Treatment Of Iatrogenic Femoral Pseudoaneurysms Research Articles

Girişimsel işlemlere bağlı gelişen femoral psödoanevrizmanın primer onarımı

Objective: This study aimed to report our clinical experience with the treatment of iatrogenic femoral pseudoaneurysms with the primary suture technique. Materials-methods: Thirty patients treated with the diagnosis of femoral pseudoaneurysm in the femoral artery between September 2015 and August 2020 participated in the Non-iatrogenic pseudoaneurysms, iatrogenic aneurysms smaller than 4 cm, and thrombosed aneurysms were excluded. All pseudoaneurysms were diagnosed by ultrasonography and computed tomography. Results: Peripheral arterial thrombosis developed in 1 (4%) patients. All femoral pseudoaneurysms were repaired with primary suture without clamping. No early postoperative deaths occurred. Conclusion: Although cross-clamp surgical treatment modalities have been described as standard surgical treatment, surgical repair with primary suture technique without clamping is a good method for iatrogenic peripheral arterial pseudoaneurysms.

Effective treatment of iatrogenic femoral pseudoaneurysms by combined endovascular balloon inflation and percutaneous thrombin injection.

The increasing number of percutaneous endovascular procedures in highly anticoagulated patients has increased the possibility of iatrogenic femoral artery pseudoaneurysm (IFAP). Ultrasound (US)-guided percutaneous thrombin injection is one of the feasible treatments; however, there are concerns about complications such as peripheral embolization. This study was performed to examine the efficacy and safety of treatment of IFAPs using a combination of percutaneous thrombin injection and intravascular balloon inflation. In this retrospective, single-center study, we analyzed 11 patients who developed and were treated for IFAPs from January 2017 through April 2020. The patients were treated with endovascular therapy (EVT) with percutaneous thrombin injection. The technique utilized fluoroscopic guidance to place a balloon at the neck of the IFAP, and the balloon was then inflated to prevent the inflow of blood to the aneurysm. We then performed US-guided thrombin injection. The mean age was 72.36 ± 10.43years; mean body mass index (BMI) was 25.25 ± 3.18. All patients had hypertension, 72.7% were undergoing hemodialysis, and 54.5% used oral anticoagulant drugs. The mean aneurysm size was 24.34 ± 13.54mm. The approach was transfemoral in ten patients and transradial in one patient. All procedures were successful, and there were no complications. The mean thrombin dose was 677.3 ± 410.7IU; the total hemostatic time was 45.4 ± 24.9min. In conclusion, the combination of percutaneous thrombin injection and endovascular balloon inflation was feasible and safe for the treatment of IFAPs. This technique may contribute to the treatment of IFAPs.

Ultrasound-Guided Fibrin Glue Injection for Treatment of Iatrogenic Femoral Pseudoaneurysms.

Introduction:Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention. Ultrasound-guided injection of thrombogenic substances into perfused arterial PSAs followed by compression therapy is a well-established and less invasive treatment option than surgical repair. Different agents are available to induce thrombosis including thrombin and a fibrin-based tissue glue, which is used as first-line treatment at our institution. This paper deals with our experience using ultrasound-guided fibrin glue injection (UGFI).Materials and Methods:Retrospective data analysis: all patients (55) treated for iatrogenic femoral PSA following digital subtraction angiography of the lower extremities between January 1, 2010, and December 31, 2018, were included. Data on epidemiology, PSA location and size, vascular risk factors, fibrin glue injection (fibrin glue volume), primary success rate of UFGI, and complications related to the treatment were analyzed.Results:A total of 55 consecutive femoral iatrogenic PSAs were treated during the defined period and 32 (58.2%) of the patients were female. Imaging was performed using ultrasound in all cases. The most common PSA location (80.0%) was the common femoral artery, mean PSA size (± SD) was 2.7 ± 1.2 cm, and neck length was 1.6 ± 1.0 cm. The dose (mean ± SD) of fibrin glue was 2.6 mL (± 1.0; maximum: 6 mL). Primary UGFI success rate was 87.3% and conversion rate to open surgery was 12.7%. Two (4%) patients required embolectomy for peripheral embolization after UGFI.Conclusion:Early results achieved with UGFI for treatment of iatrogenic femoral PSA are promising. In our cohort, UGFI was a safe and effective first-line alternative to traditional open surgery, which then was unnecessary in the vast majority of PSA cases. Further prospective studies for comparison of ultrasound-guided techniques should be encouraged.

Safety and Effectiveness of Percutaneous Low-Dose Thrombin Injection for Femoral Puncture Site Pseudoaneurysms in Neurointervention: Single-Center Experience.

PurposeWe present ultrasound-guided percutaneous low-dose thrombin (200–250 IU) injection for the treatment of iatrogenic femoral pseudoaneurysms. Second, we compared patient and procedure factors between subcutaneous hematoma and pseudoaneurysm groups.Materials and MethodsFrom April 2012 to May 2018, 8,425 patients underwent neurointervention. Among these patients, 18 had small subcutaneous hematomas and 6 had pseudoaneurysms. Pseudoaneurysms in the neck and entire sac were visualized, and low-dose thrombins were injected while visualizing a “whirlpool” hyperechoic core in the pseudoaneurysm sac. Subcutaneous hematomas were treated with simple compression. We compared the following parameters between the subcutaneous hematoma group and pseudoaneurysm group: sex, age, body mass index (BMI), type of procedure, heparin usage, sheath size, procedure time, and number of previous neurointervention procedures with the Mann-Whitney U test.ResultsMost of the pseudoaneurysms were successfully occluded with 200 IU of thrombin (n=5). Only 1 pseudoaneurysm required a slightly higher thrombin concentration (250 IU, n=1). During the short-term follow-up, no residual sac was observed and no surgical repair was necessary. Pain in the groin region was alleviated. During the 1-month follow-up, no evidence of pseudoaneurysm recurrence nor subcutaneous hematoma was noted. Patient factors (sex, age, and BMI) and procedure factors (heparin usage, sheath size, procedure time, number of previous procedures) were not statistically different between the subcutaneous hematoma and pseudoaneurysm groups.ConclusionUltrasound-guided percutaneous low-dose thrombin injection (200–250 IU) is safe, effective, and less invasive for treating iatrogenic femoral pseudoaneurysm in neurointervention.

Percutaneous ultrasound-guided balloon-assisted embolization of iatrogenic femoral artery pseudoaneurysms with Glubran®2 cyanoacrylate glue: safety, efficacy and outcomes.

Femoral pseudoaneurysm (PA) is a frequent complication of arterial access for endovascular procedures. Surgery has traditionally been considered as the gold standard of therapy. We aimed to report our experience of percutaneous ultrasound (US)-guided balloon-assisted embolization with cyanoacrylate glue for the treatment of iatrogenic femoral PAs. Retrospective two-center study of patients with femoral iatrogenic PAs treated by N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran®2 glue embolization between July 2013 and November 2017. All patients underwent contralateral arterial access with balloon placement of an appropriate size in front of the PA neck before glue/lipiodol embolization in a 1:1 ratio by percutaneous US-guided puncture of the aneurysmal sac under fluoroscopy control. Twenty-three patients (12 females, 11 males; median age, 79 years; range, 18-93 years) were included. Median PA size was 34 mm (range, 17-60 mm). The median time to treatment was 5 days (range, 1-30 days). Twenty patients (86.9%) were successfully treated by glue injection alone. The three remaining patients (13.1%) with persistent PA or associated arterial-venous fistula were immediately treated during the same procedure by additional stent-graft. Then, overall immediate and 1-month clinical success rates were 100%. No surgical conversion was necessary. No recurrence was reported during the median follow-up of 11 months (range, 2-73 months). Two (8.7%) puncture-related complications occurred at the contralateral arterial access site, which spontaneously resolved. No non-target glue embolization occurred. US-guided balloon-assisted glue embolization is safe and effective to treat iatrogenic femoral PAs in most cases, offering complete exclusion of the PA and avoiding the morbidity of open surgery.

Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms.

Arterial pseudoaneurysms are well known iatrogenic complication of percutaneous angiographic or interventional vascular procedures. In the past, the definitive treatment option was open surgical repair which is a relatively invasive procedure. In the last few years, Ultrasound (US) guided percutaneous thrombin injection has been gaining popularity as definitive treatment of pseudoaneurysms. To evaluate efficacy and safety of US guided percutaneous injection of thrombin for treatment of iatrogenic femoral pseudoanurysms at a tertiary care interventional radiological and cardiology centre. A retrospective analysis was conducted on 38 consecutive patients, diagnosed to have iatrogenic femoral artery pseudoaneurysms by Doppler study, in the period from Jan 2013 to Jun 2016. All these patients were treated by US guided percutaneous injection of thrombin solution inside the pseudoaneurysm sac till contents became echogenic and flow inside the pseudoaneurysm stopped completely. One month further follow up in all these patients was done. The dose of thrombin injected varied from 200-1000 IU (mean 300 IU). Immediate thrombosis was seen in all the pseusdoaneurysms. Follow up at 24-48 hours showed complete thrombosis and regression of pseudoaneurysm in all the patients except one in whom a small residual sac was seen which thrombosed completely on second thrombin injection. Further follow up at one month showed regression of aneurysms in all the cases. No significant post procedural clinically significant complications were seen in any of the patients. US guided percutaneous thrombin injection is a highly successful and safe procedure for the treatment of iatrogenic femoral pseudoaneurysms.

Ultrasound-guided thrombin injection for treatment of iatrogenic femoral pseudo-aneurysm: A nursing protocol

Femoral pseudo-aneurysm (FPA) is a pulsatile hematoma (false aneurysm) of the femoral artery that communicates with an artery through a disruption in the arterial wall. Most often, FPA develops after an injury or angiographic access to the femoral artery with bleeding into the adjacent tissue. FPA is an uncommon complication, but a very significant one, that can have serious consequences. FPA can initially present as a new thrill or bruit, a pulsatile hematoma, or marked pain and tenderness near the site of arterial puncture. Doppler flow imaging has been the mainstay of diagnosis. Ultrasound (US)-guided compression was the treatment of choice. However, it carries drawbacks including length of time to compress for adequate closure of the artery, discomfort to patients, high recurrence rate in patients receiving anticoagulation, femoral artery thrombosis, and a success rate of only 75% overall. An alternative to compression is US-guided thrombin injection (UGTI) of the FPA. This is a safe procedure that can be done as an outpatient or in an office setting. This paper will provide nursing guidelines and rationale as well as a nursing protocol for the management of patients who undergo UGTI for FPA.

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

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

Objective Iatrogenic femoral pseudoaneurysm is a well-known vascular access site complication. Many invasive and noninvasive techniques have been proposed for the management of this relatively common complication. In this study, we aimed to evaluate effi ciency and safety of stethoscopeguided compression as a novel noninvasive technique in the femoral pseudoaneurysm treatment.Methods and results We prospectively included 29 consecutive patients with the diagnosis of femoral pseudoaneurysm who underwent coronary angiography. Patients with a clinical suspicion of femoral pseudoaneurysm were referred to colour Doppler ultrasound evaluation. The adult (large) side of the stethoscope was used to determine the location where the bruit was best heard. Then compression with the paediatric (small) side of the stethoscope was applied until the bruit could no longer be heard and compression was maintained for at least two sessions. Once the bruit disappeared, a 12-hour bed rest with external elastic compression was advised to the patients, in order to prevent disintegration of newly formed thrombosis. Mean pseudoaneurysm size was 1.7 ± 0.4 cm × 3.0 ± 0.9 cm and the 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%), the pseuodoaneurysms were successfully closed after 2 sessions of 15-minute compression. No severe complication was observed.Conclusion Stethoscope-guided compression of femoral pseudoaneurysms is a safe and eff ective novel technique which requires less equipment and expertise than other contemporary methods.

TCT-403 Percutaneous Ultrasound-Guided Thrombin Injection as a Safe and Efficacious Primary Treatment of Iatrogenic Femoral Pseudoaneurysms for the Interventional Cardiologist

TCT-403 Percutaneous Ultrasound-Guided Thrombin Injection as a Safe and Efficacious Primary Treatment of Iatrogenic Femoral Pseudoaneurysms for the Interventional Cardiologist

Treatment of Iatrogenic Femoral Pseudoaneurysm with Ultrasound-guided Manual Compression; A Case Report

Treatment of Iatrogenic Femoral Pseudoaneurysm with Ultrasound-guided Manual Compression; A Case Report

Treatment of Iatrogenic Femoral Pseudoaneurysm by Ultrasound-Guided Compression Therapy and Thrombin Injection

Development of an arterial pseudoaneurysm is a common complication following cardiac catheterization. We analyzed data from 6,300 patients who received left heart catheterization at our institution. One day after the procedure, approximately 10% of the patients were examined with duplex sonography. In 204 patients (3.0%), a pseudoaneurysm of the femoral artery was diagnosed. All patients underwent compression therapy. Thereby, 159 of the pseudoaneurysms could be treated successfully. The remaining 45 pseudoaneurysms had a maximal diameter of more than 1.5 cm. Forty-two patients underwent ultrasound and biopsy-line-guided thrombin injection without complications. This strategy resulted in a successful occlusion in 41 cases. Pseudoaneurysms smaller than 2 cm can be treated with compression therapy. Larger pseudoaneurysms can be occluded by thrombin injection using ultrasound guidance. Patients with a pseudoaneurysm with a wide "neck" should be treated surgically, because the risk of an arterial occlusion following thrombin injection cannot be excluded.

医原性大腿仮性動脈瘤に対する超音波ガイド下トロンビン注入療法の経験

医原性大腿仮性動脈瘤に対する超音波ガイド下トロンビン注入療法の経験

BEHANDELING VAN IATROGENE FEMORALE PSEUDOANEURYSMATA DOOR MIDDEL VAN ECHOGELEIDE PERCUTANE TROMBINE-INJECTIE: DOELTREFFENDHEID EN COMPLICATIES

Treatment of iatrogenic femoral pseudoaneurysms by ultrasound-guided percutaneous thrombin injection: effectiveness and complications.Aim: We retrospectively assessed the effectiveness of ultrasound-guided percutaneous thrombin injection in the treatment of iatrogenic femoral pseudoaneurysms and registered the occurrence of complications in the systemic circulation.Methods: We performed ultrasound-guided thrombin injection in 26 iatrogenic femoral pseudoaneurysms: 24 were classified as single en 2 as complex. We registered the volume and the pseudoaneurysm neck measurements, as well as the complication rate.Results: Ultrasound-guided percutaneous thrombin injection led to a successful obliteration of pseudoaneurysm in 25 out of 26 cases (96.2%). The thrombin amount varied between 250 and 1000 IU. A thrombosis of the common femoral artery after the thrombin injection occurred only in one patient.Conclusion: Ultrasound-guided percutaneous thrombin injection is effective and safe in the treatment of iatrogenic femoral pseudoaneurysms provided the exclusion criteria are respected. Complications are rare.

900 Ultrasonic detection and percutaneous treatment of iatrogenic femoral pseudoaneurysms in echo laboratory

900 Ultrasonic detection and percutaneous treatment of iatrogenic femoral pseudoaneurysms in echo laboratory

Human Thrombin for Treatment of Pseudoaneurysms: Comparison of Bovine and Human Thrombin Sonogram-Guided Injection

The purpose of this research was to review our experience and determine the success rate of percutaneous sonogram-guided human thrombin injection to treat iatrogenic femoral pseudoaneurysms and compare this with the results obtained with bovine thrombin injection. In our experience, the use of human thrombin for the treatment of iatrogenic femoral pseudoaneurysms is highly efficient (100%), the administered dose is significantly less than with bovine thrombin, and the risk for allergy is potentially lower. At our hospital, human thrombin has replaced bovine thrombin and is the first line of treatment for an iatrogenic pseudoaneurysm.

Utilidad de la inyección de trombina dirigida por ecografía en los seudoaneurismas femorales iatrogénicos después del fracaso de la compresión

In december 2000, we began to treat iatrogenic femoral pseudoaneurysms with direct thrombin injection under sonographic guidance after failed sonographically guided compression repair. Our purpose was to determine the success and complications rate of this technique. We treated 50 patients who had iatrogenic femoral pseudoanerysms using direct thrombin injection. A 22-gauge spinal needle was placed into the psudoaneurysm lumen with sonographic guidance, and bovine thrombin (mean dose, 1200 units; range 200-7000 units) was injected under continous color Doppler sonographic visualization. Patient demographics clinical variables, and pseudoaneurysms characteristics were collected. The overall success rate was 98% (49/50). 30 patiens only required one thrombin injection, with mean thrombosis time of 4 s. When more than one injection was required the mean thrombosis time increased to 9,5 s. There was correlation between thrombosis time and the pseudoaneurysm size (p < 0.005); and between pseudoaneurysm size and the dose of thrombin used. No mayor sedation was needed and no recurrent pseudoaneurysms were observed. With the exception of a mild local eritema in one patient no complications were found. The thrombin injection under sonographic guidance is a quick, effective and secure method of therapy for the treatment of iatrogenic femoral pseudoaneurysms. Failures and complications are infrequents. At our hospital sonographically guided thrombin injection had replaced compression repair.

Tratamiento de pseudoaneurismas arteriales yatrógenos con inyección de trombina humana

Summary Introduction The incidence of iatrogenic pseudoaneurysms has risen due to the increased number of intervention approaches and the associated anticoagulation. The search for an effective treatment as opposed to surgery has been a challenge over the last few years.Aims. To analyse the effectiveness and safety of treatment with human thrombin (HT) in a series of 10 iatrogenic pseudoaneurysms. Patients and methods Eight patients (five females and three males), with an average age of 67years (46-85), had a total number of 10pseudoaneurysms in the common femoral artery, secondary to cardiac catherization (five), diagnostic arteriography (one), cerebral aneurysm embolization (one) and intraarterial fibrinolysis (one). Selection for treatment was based on the following: a diameter above 15 mm (15-35) and localization had to be anterior with respect to the artery. Saline solution of HT (100 U/cm3, from Tissucol®) and a 22G needle were used. 100-400 U were injected into the cavity by echographically-guided percutaneous injection. Two patients received anticoagulants during the procedure. Ankle-arm indices and pulses were explored before and after the injection. Controls were conducted at 24 hours, 2 and 6 months. Results The total thrombosis of the cavity came about after only a few seconds, without any changes in ankle-arm index or pulses. There was only one relapse in apseudoaneurysm, at 24 hours. Conclusions Treatment using percutaneous HT injection is effective (90% primary thrombosis), safe (without pain or complications in our series) and of short duration for the first-line treatment of iatrogenic femoral pseudoaneurysms.

Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution.

In September 1998, we began to treat iatrogenic femoral pseudoaneurysms with direct thrombin injection under sonographic guidance. Our purpose was to determine the success and complication rate of this technique. We treated 114 consecutive patients who had iatrogenic femoral pseudoaneurysms using direct thrombin injection. A 22-gauge spinal needle was placed into the pseudoaneurysm lumen with sonographic guidance, and bovine or human thrombin (mean dose, 306 U; range, 50--1600 U) was injected under continuous color Doppler sonographic visualization. Distal pulses were monitored. Patient demographics, clinical variables, and pseudoaneurysm characteristics were collected. One hundred three (90%) of 114 patients had pseudoaneurysm thrombosis after the first procedure. Of the remaining 11 patients who required a second procedure 1 day later, thrombosis occurred in seven (64%) of 11. Thus, the overall success rate was 96% (110/114). Of the patients who required one injection, the mean thrombosis time was 12 sec (range, 3--90 sec). Three (3%) of 114 patients required conscious sedation. Of the patients with successful thrombosis, 24-hr follow-up sonograms showed no recurrent pseudoaneurysm. Four patients (4%) had potential complications: a "blue toe" 15 hr after the thrombin injection that resolved spontaneously, a groin abscess, leg ischemia that resolved spontaneously after 4 hr, and crampy buttock pain that resolved spontaneously. For the treatment of iatrogenic femoral pseudoaneurysms, thrombin injection under sonographic guidance is a quick and effective method of therapy. Failures and complications are infrequent. At our institution, sonographically guided thrombin injection has replaced compression repair.

Femoral artery thrombosis after percutaneous thrombin injection of an external iliac artery pseudoaneurysm

Ultrasound-guided percutaneous thrombin injection has been developed as a less invasive and highly successful treatment of iatrogenic femoral pseudoaneurysms. Most of these lesions have been the result of catheterization procedures. This method has proved to be highly effective, and few complications have been reported. Specifically, native arterial thrombosis, although recognized as a severe complication, has been mentioned only briefly in the literature. We present a case of the successful management of native arterial thrombosis after attempted percutaneous thrombin injection of a chronic external iliac artery pseudoaneurysm. This case serves to illustrate the risk factors for this complication and the treatment options once it occurs. The success of this treatment with acute iatrogenic femoral pseudoaneurysms may not necessarily translate into similar success in other anatomic locations and clinical situations. (J Vasc Surg 2001;33:1093-6.)