Treatment Of Pseudoaneurysm Research Articles

Ultrasound-Guided Thrombin Injection for the Treatment of Femoral Pseudoaneurysm in Pediatric Patients

Eight patients with nine femoral pseudoaneurysms were treated with 13 ultrasound-guided thrombin injections. Mean patient age was 3.3 years (range, 5 mo to 13.6 y), mean pseudoaneurysm diameter was 2.0 cm ± 0.6, and mean thrombin dose was 119 IU (500 IU/mL ± 116; 0.95 CI). Mean follow-up was 27 days (range, 7–120 d). Eight pseudoaneurysms were successfully treated, and one failed to close as a result of arterial wall disease. No complications were observed. The approach used at the authors’ pediatric institution resulted in safe and effective treatment of femoral pseudoaneurysms.

Ultrasound-Guided Percutaneous Thrombin Injection of Common Carotid Pseudoaneurysm following Carotid Endarterectomy is Possible

Pseudoaneurysm (PSA) of the carotid artery is a rare complication of carotid endarterectomy (CEA) with an incidence of less than 1%. PSAs of other named arteries are commonly treated with ultrasound-guided thrombin injection; however, there are few accounts in the literature discussing the use of this technique for the treatment of carotid PSA, specifically, and none for carotid PSA after CEA. We present the case of an 86-year-old woman with a left common carotid artery PSA, which was noted after left CEA. As emergent treatment, ultrasound-guided direct percutaneous thrombin injection was used without embolic protection. This produced immediate thrombosis of the PSA, without complication. Arterial duplex at long-term follow-up demonstrated sustained PSA closure and patency of the carotid artery system. We report our case and review of the very limited available literature on this procedure.

Ultrasound-guided thrombin injection for treatment of superficial traumatic pseudoaneurysms and associated expanding hematomas: experience in five patients.

BackgroundAngiography allows for excellent characterization and treatment of traumatic pseudoaneurysms. However, ultrasound-guided thrombin injection for pseudoaneurysm thrombosis allows for radiation-free treatment of superficial pseudoaneurysms and superficial expanding hematomas.MethodsA retrospective review of 5 patient cases treated under this paradigm was performed following institutional review board approval. Outcomes following intervention were recorded and compared amongst the patient cohort.ResultsUltrasound-guided closure of traumatic pseudoaneurysms allowed for reduced procedural times and procedural invasiveness.ConclusionsAs demonstrated by the following cases, ultrasound guided thrombin injection is a good method of primary treatment for superficial pseudoaneurysms, or as an alternative treatment in cases where transcatheter embolization fails.

EPTFE stent graft in non-steno-occlusive arterial disease: 2 centers retrospective study.

We report our experience regarding use of Fluency stent graft (Bard, Murray Hill, NJ, USA) for the treatment of peripheral aneurysms, pseudoaneurysms, arteriovenous fistulae, dissections and arterial ruptures, lacerations or perforations. This two-center study included 59 patients (40M, 19F) with a mean age of 64.37years (range 20-91years). In total 61 lesions were treated, so subdivided: 10 true aneurysms, 26 pseudoaneurysms, 5 iatrogenic arteriovenous fistulae, 20 arterial ruptures, lacerations or perforations. Immediate technical success was obtained in 60 of 61 lesions (98.3%); in 1 case (pseudoaneurysm of hepatic artery) additional embolization of the gastroduodenal artery with microcoils was needed. Follow-up was available for 57 patients and 59 lesions; mean period was 23.52months (range 1-60months). At 1-year primary patency was 89.47%, whereas secondary patency was 96.4%. Endovascular application of Fluency stent graft seems to offer an effective, and durable less invasive alternative to standard surgical techniques for the treatment of peripheral aneurysms, pseudoaneurysms, iatrogenic arteriovenous fistulae and arterial ruptures, or penetrating injuries.

Splenic Artery Pseudoaneurysm - Unusual Pediatric Case

Splenic artery is the third most frequently place of aneurysm in abdominal vessel taking place after abdominal aorta and iliac arteries. Pseudoaneurysm although differs from true one by histological point of view generally has same symptoms, complication. But aneurysms and pseudoaneurysms of the splenic artery require different management strategies. This entity can encounter in adult population not so rare but it is very unusual to see it in children. In our case we show complicated splenic artery pseudoaneurysm, it background and endovascular treatment.

Ultrasound-Guided Temporal Artery Pseudoaneurysm Repair with Thrombin Injection

Abstract: Superficial temporal artery pseudoaneurysm a relatively uncommon condition mostly resulted from traumatic injury. Although the most successful standard treatment has been surgical resection, other nonsurgical treatment methods have been employed, including thrombin injection, endovascular embolization, coiling, or conservative treatment. We report a case or right superficial temporal pseudoaneurysm successfully treated with thrombin injection under ultrasound guidance. Our case provides more evidence regarding the efficiency and safety of treatment of pseudoaneurysm with thrombin injection under ultrasound guidance. Case Presentation: A 41-year-old presented with a progressive right temporal throbbing headache as well as a right preauricular pulsating mass for one week (Figure A). The symptoms started gradually one week after a motor vehicle accident, during which he suffered a large laceration to the right-sided parietotemporal area of the head that necessitated more than 20 stitches. CTA of the head showed right preauricular pseudoaneurysm of the superficial temporal artery of 16 × 9.3 × 8.6 mm in size. Sonography of the right temporal region demonstrated a ”Ying/Yang” flow (Figure B, Video) and some eccentric thrombus within this pseudoaneurysm.

Efficacy of Multilayer Flow Modulator in treatment of thoracic aortic pseudoaneurysm in a case of Behçet's disease

Behçet's disease (BD) is a multi-systemic, autoimmune primitive vascularity of unknown aetiology. It is common around the Mediterranean basin and in south-east Asia. Arterial lesions are relatively rare but when they involve the aorta, and they become life-threatening. The classic treatment for pseudoaneurysms combines surgery and double therapy with an immunosuppressant and steroids. The risk of recurrence and the life-threatening risk of surgical treatment have led to a preference for endovascular treatment for the complex aortic localisations linked to BD.We report an original observation of a symptomatic distal thoracic aortic pseudoaneurysm with haemothorax which revealed BD. We treated it with the implantation of a Multilayer Flow Modulator combined with double therapy: immunosuppressants and steroids.Two years after the procedure, the patient is in good condition with a follow-up CT scan showing total disappearance of aneurysmal sac and patent visceral arteries.

Surgical treatment of traumatic lower limb pseudoaneurysm

ObjectiveTo summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm. MethodsTwenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012. The treatment protocols included interventional covered-stent placement (10 cases), spring coil embolization (2 cases), and surgical operation (8 cases). Surgical operations included pseudoaneurysm repair (2 cases), autologous-vein transplantation (1 case), and artificial-vessel bypass graft (5 cases). ResultsAll the patients were successfully treated without aggravating lower limb ischemia. Pseudoaneurysm disappeared after treatment. A surgical operation is suitable to most pseudoaneurysms, but its damage is relatively obvious and usually leads to more bleeding. It also requires a longer operating time. Compared to a surgical operation, interventional therapy is less traumatic and patients usually have a quicker recovery (P<0.05). All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination. There were no cases of pseudoaneurysm recurrence. ConclusionBoth surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part VI - Ultrasound-Guided Vascular Interventions.

The sixth part of the Guidelines on Interventional Ultrasound produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for ultrasound guidance and assistance in vascular interventions. Based on convincing data, real-time sonographic guidance for central venous access is strongly recommended as a key safety measure. Systematic analysis of scientific literature shows that in difficult situations and special circumstances US guidance may also improve the efficacy and safety of peripheral venous and arterial access and endovascular interventions. Moreover, the recommendations of this guideline endorse the use of ultrasound to detect complications of vascular access and US-guidedinterventional treatment of arterial pseudoaneurysms.

Endovascular repair of pseudoaneurysms after open surgery for aortic coarctation.

To analyse early and long-term results of thoracic endovascular aortic repair (TEVAR) in patients with pseudoaneurysms after open aortic coarctation (CoA) repair. A total of 11 patients of 418 patients who had been treated with TEVAR during the period from January 1998 to April 2015 (8 males; median age 53 years) were retrospectively analysed. Dacron patch aortoplasty was primarily performed in 9 patients and subclavian flap aortoplasty in 2 patients. Seven of the 11 patients had asymptomatic pseudoaneurysms (median diameter 56 mm, range 20-65 mm) diagnosed by routine screening. Symptomatic patients presented with haemoptysis, lower limb ischaemia, haemodynamic collapse and back pain and underwent emergency repair (4/11). Adjunctive procedures at the proximal landing zone were required in 7/11 patients. The median number of implanted endoprostheses per patient was 1 (range: 1-5). The median follow-up was 60 months (range 6-161 months). Technical success was achieved in 91% (10/11; 1 secondary elective open conversion). The 30-day mortality was 0%. The stroke rate was 18% (2 non-disabling strokes). In 2 patients (20%), stent-graft displacement during deployment was observed. The reintervention rate was 33% (Type Ib endoleak, left arm claudication, partial coverage of the left common carotid artery). Clinical success during follow-up was achieved in 10/11 patients. In 9/10 patients, aneurysm sac shrinkage was observed. The Type II endoleak rate was 10% (1/10; intercostal artery). The overall mortality rate was 9% (1 patient died of amyotrophic lateral sclerosis). Endovascular treatment of post-coarctation pseudoaneurysms is feasible in elective and emergency cases, yielding durable results in the long term. Due to anatomical specifics, implantation may be challenging and requires careful procedural planning. On-site cardiothoracic surgery backup is essential in case open conversion is required.

Application of Pipeline Embolization Device for Iatrogenic Pseudoaneurysms of the Extracranial Vertebral Artery: A Case Report and Systematic Review of the Literature.

Traumatic pseudoaneurysms of the vertebral artery (VA) are uncommon vascular lesions and definitive management is often challenging. Between 0% and 8% of craniocervical fusions are complicated by VA injury. In these cases, preserving the vertebral artery while treating the pseudoaneurysm is the goal of any treatment option. We describe the second known case of a patient with and iatrogenic extracranial vertebral artery pseudoaneurysm treated effectively using the Pipeline Embolization Device (PED) (Ev3 Neurovascular, Irvine, CA). Although there have been only two cases reported, the use of flow-diverting stents appears to be efficacious for the treatment of non-actively bleeding traumatic pseudoaneurysms.

Pseudoaneurysm of Distal Anterior Cerebral Artery Branch Following External Ventricular Drain Placement.

External ventricular drains (EVDs) are routinely placed as part of the management of intracranial hypertension. Pseudoaneurysm formation after EVD placement is a rare complication that can occur as a result of direct trauma to the cerebral vasculature. Prompt recognition and treatment may prevent future rupture. To present our management strategy of a unique case of pseudoaneurysm formation in the context of the medical literature on these rare complications. An EVD was placed in a 58-year-old female patient who presented with intracranial hypertension after subarachnoid hemorrhage secondary to a ruptured posterior communicating artery aneurysm before coiling of the aneurysm. On postbleed day 10, a pseudoaneurysm was identified in the distal anterior cerebral artery adjacent to the EVD tract. The pseudoaneurysm was successfully treated with surgical resection. Pseudoaneurysm formation after EVD placement is a rare but serious complication. We do not recommend routine screening for this complication; however, further investigation may be warranted when a delayed EVD tract hemorrhage is encountered. Prompt treatment of pseudoaneurysms is necessary to prevent future hemorrhage.

Endovascular Embolization of Visceral Artery Pseudoaneurysms Using Modified Injection Technique with N-Butyl Cyanoacrylate Glue

PurposeTo evaluate the indications, feasibility, safety, and effectiveness of N-butyl cyanoacrylate (NBCA) with modified injection technique in embolization of visceral artery pseudoaneurysms (PSAs). Materials and MethodsA retrospective evaluation was performed of 31 patients (26 men, 5 women; mean age, 32.6 y) with visceral artery PSAs that were treated with embolization using NBCA with modified sequential injection and flushing technique. The most common indication for using NBCA was preservation of a major feeding artery (n = 18), followed by difficult catheterization secondary to arterial tortuosity (n = 5), failed previous coil embolization (n = 4), and short landing zone for coils (n = 4). NBCA alone was used in 25 patients, and NBCA with coils was used in 6 patients. The patients were followed clinically until discharge and 1 and 3 months after discharge. ResultsThe mean amount of NBCA–ethiodized oil (Lipiodol; Guerbet LLC, Villepinte, France) mixture injected was 0.24 mL (range, 0.1–1.1 mL). Embolization with NBCA was technically successful in all (100%) patients. Recurrence was seen in 3 (9.7%; 2—splenic artery; 1—left gastric artery) patients after a mean time of 16.3 days (range, 10–27 d) of initial embolization resulting in clinical success of 90.3%. All 3 patients underwent successful repeat embolization with secondary technical success rate of 100%. Minor (pain) and major (nontarget embolization in 2; microcatheter adhesion and fracture in 1) complications were seen in 3 patients each. ConclusionsNBCA is a safe and effective embolization agent when injected with modified technique in treatment of visceral artery PSAs.

The Dual Layer Casper Micromesh Stent: Taking Advantage of Flow-Diverting Capabilities for the Treatment of Extracranial Aneurysms and Pseudoaneurysms.

(Microvention, Tustin, CA) is a low-profile closed cell stent with an increased mesh density and reduced pore size compared to commonly utilized stents in carotid artery procedures. We describe our preliminary experience from flow diversion in two iatrogenic ECAP with the Casper stent in a retrospective observational analysis of patients with extracranial aneurysms treated endovascularly with the Casper stent. Patients were followed for up to 6 months (clinical exam and imaging). According to the institutional review board, the current analysis did not require approval. All patients or their legal representatives gave informed consent.

Case-report: endovascular treatment of aortic pseudo-aneurysm caused by Fishbone.

Aortic pseudo-aneurysm (APA) is a rare disease in clinic. Because of its relative rarity, we are far from making any conclusion regarding the natural history and appropriate therapeutic strategy for this condition. This study is to investigate the treatment effect of interventional therapy in aortic pseudo-aneurysm. A woman of 68 years old diagnosed with APA caused by fishbone was treated with stent grafts. After treatment, the therapeutic effect was assessed by measuring the size of trauma. The patient recovered well after stent grafts treatment, as her trauma was minimal. However, some complications of intravascular interventional treatment were observed. Compared with conventional surgery, interventional therapy of intravascular stent grafts has its merits. Therefore, this strategy was worthy to apply in the treatment of aortic pseudo-aneurysm.

Contemporary outcomes of intact and ruptured visceral artery aneurysms

The treatment outcomes of ruptured visceral artery aneurysms (rVAAs) have been sparsely characterized, with no clear comparison between different treatment modalities. The purpose of this paper was to review the perioperative and long-term outcomes of open and endovascular interventions for intact visceral artery aneurysms (iVAAs) and rVAAs. This was a retrospective review of all treated VAAs at one institution from 2003 to 2013. Patient demographics, aneurysm characteristics, management, and subsequent outcomes (technical success, mortality, reintervention) and complications were recorded. The study identified 261 patients; 181 patients were repaired (77 ruptured, 104 intact). Pseudoaneurysms were more common in rVAAs (81.8% vs 35.3% for iVAAs; P < .001). The rVAAs were smaller than the iVAAs (20.7 mm vs 27.5 mm; P = .018), and their most common presentation was abdominal pain; 29.7% were hemodynamically unstable. Endovascular intervention was the initial treatment modality for 67.4% (75.3% for rVAAs, 61.5% for iVAAs). The perioperative complication rate was higher for rVAAs (13.7% vs 1% for iVAAs; P = .003), as was mortality at 30 days (13% vs 0% for iVAAs; P = .001), 1 year (32.5% for rVAAs vs 4.1% for iVAAs; P < .001), and 3 years (36.4% for rVAAs vs 8.3% for iVAAs; P < .001). Lower 30-day mortality was noted with endovascular repair for rVAAs (7.4% vs 28.6% open; P = .025). Predictors of mortality for rVAAs included age (odds ratio, 1.04; P = .002), whereas endovascular repair was protective (odds ratio, 0.43; P = .037). Mean follow-up was 26.2 months, and Kaplan-Meier estimates of survival were higher for iVAAs at 3 years (88% vs 62% for rVAAs; P = .045). The 30-day reintervention rate was higher for rVAAs (7.7% vs 19.5% for iVAAs; P = .019) but was similar between open and endovascular repair (8.2% vs 15%; P = NS). rVAAs have significant mortality. Open and endovascular interventions are equally durable for elective repair of VAAs, but endovascular interventions for rVAAs result in lower morbidity and mortality. Aggressive treatment of pseudoaneurysms is electively recommended at diagnosis regardless of size.

Clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using N-butyl cyanoacrylate (NBCA).

Transcatheter endovascular embolization within a reasonable time before rupture or deterioration of a patient's general condition is an important procedure for managing visceral pseudoaneurysms. N-butyl 2-cyanoacrylate (NBCA, enbucrilate) is an embolic material used in the blockade of visceral pseudoaneurysms. This study evaluated the clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using NBCA. Between June 2004 and February 2014, 13 patients (9 males and 4females; age range, 26-80years; mean, 57.9years) with 14 pseudoaneurysms were treated by transcatheter embolization using NBCA. NBCA was mixed with iodized oil at a 1:3 ratio to control its polymerization time and to render it radiopaque. Pseudoaneurysms were located on the gastroduodenal artery (n=1), pancreaticoduodenal artery (n=2), dorsal pancreatic artery (n=1), proximal jejunal artery (n=1), colic artery (n=1), splenic artery (n=3), renal artery (n=4; two in one patient), and hepatic artery (n=1). All patients recovered immediately following the embolization procedure, and two patients showed minor complications that required only medical observation. Transcatheter embolization using NBCA for the treatment of visceral pseudoaneurysms is a safe, effective, and low-cost treatment method with a high success rate.

Abstract No. 18 - Bare metal versus covered stents for treatment of intragraft stenosis within prosthetic hemodialysis arteriovenous grafts

Angioplasty is the standard method for treatment of intragraft stenosis within prosthetic hemodialysis grafts. While stenting can be performed, there are no comparative data in the literature on various stent types at this location. Therefore, the purpose of this study was to compare post-intervention access patency rates after deployment of bare metal versus covered stents for the treatment of intragraft stenoses. Our procedural database was retrospectively reviewed for all percutaneous interventions on prosthetic hemodialysis grafts over a 7-year period in which a stent was deployed at the site of an intragraft stenosis. 31 stent deployments within 22 patients were identified (15 males, 7 females, mean age 57.4 years). All stents were deployed due to suboptimal results with angioplasty (“bail-out”). Intragraft stents deployed for the treatment of anastomotic stenosis, pseudoaneurysms, or bleeding were excluded. Post-intervention access patencies were calculated using Kaplan-Meier analysis and compared using the logrank test. 21 covered stents and 10 bare metal stents were deployed for the treatment of intragraft stenoses. 90% of the grafts were thrombosed at presentation. The 3 and 6 month post-intervention primary access patency rates for bare metal stents were not significantly different from covered stents: 44% and 22% compared to 45% and 25%, respectively (p=0.92). The 6 and 12 month post-intervention secondary access patency rates were also not significantly different: 50% and 30% for bare metal stents and 80% and 55% for covered stents (p=0.28). The 6 month lesion patency rate was 56% and 70%, respectively (p=0.45). In this retrospective study with limited sample size, bare metal and covered stents deployed to treat intragraft stenosis resistant to angioplasty demonstrated similar primary, secondary, and lesion patency rates.

Pseudoaneurysm of Posterior Tibial Artery Management: Case Report and Review of Literature

Pseudoaneurysm (PA) of posterior tibial artery (PTA) is not very common and that of middle one-third of PTA is rare. Endovascular treatment of symptomatic PAs has become a viable less invasive option compared to open repair. In this case report, a 64-year-old gentleman came with acute thrombosis of superficial femoral artery which was treated successfully by embolectomy. He later presented to us with increasing pain over the calf region which on duplex scan revealed us a PA of middle one-third of PTA. It was successfully managed by endovascular stenting without compromising the distal blood flow. An extensive review of the literature has also been performed. J Curr Surg. 2015;5(4):209-212 doi: http://dx.doi.org/10.14740/jcs279w

IVR治療8カ月後に再発した膵頭十二指腸切除術後仮性動脈瘤の1例

IVR治療8カ月後に再発した膵頭十二指腸切除術後仮性動脈瘤の1例