Ultrasound-guided Compression Repair Research Articles

Factors for failure of ultrasound-guided compression repair for femoral pseudoaneurysms after neuroendovascular therapy.

Pseudoaneurysms are a serious complication of neuroendovascular therapy with femoral artery puncture, for which ultrasound-guided compression repair (UGCR) is often the first choice of radical therapy. We sought to retrospectively investigate the factors for failure of UGCR for pseudoaneurysm at the femoral artery puncture site. Among patients undergoing neuroendovascular therapy with femoral artery puncture at our hospital between January 2018 and April 2021, those who received a diagnosis of pseudoaneurysm and underwent UGCR were enrolled. They were classified into two groups according to whether UGCR was successful (UGCR group) or was converted to surgical repair (SR group). Patient and procedural characteristics were compared between the two groups. During the study period, 577 patients underwent neuroendovascular therapy with femoral artery puncture, 10 of whom (1.7%) received a diagnosis of pseudoaneurysm and underwent UGCR. There were seven patients in the UGCR group and three patients in the SR group. The sheath diameter tended to be larger in the SR group than in the UGCR group (p = 0.16). The modified Rankin scale score when a diagnosis of pseudoaneurysm was made was significantly lower in the SR group than in the UGCR group (1 [0-2] vs. 3 [2-5], p = 0.037). Physical activity may be associated with failure of UGCR. In patients with high physical activity, the use of sedatives and analgesics to keep them at rest during puncture site compression after UGCR may lead to successful UGCR.

Interarterial Pseudoaneurysm: A Potential Nightmare

Femoral artery pseudoaneurysm (FAP) is one of the most troublesome complications related to femoral artery access site after cardiovascular catheterization procedures and occurs in 0.8%–2.2% of the cases of cardiovascular interventional procedures. Management is by ultrasound-guided compression repair (UGCR). A 75-year-old male presented with anterior wall ST-elevation myocardial infarction and after percutaneous transluminal coronary angioplasty, developed FAP. This pseudoaneurysm had an interarterial communication between superficial femoral artery and deep femoral artery. It is unusual to have communication of pseudoaneurysm with two branches of femoral artery. Diagnosis was made using vascular sonography and Doppler study. Closure of this aneurysm was done by simple pressure with Doppler probe at both the narrow ends of the aneurysm. Arterial color Doppler is the mainstay for diagnosing FAPs. This case describes an interarterial pseudoaneurysm which is a rare entity to witness and the different modalities for its management, the most common one being UGCR.

Repair of Femoral and Popliteal Artery Aneurysms

Femoral and popliteal artery aneurysms constitute most peripheral aneurysms. In general, with both femoral and popliteal artery aneurysms, elective repair and reconstruction tend to be associated with significantly better postoperative outcomes than emergency repair undertaken after a limb-threatening complication. Specific treatment decisions may be influenced by the presence or absence of symptoms of aneurysmal disease. For femoral artery aneurysms, this chapter presents the preoperative evaluation, operative planning, operative technique (endovascular repair, ultrasound-guided compression, and open surgical repair), and outcome evaluation. For popliteal aneurysms, this chapter discusses the preoperative evaluation, operative planning (indications for repair and preoperative arterial thrombolysis), operative technique (open vs. endovascular repair), and outcome evaluation (dependent on whether surgical or endovascular). This review contains 15 figures, 9 tables, and 41 references. Keywords:Lower extremity aneurysm, popliteal artery aneurysm, femoral artery aneurysm, surgical repair, endovascular repair, thrombosis, embolization

Repair of Femoral and Popliteal Artery Aneurysms

Femoral and popliteal artery aneurysms constitute most peripheral aneurysms. In general, with both femoral and popliteal artery aneurysms, elective repair and reconstruction tend to be associated with significantly better postoperative outcomes than emergency repair undertaken after a limb-threatening complication. Specific treatment decisions may be influenced by the presence or absence of symptoms of aneurysmal disease. For femoral artery aneurysms, this chapter presents the preoperative evaluation, operative planning, operative technique (endovascular repair, ultrasound-guided compression, and open surgical repair), and outcome evaluation. For popliteal aneurysms, this chapter discusses the preoperative evaluation, operative planning (indications for repair and preoperative arterial thrombolysis), operative technique (open vs. endovascular repair), and outcome evaluation (dependent on whether surgical or endovascular). This review contains 15 figures, 9 tables, and 41 references. Keywords:Lower extremity aneurysm, popliteal artery aneurysm, femoral artery aneurysm, surgical repair, endovascular repair, thrombosis, embolization

Ultrasound-guided thrombin injection versus ultrasound-guided compression repair in the treatment of post-catheterization femoral artery pseudoaneurysm: King Saud University Medical Center Experience.

This study aims to evaluate the effectiveness of ultrasound-guided thrombin injection versus ultrasound-guided compression repair in the management of iatrogenic femoral artery pseudoaneurysms. Between June 2006 and December 2015, a total of 29 consecutive patients (15 males, 14 females; mean age 54 years; range 26 to 81 years) with a femoral pseudoaneurysm treated by ultrasound-guided thrombin injection were retrospectively analyzed. These patients were compared with a historical group of 36 patients (21 males, 15 females; mean age 44 years; range 32 to 65 years) who underwent ultrasound-guided compression repair between February 1999 and May 2006. Medical records and vascular laboratory findings of all patients were reviewed. Successful treatment was defined as complete cessation of flow into the false lumen with preservation of flow in the femoral artery. The ultrasound-guided thrombin injection showed a success rate of 100%, whereas ultrasound-guided compression repair had a success rate of 80.5%, which was possibly affected by anticoagulant therapy, hypertension, and an aneurysm size of >6 cm. However, none of these factors did not affect the success of thrombin injections. Ultrasound-guided thrombin injection is a highly successful, easy to perform, accepted, and well-tolerated method by patients. It is more effective compared to compression therapy in patients with hypertension, large aneurysms, and who are on anticoagulant therapy.

Ultrasound-guided Compression Repair of Post Catheterisation Femoral Artery Pseudoaneurysm: A Retrospective Study from a Tertiary Cardiac Institute

Ultrasound-guided Compression Repair of Post Catheterisation Femoral Artery Pseudoaneurysm: A Retrospective Study from a Tertiary Cardiac Institute

Risk factors attributed to failure of ultrasound-guided compression for post-cardiac catheterization femoral artery pseudoaneurysms.

Background:Femoral pseudoaneurysm is the most important access site complication following cardiac catheterization. Ultrasound-guided compression repair is a safe and effective therapeutic modality with variable failure rates and risk factors. The aim of this study was to investigate which factors were associated with a higher incidence of ultrasound-guided compression repair failure for post-cardiac catheterization femoral pseudoaneurysm.Methods:Data were retrospectively collected from medical records at King Abdullah University Hospital during the period from January 2011 to December 2016. A total of 42 patients with post-cardiac catheterization femoral pseudoaneurysm had attempted ultrasound-guided compression repair. Data regarding patients, procedure and aneurysm-related factors were evaluated by univariate analysis and multivariate logistic regression.Results:Ultrasound-guided compression repair failed in 31% of the patients. Patients with body mass index of ⩾28 kg/m2, platelet count of ⩽180,000/L, time lag (age of aneurysm) of >48 h following puncture time, aneurysmal neck diameter of ⩾4 mm and communicating tract length of <8 mm were associated with higher rate of ultrasound-guided compression repair failure in the univariate analysis. In the multivariate analysis, time lag (age of aneurysm) > 48 h (odds ratio = 5.7), body mass index ⩾ 28 kg/m2 (odds ratio = 7.8), neck diameter > 4 mm (odds ratio = 14.4) and tract length < 8 mm (odds ratio = 18.6) were significantly associated with ultrasound-guided compression repair failure.Conclusion:Ultrasound-guided compression repair for patients with post-cardiac catheterization femoral pseudoaneurysm was successful in 69% of the patients. Risk factors for failed ultrasound-guided compression repair were as follows: delayed ultrasound-guided compression repair of >48 h, body mass index ⩾ 28 kg/m2, wide neck diameter > 4 mm and short aneurysmal communication tract < 8 mm.

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.

Iatrogenic femoral artery pseudoaneurysm complicating vascular access for haemodialysis in a patient with end-stage renal disease; unexpected occurrence after a common procedure

Pseudoaneurysm is a collection of blood formed as a result of a vascular injury and retained in the tissues surrounding the vessel breached. There is a complete rupture through the three walls of the artery: The intima, media, and adventitia are compromised. In the femoral region, the escaping blood pools as a well-circumscribed mass and is constrained by the surrounding soft tissues. Pseudoaneurysms can develop following penetrating trauma or arterial catheterization. It can uncommonly complicate procedures in the femoral region. Ultrasound-guided compression repair, minimally invasive percutaneous treatments, and surgical repair are the three therapeutic options. We present a 58-year-old woman with end-stage renal disease who developed a pseudoaneurysm of the femoral artery caused by inadvertent puncture of the artery in an attempt to catheterize the femoral vein for an emergency hemodialysis. The pseudoaneurysm was treated by ultrasound-guided compression. It is important to recognize the indications for surgery to avoid delay in the management of this potentially limb- or life-threatening condition.

Femoral artery pseudoaneurysm following trivial trauma: a rare case scenario

Pseudoaneurysm (PSA) formation in femoral artery is rare; the most common cause being arterial catheterization or penetrating trauma. Though the overall incidence of femoral artery pseudoaneurysm (FAP) following catheterization procedures is low, due to increase in number of invasive cardiovascular procedures, FAP is presented as a frequent problem. FAP can present a new thrill or bruit, pulsatile hematoma, or marked pain or tenderness. We have described a rare case report of a patient who developed a femoral artery pseudoaneurysm (FAP) following trivial trauma. In our knowledge, this is the first case report of trivial trauma leading to FAP formation. Doppler flow imaging is the mainstay of diagnosis. However, in certain cases, computed tomographic angiography is needed to plan treatment. Therapeutic options for femoral pseudoaneurysm range from observation, ultrasound-guided compression repair (UGCR), ultrasound-guided thrombin injection (UGTI), coil embolization, and endovascular repair using stent grafts to open surgical repair.

Successful endovascular treatment of iatrogenic thyrocervical trunk pseudoaneurysm with concomitant arteriovenous fistula using 0.010-inch detachable microcoils.

Pseudoaneurysms (PsA) and arteriovenous fistulae (AVF) of the thyrocervical trunk and its branches are rare complications of traumatic or iatrogenic arterial injuries. Most such injuries are iatrogenic and are associated with central venous catheterization. Historically, thyrocervical trunk PsA and AVF have been managed with open surgical repair; however, multiple treatment modalities are now available, including ultrasound-guided compression repair, ultrasound-guided thrombin injection, and endovascular repair with covered stent placement. We report a case of a 65-year-old woman with an iatrogenic thyrocervical trunk PsA with concomitant AVF that developed after attempted internal jugular vein cannulation for hemodialysis access. The PsA was successfully treated by transcatheter coil embolization using 0.010-inch detachable microcoils. Our case is the first published instance of a thyrocervical trunk PsA with concomitant AVF that was successfully treated by endovascular procedure.

Radial artery pseudoaneurysm managed by prolonged ultrasound-guided compression repair and aided by interval application of compression device.

We report a case of a right radial pseudoaneurysm due to assault. The pseudoaneurysm was treated successfully with prolonged ultrasound-guided compression for more than 300 minutes over multiple sittings coupled with the use of a compression device. We believe that if initial compression fails, a prolonged ultrasound-guided compression repair coupled with a compression device can greatly improve the success rates and can negate the use of more invasive procedures to treat pseudoaneurysms.

Endovascular repair of giant iatrogenic femoral artery pseudoaneurysm: case report and literature review

Femoral Artery Pseudoaneurysm (FAP) is one of the most troublesome complications after various invasive cardiovascular procedures related to the femoral arterial access site. It occurs in 0.8% to 2.2% post Intra Aortic Balloon Pump (IABP) removal Messina et al. (J Vasc Surg 13:593–600, 1991). Doppler flow mapping confirms the diagnosis. Angiography provides information regarding native vessel morphology and the relation of the pseudoaneurysm to major branches. Ultrasound-Guided Compression Repair (UGCR) has been a successful modality of FAP management while minimally invasive percutaneous treatments include thrombin injection, coil embolization and insertion of covered stents. We report a case of iatrogenic FAP who was a high risk candidate for UGCR or surgical repair. She was successfully managed by percutaneous implantation of endovascular covered stent with a rapid return to ambulatory activity and minimised hospital stay. This treatment method may be a safe and effective alternative to surgery in selected patients.

Life-Threatening Rupture of a False Aneurysm after Femoral Arterial Catheterization: Unexpected Delay after a Common Procedure

We report the case of a 79-year-old patient who presented with a femoral iatrogenic pseudoaneurysm of delayed and unusual onset with immediately life-threatening massive bleeding. Ultrasound is the method of choice for the diagnosis of pseudo aneurysm. If there is not spontaneous closure, ultrasound-guided compression repair, minimally invasive percutaneous treatments, and surgical repair are the three therapeutic options.

Radial Artery Pseudoaneurysm Managed by prolonged Ultrasound Guided Compression Repair Aided by Interval Application of Compression Device

Radial Artery Pseudoaneurysm Managed by prolonged Ultrasound Guided Compression Repair Aided by Interval Application of Compression Device

Ultrasound-guided compression repair of peripheral artery pseudoaneurysm: 8 years’ experience of a single institute

BackgroundFemoral artery pseudoaneurysm is a rare complication but with increasing frequency nowadays due to the advances of endovascular intervention. Rare cases of brachial orpopliteal artery pseudoaneurysms had ever been reported and the predictive factors of failed ultrasound-guided compression repair (UGCR) are controversial. MethodsDuring the past 8 years, 21 patients (12 males and nine females; median age, 64 years) with peripheral pseudoaneurysms (femoral artery, n = 17; brachial artery, n = 3; popliteal artery, n = 1) were enrolled. A high frequency of 10–12 MHz color ultrasound was used to evaluate the presence of a pseudoaneurysm. The area of the pseudoaneurysm sac and the width and length of the pseudoaneurysm neck were recorded. Under real-time ultrasound guiding, gradual pressure was applied with the probe to obliterate flow in the pseudoaneurysm neck while still allowing flow through the supplying artery for approximately 10–15 minutes with at most three times (45 minutes’ compression). Follow-up color sonography was obtained at 24 hours to detect any recurrence. ResultsThe mean area and the largest dimension of the 21 pseudoaneurysms were 7.3 ± 6.5 cm2 and 3.6 ± 1.8 cm, respectively. The mean width and the mean length of the pseudoaneurysm neck were 2.1 ± 0.9 and 3.3 ± 2.0 mm, respectively. Successful thrombosis of the pseudoaneurysm was achieved in 19(90.5%) patients. The mean compression time of the 19 successful UGCR was 21.2 ± 11.0 minutes. Two patients failed the UGCR procedure after a 45-minute compression. Both of the two pseudoaneurysms were located in the femoral artery with a large width of the pseudoaneurysm neck (4 and 5 mm, respectively). ConclusionUGCR is a safe and cost-effective therapy for treating peripheral pseudoaneurysms of not only femoral artery, but also brachial artery and popliteal artery. We considered the width of the pseudoaneurysm neck to be the predictive factor of technical success.

Treatment of an iatrogenic femoral artery pseudoaneurysm with concomitant arteriovenous fistula with percutaneous implantation of an amplatzer vascular plug

Iatrogenic pseudoaneurysms can occur following percutaneous cardiac and peripheral procedures. There are multiple modalities available for the treatment of pseudoaneurysms including ultrasound guided compression repair, ultrasound guided thrombin injection, or endovascular repair with covered stent placement. If these methods are not indicated or unsuccessful, patients typically require open surgical repair. We report a case of a woman with a post-procedural pseudoaneurysm with concomitant arteriovenous fistula who was treated percutaneously with the implantation of an Amplatzer vascular plug. This novel technique was safe and effective and allowed our patient to avoid the morbidity and mortality associated with surgical repair.

Ultrasound-guided compression repair for iatrogenic femoral artery pseudoaneurysm

To evaluate relative factors affecting the efficiency of ultrasound-guided compression repair in iatrogenic femoral artery pseudoaneurysm. Ultrasound-guided manual compression was performed in 42 patients of iatrogenic femoral artery pseudoaneurysm from June 2004 to June 2010. There were 28 male and 14 female patients, with a mean age of (52 ± 5) years. These patients were presented with femoral artery pseudoaneurysm after catheterisation procedure by percutaneous femoral artery puncture and confirmed by color doppler flow image. Ultrasound-guided manual persistent compression with probe was performed at the puncture site between femoral artery and pseudoaneurysm, until completely thrombosis of pseudoaneurysm, whereas the pseudoaneurysm failed to complete closure required surgical repair. Out of 42 patients, 34 patients (81.0%) were successfully treated by compression resulted in completely thrombosis. There were 8 (19.0%) failures conversion to surgery. Factors associated with success were size of pseudoaneurysm (< 25 mm, 25 - 40 mm, > 40 mm; χ(2) = 13.956, P = 0.001), anti-coagulation status (χ(2) = 5.578, P = 0.010), depth of artery break (< 50 mm, 50 - 80 mm, > 80 mm; χ(2) = 14.055, P = 0.001), pseudoaneurysm communicated with common femoral artery, superficial femoral artery and profunda femoral artery (χ(2) = 8.968, P = 0.011), as well as days to presented with pseudoaneurysm (< 3 d, ≥ 3 d; χ(2) = 5.733, P = 0.012). In multivariate Logistic regression analysis, success by compression was associated with size of pseudoaneurysm (WALD = 5.34, P = 0.021) and with depth of artery break (WALD = 4.84, P = 0.028). The ultrasound-guided compression repair of iatrogenic femoral artery pseudoaneurysm is safe, convenient, inexpensive and reliable treatment.

Noninvasive technique of preventing thrombin escape into the systemic circulation during ultrasound-guided thrombin injection (UGTI) of the postcatheterization pseudoaneurysms

Abstract Introduction Iatrogenic, postcatheterization pseudoaneurysms (PSA) of the femoral artery are a common complication after diagnostic and interventional procedures, with up to 7.7% incidence. Treatment includes surgical repair, ultrasound-guided compression (USGC) repair of the tract of the PSA, or recently ultrasound-guided thrombin injection (UGTI). Large (&gt;1.8 cm) PSA sac with short (&lt;3 mm) and/or wide (&gt;3 mm) tract has higher complication ratio such as thromboembolic events after UGTI. Those cases are considered for protective balloon inflation during thrombin injection. The aim of our study was to evaluate the success rate of preventing escape of the thrombin during UGTI with simultaneous manual compression on ipsilateral iliac artery. Methods and results We reported 46 patients, 17 males and 29 females, aged 53–74 years, with iatrogenic, postcatheterization femoral artery PSA. Out of 46 patients, 7 were successfully treated with USGC. The rest of the patients were treated with UGTI with simultaneous manual compression on ipsilateral iliac artery to stop the flow in PSA, and to avoid thrombin escape into the native circulation. Success rate of UGTI with manual compression of ipsilateral iliac artery was 97% with the complication rate of 2.6%. Conclusion Our study confirms that UGTI treatment of the PSA of the femoral artery combined with compression of the ipsilateral iliac artery could be a safe and reliable method of the thrombin escape prevention into the systemic circulation, as good as more invasive and demanding methods.

Alternative treatment for postcatheterisation femoral false aneurysm

The incidence of femoral postcatheteriation pseudoaneurysm ranges from 0.1 to 2.0% in diagnostic procedures to 5% in therapeutic procedures. There are several treatment options for pseudoaneurysms, from conservative management to conventional surgical intervention. For medium-sized pseudoaneurysms, ultrasound-guided compression repair or percutaneous injection of thrombin/coagulation factor XIII are the treatments of choice. In this paper, we describe two cases of post-therapeutic catheterization pseudoaneurysm, in which endovascular and conventional surgery were combined. The association of these two modalities of treatment decreased blood loss in comparison with conventional surgery alone, besides reducing surgical trauma and hospital stay.