm. Femoral artery US was performed. A 3.2 cm×1.5 cm×15 cm sized pseudoaneurysm which was surrounded by some hematoma was identified. Doppler revealed high velocity ISSN 1975-4612 Copyright c 2008 Korean Society of Echocardiography www.kse-jcu.org

Endovascular Treatment of Femoral Artery Pseudoaneurysm in a HIV Positive Patient – A Case Report

Arterial pseudoaneurysm formation has been increasingly reported in HIV positive patients and generally surgery is indicated. We paced an endovascular stent in a femoral artery pseudoaneurysm of a 30-year-old HIV-positive male. Early results of this procedure are good. We believe that implantation of an endovascular stent graft can result in a shorter hospital stay and can significantly reduce morbidity for HIV-positive patients with pseudoaneurysms. Endovascular Treatment of Femoral Artery Pseudoaneurysm in a HIV Positive Patient – A Case ReportEJVES ExtraVol. 13Issue 6PreviewArterial pseudoaneurysm formation has been increasingly reported in HIV positive patients and generally surgery is indicated. We paced an endovascular stent in a femoral artery pseudoaneurysm of a 30-year-old HIV-positive male. Early results of this procedure are good. We believe that implantation of an endovascular stent graft can result in a shorter hospital stay and can significantly reduce morbidity for HIV-positive patients with pseudoaneurysms. Full-Text PDF Open Access

Delayed Femoral Vein Thrombosis after Ultrasound-guided Thrombin Injection of a Postcatheterization Pseudoaneurysm

Ultrasound-guided thrombin injection is a highly effective therapy for postcatheterization pseudoaneurysm. Despite a very low complication rate, a number of severe arterial thrombotic events have been reported. We present an unusual case of acute femoral vein thrombosis occurring several hours after successful treatment of femoral artery pseudoaneurysm by ultrasound-guided thrombin injection. Pathophysiologic mechanisms are discussed. This case highlights the potential hazards of instilling such a powerful thrombogenic substance in the immediate vicinity of other vascular structures.

Treatment of femoral artery pseudoaneurysms using ultrasound-guided thrombin injection

Femoral artery pseudoaneurysms, a complication of femoral arterial puncture, is increasing in frequency with the proliferation of endovacular interventions. Pseudoaneurysms have historically been treated by open surgical repair, and more recently by ultrasound-guided compression. Ultrasound-guided compression is painful, and has a relatively low success rate of 51% to 73%. Since 1991, ultrasound-guided thrombin injection has become a treatment option. During injection of thrombin into a pseudoaneurysm, immediate thrombosis can be demonstrated within seconds. The entire procedure can be accomplished within 5 minutes, is simple to learn, and can be performed safely on an outpatient basis. © 2003 Elsevier Inc. All rights reserved.

Treatment of Femoral Artery Pseudoaneurysms with Percutaneous Thrombin Injection

The objective of this study was to prospectively evaluate the efficacy of ultrasound-guided thrombin injection for the treatment of post-catheterization femoral artery pseudoaneurysms. Between August 1, 1998 and August 31, 1999, 38 patients underwent ultrasound-guided injection of thrombin into 39 femoral false aneurysms. Peripheral pulses and ankle/brachial indices were assessed before and after the injection. Patients were followed with a control duplex scan within 4 weeks. The good results from this study showed that ultrasound-guided thrombin injection is an effective method for the treatment of post-catheterization false aneurysms. In a minority of patients, signs consistent with arterial embolization or vasospasm were identified.

Ultrasound guided compression of femoral artery pseudoaneurysms: Modified digital technique shortens repair time

Ultrasound guided graded manual compression therapy has become the standard treatment for femoral artery pseudoaneurysms. It entails blunt ultrasound probe compression on the neck of the aneurysm for considerable periods of time. We describe a technique using digital compression after ultrasound localization of the neck enabling easier and more effective targeting of the manual pressure. Preliminary experience in six consecutive cases has shown it to be effective, safe and to have relatively short compression times. Ultrasound guided digital compression has the potential to deliver more effective pressure making this often onerous procedure less demanding on both patient and operator.