Treatment Of Femoral Pseudoaneurysms Research Articles

SP5.2.4 Stent-graft endobypass for non-infected femoral pseudoaneurysms in high-risk surgical patients: acceptable short-to-mid-term results

Abstract Aim Stent-grafts are finding a place in the treatment of femoral pseudoaneurysms (FpsAs), having been described in the treatment of infected pseudoaneurysms. We present the results of endovascular treatment of non-infected FpsAs using stent-grafts. Methods Case series of patients who underwent stent-graft coverage of FpsAs from January 2016 to December 2020. Stent-graft fractures, occlusions and reinterventions, length of stay (LOS) and 30-day mortality were assessed. Results 11 patients (mean age 75±10.3 years, 7 males; all ASA 3 or 4) underwent stent-graft coverage of FpsAs. Original procedures linked to the formation of FpsA were iliofemoral bypass (n = 3), femorofemoral crossover (n = 3), percutaneous coronary interventions (n = 2), aortobifemoral bypass (n = 1), endovascular aneurysm repair (n = 1) and femoral endarterectomy (n = 1). 3 patients had previous open FpsA repair. Technical success of deployment was 100%. Stent-grafts used included Viabahn Endoprosthesis (WL Gore & Associates, Flagstaff USA; n = 8), Viabahn VBX (WL Gore & Associates; n = 1) and BeGraft (Bentley InnoMed GmbH, Hechingen, Germany; n = 2). All patients were maintained on either antiplatelets or anticoagulant. 10 patients were available for analysis (1 lost to follow-up); radiological follow-up included initial computed tomography angiography and later combined duplex ultrasonography/plain radiography. Median LOS was 4 days (IQR 4). 30-day mortality was 0%. Median survival was 12 months (IQR 17). There was one stent-graft occlusion requiring thrombectomy but no fractures were observed in this series. Conclusions This small series suggests that there may be a role for stent-grafts in treatment of FpsAs in carefully selected patients. Given lack of data on long-term outcomes, continued surveillance is recommended.

Femoral Pseudoaneurysm Treatment by Local Thrombin Injection

Objetivos. El objetivo de este estudio ha sido evaluar la seguridad y eficacia del cierre del pseudoaneurisma femoral iatrogenico mediante la inyeccion de trombina local guiada por ecografia Doppler. Metodos y resultados. Entre Marzo 2007 y Junio 2016 se incluyeron para tratamiento un total de 32 pacientes con inyeccion de trombina. La edad media fue 64,3±10,2 anos. La mayoria de los pseudoaneurismas estuvieron asociados a la realizacion de cateterismos coronarios diagnosticos o terapeuticos (59,3%). Siete pacientes habian recibido tratamiento anticoagulante y 21 doble antiagregacion plaquetaria. En todos los casos se intento previamente cierre por compresion manual. La media del diametro mayor de los pseudoaneurismas fue de 38 mm. Luego del tratamiento la trombosis inmediata del saco ocurrio en 28 pacientes (87,5%), mientras que 4 pacientes requirieron de una segunda inyeccion, determinando un exito del 96,8%. En un solo paciente este tratamiento no fue efectivo, con posterior conversion a reparacion quirurgica programada. La dosis media de trombina fue de 450 Unidades. Un unico paciente presento complicacion trombotica venosa que requirio terapia anticoagulante con buena evolucion clinica. Conclusion . El tratamiento del pseudoaneurisma con inyeccion local de trombina guiado con eco-Doppler es una alternativa terapeutica segura y eficaz para pacientes con pseudoaneurisma femoral refractarios a la compresion manual.

Treatment for femoral pseudoaneurysms.

Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, but sometimes definitive treatment is needed. Surgery has traditionally been considered the 'gold standard' treatment, although it is not without risk in patients with severe cardiovascular disease. Less invasive treatment options such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited. This is an update of a Cochrane review first published in 2006. To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as blind manual or mechanical compression, ultrasound-guided compression, or percutaneous thrombin injection. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9). Randomised controlled trials (RCTs) comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review. Four studies were included in the analyses comparing: manual compression versus ultrasound-guided compression; ultrasound-guided application of a mechanical device (FemoStop) versus blind application; and ultrasound-guided compression versus percutaneous thrombin injection (two studies). There were no studies with a surgical intervention arm. Data were extracted independently by both authors. Compression (manual or FemoStop) was effective in achieving pseudoaneurysm thrombosis although ultrasound-guided application failed to confer any benefit (risk ratio (RR) 0.96; 95% confidence interval (CI) 0.88 to 1.04).Percutaneous thrombin injection was more effective than a single session of ultrasound-guided compression in achieving primary pseudoaneurysm thrombosis within individual RCTs but merged data failed to show statistical significance (RR 2.81; 95% CI 0.44 to 18.13). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported apart from one deep vein thrombosis in the compression group. The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use compression (blind or ultrasound-guided) as first-line treatment, reserving thrombin injection for those in whom the compression procedure fails.

Percutaneous treatment of femoral pseudoaneurysms: comparison of fibrin sealant against thrombin

INTRODUCTION: Femoral pseudoaneurysms are a complication that occurs in connection with up to 8% of percutaneous procedures. Of the available treatments, ultrasound guided thrombin injection has a high success rate and is well-tolerated by patients. The combination of thrombin and fibrinogen known as fibrin sealant forms a stable clot and can be used to treat pseudoaneurysms, particularly those with complex anatomy and larger size. OBJECTIVE: To compare the results of treating femoral pseudoaneurysm in two ways: Group T was treated with thrombin alone and Group T+F was treated with fibrin sealant (thrombin+fibrinogen). METHODS: A retrospective analysis was conducted of femoral pseudoaneurysm cases treated between January 2005 and December 2012. RESULTS: Twenty-eight patients were treated, 21 with thrombin alone and seven with fibrin sealant. All patients in group T were treated successfully, but only four patients in group T+F were treated successfully (57.1% success rate in Group T+F, p<0.01). The three cases of failure in group T+F needed surgery and in one of these cases the complication was embolization to the femoral bifurcation. The pseudoaneurysms that were treated with fibrin sealant were larger (25 cm3 in Group T and 57.7 cm3 in Group T+F, p=0.02) and required larger volumes of thrombin (0.5 mL in Group T and 1.0 mL in Group T+F, p<0.01). There was one complication in Group T and two complications in Group T+F (p<0.01). CONCLUSIONS: Irrespective of the small number of cases reviewed, treatment with thrombin alone was superior to treating with fibrin sealant, since it caused few complications and was more effective at correcting pseudoaneurysms.

An alternative noninvasive technique for treatment of iatrogenic femoral pseudoaneurysms: stethoscope guided compression

Purpose: In this study, we aimed to evaluate efficiency and safety of stethoscope guided compression as a novel noninvasive technique in the femoral pseudoaneurysm treatment. Methods and results: We prospectively included 29 consecutive patients with diagnosis of femoral pseudoaneurysm who underwent coronary angiography. Patients with clinical suspicion of femoral pseudoaneurysm were referred to color Doppler ultrasound evaluation. Adult side of the stethoscope was used to determine location of bruit. Then, compression with pediatric side of stethoscope was applied until bruit could not be heard and compression was maintained for at least two sessions. Once bruit disappeared, 12- hour bed rest with external elastic compression was advised, in order to prevent disintegration of newly formed thrombosis. Mean pseudoaneurysm size was 1.7±0.4 cm × 3.0±0.9 cm and mean duration of compression was 36.2±8.5 minutes. Twenty-six (89.6%) of these 29 patients were successfully treated with stethoscope guided compression. In 18 patients (62%), pseuodoaneurysms were successfully closed after 2 sessions of 15-minute compression. Only one patient experienced mild vagal reaction. ![Figure][1] Figure 1 Conclusion: Stethoscope guided compression of femoral pseudoaneurysms is a safe and effective novel technique which require less equipment and expertise than other contemporary methods. [1]: pending:yes

Femoral artery pseudoaneurysm as a complication of angioplasty. How can it be prevented?

Femoral pseudoaneurysm is a common complication of repeated femoral puncture during cardiac catheterisation. We describe here the development of femoral pseudoaneurysms in a patient with Takayasu's arteritis, which healed in...

Treatment of Femoral Pseudoaneurysms with Endograft in High-risk Patients

Treatment of Femoral Pseudoaneurysms with Endograft in High-risk Patients

Treatment of Femoral Pseudoaneurysms with Endograft in High-risk Patients

IntroductionAnastomotic aneurysms are a late complication after arterial reconstruction. Current treatment usually consists of open repair but we describe our experience with endovascular repair of femoral pseudoaneurysms. ReportSix patients with seven femoral pseudoaneurysms were treated with percutaneously inserted endografts. Control angiography confirmed immediate technical success in all cases. Exclusion of the para-anastomotic aneurysm was obtained in all cases. No major complications or postoperative mortality were observed. No occlusions of the endografts occurred and no endoleaks were noticed. DiscussionEndovascular exclusion of femoral pseudoaneurysms is feasible and reliable. Long-term follow-up will demonstrate if this approach in selected patients is justified.

Femoral pseudoaneurysms: management with percutaneous thrombin injections--success rates and effects on systemic coagulation.

To determine the success rate of percutaneous ultrasonographically (US) guided thrombin injection in the treatment of femoral pseudoaneurysms and to evaluate the effects of thrombin injection on systemic coagulation parameters. Fifty femoral pseudoaneurysms (37 simple pseudoaneurysms with one lobe and 13 complex pseudoaneurysms with two or three lobes) were treated with US-guided percutaneous thrombin injections. Pseudoaneurysm size, neck length and width, thrombin dose, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 12-24 hours and 5-7 and 21-25 days. In 25 patients, activated thromboplastin time, Quick test (prothrombin time), thrombin time, fibrinogen, D-dimer, antithrombin III, thrombin-antithrombin III complex, and prothrombin fragments 1 and 2 were determined before and at 2, 5, and 10 minutes after thrombin injection. Differences in results before and those after thrombin injection were evaluated by means of the one-sample t test. Mean volume of pseudoaneurysms was 5.84 cm(3) +/- 4.89 (SD). Fifty-eight thrombin injections were performed. Mean thrombin dose was 357 IU +/- 291 in simple and 638 IU +/- 549 in complex pseudoaneurysms. Primary success rate was 36 of 37 (97%) for simple and eight of 13 (61%) for complex pseudoaneurysms. Reperfusion occurred in four complex pseudoaneurysms (none in simple ones). Secondary success rate was 100%. No thromboembolic, infectious, or allergic complications occurred. During follow-up, reperfusion was detected in one patient with a complex pseudoaneurysm. Levels of thrombin-antithrombin III complex increased significantly (P <.05) after thrombin injection, whereas changes in all other laboratory tests were not significant. US-guided percutaneous injection of thrombin is successful and safe in the management of femoral pseudoaneurysms. The increase of thrombin-antithrombin III complex indicates the possibility of thrombin passage into the arterial circulation.

Treatment of femoral pseudoaneurysms. Percutaneous US-guided thrombin injection versus US-guided compression

Thrombin injection in femoral pseudoaneurysms has been suggested to be superior to traditional US-guided compression. Our aim was to evaluate results with compression therapy with special reference to use of thrombin in case of failure. We also studied 7 patients who underwent primary thrombin injection. We retrospectively reviewed all (n=44) femoral artery pseudoaneurysms diagnosed at our department during October 1998-May 1999. US-guided compression with the Femostop device or US-guided thrombin injection (100-1000 IU) was the first choice according to the physicians' preference, followed by the other regime if the first choice was non-successful. Thirty-nine (89%) of the patients received anticoagulation treatment and/or concomitant antiplatelet drugs. Out of the 44 patients, 37 were treated with compression as the first choice. This regime was successful in 22 (59%). This group included 2 lesions that resolved spontaneously after initially failed compression and 1 deep venous thrombosis after treatment. The persistent 15 pseudoaneurysms after failed compression received thrombin injection, and it was also the primary therapy in 7 patients. Complete thrombosis within the pseudoaneurysm was immediately induced after treatment. One early recurrence required a second injection. No complication of thrombin was noted and no surgery was required. US-guided thrombin injection is an effective treatment for embolisation of pseudoaneurysms. The technique is superior to compression therapy.

Treatment of femoral pseudoaneurysms. Percutaneous US-guided thrombin injection versus US-guided compression.

Thrombin injection in femoral pseudoaneurysms has been suggested to be superior to traditional US-guided compression. Our aim was to evaluate results with compression therapy with special reference to use of thrombin in case of failure. We also studied 7 patients who underwent primary thrombin injection. We retrospectively reviewed all (n=44) femoral artery pseudoaneurysms diagnosed at our department during October 1998-May 1999. US-guided compression with the Femostop device or US-guided thrombin injection (100-1000 IU) was the first choice according to the physicians' preference, followed by the other regime if the first choice was non-successful. Thirty-nine (89%) of the patients received anticoagulation treatment and/or concomitant antiplatelet drugs. Out of the 44 patients, 37 were treated with compression as the first choice. This regime was successful in 22 (59%). This group included 2 lesions that resolved spontaneously after initially failed compression and 1 deep venous thrombosis after treatment. The persistent 15 pseudoaneurysms after failed compression received thrombin injection, and it was also the primary therapy in 7 patients. Complete thrombosis within the pseudoaneurysm was immediately induced after treatment. One early recurrence required a second injection. No complication of thrombin was noted and no surgery was required. US-guided thrombin injection is an effective treatment for embolisation of pseudoaneurysms. The technique is superior to compression therapy.

Nonsurgical Treatment of Femoral Pseudoaneurysm Complicating Catheterization Through Femoral Artery

Nonsurgical Treatment of Femoral Pseudoaneurysm Complicating Catheterization Through Femoral Artery