Ultrasound-guided Compression Research Articles

Observation of ultrasound-guided thrombin injection in the treatment of 30 patients with femoral artery pseudo-aneurysm

Objective To study the clinical applicated value of thrombin injection in the treatment of 30 patients with femoral artery pseudo-aneurysm guided by color Doppler ultrasound. Methods 60 patients with femoral artery pseudoaneurysm were selected as the observation group, according to a random number table, they were divided into A group and B group, A group was treated with ultrasound guided compression therapy, B group was treated with ultrasound guided thrombin injection;also early femoral artery pseudoaneurysm OK conventional surgical methods for the treatment of 30 patients in the control group. The statistical method of uhrasound-guided two treatment success rate,thrombus formation time and observation group and control group success rate and complication rate. Results Ultrasound-guided compression therapy for 30 cases, 14 cases of successful initial oppression, oppression success rate of 46.6% for the first time,repeat oppression the success rate of 87.5%. Two cases were cured after thrombin injection therapy. B group was treated with thrombin injection of endovascular,24 cases in 30 cases were cured after first injection, the first injection success rate of 80.0% ;all cases were cured after two injections. Thrombus formation time was （0.30 ± 0.05 ）min. treatment success rates for the first time and thrombus formation time were significantly different（ all P 〈 0.01 ）. 30 cases were cured by surgical treatment. Postoperative complication rate was 6.7%. The first treatment success rates and complication rates of the two groups were significantly different（ P 〈 0.05 ）. The total success rates of the observation group and the control group were 100% respectively. The difference was not statistically significant（ P 〉 0.05 ）. Compared with the observation group, the incidence rate of postoperative complications of con- trol group was 6.7% （P 〉 0.05）. Conclusion In the femoral artery pseudoaneurysm positioning and puncture therapy, Color Doppler ultrasound-guided thrombin may provide a reliable basis, thrombosis treatment success rate and thrombus formation time were significantly better than that of ultrasound-guided compression therapy ,which has broad application prospects. Key words: Uhrasonography, Interventional ; Therapies, Investigational; Aneurysm, False

Arterial Pseudoaneurysm in Neonates with Hemophilia: Successful Treatment with Noninvasive Clotting Factor Replacement and Ultrasound-guided Compression

Vascular cannulation is an invasive procedure that carries the risk of complications such as pseudoaneurysms. Hemophilia, the most common severe bleeding disorder of inheritance, increases the risk of such complications through underlying hypocoagulability. Although surgical ligation has been considered the gold standard treatment, less invasive options are currently available. Here we present 2 hemophiliac neonates for whom clotting factor replacement and ultrasound (US)-guided compression were successfully used. A 3-week-old male infant and a 4-week-old male infant presented with masses in the left antecubital area and the radial aspects of both wrists, respectively, after arterial punctures. The US confirmed the presence of pseudoaneurysms located at the left brachial artery and right radial artery. US-guided compressions with clotting factor administration initially attempted while confirming a thrombus inside the pseudoaneurysm sac indicated successful management. Arterial cannulation and other procedures in hemophiliac neonates must be attempted with caution because pseudoaneurysms or uncontrolled bleeding may occur. If laboratory analyses or invasive procedures are needed for neonates with a bleeding tendency or a suspected hemophiliac disorder, arterial or venous cannulation requires more caution or should be avoided if possible. This case report suggests that US-guided compression and clotting factor administration are suitable modalities for the treatment of small pseudoaneurysms in hemophilia patients.

Percutaneous ultrasound-guided thrombin injection is effective even in infants with external iliac artery pseudoaneurysms.

Iatrogenic pseudoaneurysms are extremely rare in children. Conventional management of pseudoaneurysms in adults has included surgical repair, ultrasound-guided compression, and more recently, endovascular embolization. However, in infants and children, there is little information regarding the applicability of such treatment modalities, which have been effective in adults, because of its rarity. Here, we present the case of a 6-month-old infant who developed a postprocedural pseudoaneurysm of the external iliac artery, which was successfully treated with ultrasound-guided percutaneous thrombin injection.

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.

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.

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.

Stomal Varices: Management With Decompression TIPS and Transvenous Obliteration or Sclerosis

Stomal or parastomal varices are extraperitoneal ectopic mesenteric varices. Parastomal varices are not common but can be a source of considerable bleeding. They usually occur in the setting of portal hypertension, although, in theory, they can occur because of vascular thrombosis of the mesentery. An obstructive element (not necessarily venous thrombosis, but a constrictive effect) most likely exists and thus localizes the bleeding to the stomal mesenteric varices. This obstruction can be due to postsurgical changes associated with the stoma creation itself. Bleeding is the main presentation of stomal varices. Bleeding can be life threatening; however, most of it can be controlled by manual compression by patients who are consciously aware. Anecdotally, there are 2 pathologic bleeding presentations. Certain stomas are diffusely congested and ooze blood diffusely, and others bleed focally from a particular site (from a particular mesenteric varix). The focal bleeders are the ones that respond favorably to manual compression by the patient. The stomas that are diffusely congested or engorged with diffuse venous oozing do better with transjugular intrahepatic portosystemic shunt (TIPS) decompression. Bleeding from focal varices in the stoma (with the rest of the stomal mucosa looking normal and not engorged) can be treated with TIPS (if the portal or mesenteric vein or both are patent) or with transvenous obliteration utilizing 1% sodium tetradecyl sulfate (not 3% sodium tetradecyl sulfate). Balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration, trans-TIPS balloon-occluded antegrade transvenous obliteration can all be adequate approaches to transvenous obliteration. However, the least invasive (in the authors' opinion) and simplest is the direct mesenteric venous stick (balloon-occluded antegrade transvenous obliteration-type) approach with ultrasound-guided compression of the systemic outflow vein.

Radial artery pseudoaneurysm as an extremely rare complication associated with transradial catheterisation

The transradial approach has recently been recommended as the first choice of arterial access to reduce vascular complications during percutaneous coronary diagnostic and interventional procedures. Radial artery pseudoaneurysm is an extremely rare complication associated with transradial access. We report such a case in an 85 year-old woman with a diagnosis of coronary artery syndrome who underwent cardiac catheterisation via the transradial approach. An 85 year-old woman with a history of hypertension and recurring chest pain, slightly elevated level of troponin I (0.9 [n: < 0.1] ng/mL), left bundle branch block and atrial fibrillation on ECG tracing (duration unknown) was referred to our department with a diagnosis of acute cardiac syndrome. Before admission, she was treated with acetylosalicic acid, perindopril, bisoprolol and indapamide. Echocardiography showed a slightly enlarged left ventricle with decreased ejection fraction (45%), moderate mitral regurgitation and slightly enlarged left atrium. Coronary angiography performed via the left radial artery using a 6 F catheter sheath and 5 F diagnostic catheters revealed non-significant atherosclerosis in coronary arteries. As per convention, a 5,000 IU heparin bolus was administered though the sheath. The arterial sheath was withdrawn just after the procedure and a compressive dressing was applied for 2 h. The next morning, enoxaparin was administered because of sustained atrial fibrillation (AF) with a CHA2DS2-VASc score of 4. Two days after the radial artery puncture, a painful swelling with a small haematoma was noted at the site of radial access. Colour Doppler ultrasonography (USG) revealed a pseudoaneurysm (Fig. 1A) with a typical to-and-fro flow in its neck (Fig. 1B). Enoxaparin was stopped and prolonged compression was applied for the next 24 h, but only partial thrombosis with continued flow through the neck was seen on follow-up USG (Fig. 2). After obtaining verbal informed consent, the patient underwent ultrasound-guided compression therapy for 25 min at the neck of the pseudoaneurysm, successfully obtaining complete thrombosis (Fig. 3). The sinus rhythm was restored spontaneously, but short episodes of AF were recorded on 24-h ECG monitoring. After confirmation 2 weeks later of complete resolution of the radial artery pseudo aneurysm and normal blood flow in the radial artery, oral anticoagulation was recommended. Although uncommon, radial-related vascular complications are possible and may not be trivial. Early confirmation and treatment of a radial artery pseudoaneurysm using USG is essential to avoid further complications such as hand ischaemia, compartment syndrome, neurologic complications and spontaneous rupture.

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.

Effect of foam sclerotherapy on healing and long-term recurrence in chronic venous leg ulcers

The ESCHAR trial showed that superficial venous surgery and compression in chronic venous ulceration achieved a 24-week healing rate of 65% and 12-month recurrence rate of 12%. Foam sclerotherapy treatment is an alternative to surgery. The aim of this study is to assess the effect of foam sclerotherapy on ulcer healing and recurrence in chronic venous leg ulcers. Chronic venous leg ulcers (CEAP [clinical, aetiological, anatomical and pathological elements] 5 and CEAP 6) with superficial venous reflux were treated between March 2006 and June 2011 with ultrasound-guided foam sclerotherapy and compression.Venous duplex was performed on all legs before and after treatment. Twenty-four-week ulcer healing and one- and four-year ulcer recurrence rates were calculated using Kaplan–Meier survival analysis. Two hundred legs (186 patients) with chronic venous ulcers (CEAP 5: n ¼ 163 and CEAP 6: n ¼ 37) were treated with foam sclerotherapy. Complete occlusion was achieved in 185/200 (92.5%) limbs, short segment occlusion in 14/200 (7%) limbs and one leg segment failed to occlude. One patient suffered an asymptomatic non-occlusive deep vein thrombosis (DVT) diagnosed on duplex scan at one week and one presented with an occlusive DVT three weeks following a normal scan at one week. One patient developed an asymptomatic occlusive DVT at two weeks following a non-occlusive DVT diagnosed on initial one-week scan. Eighteen patients were lost to follow-up (3 moved away and 15 died of unrelated causes). The 24-week healing rate was 71.1% and one- and four-year recurrence rates were 4.7% and 28.1%, respectively. Foam sclerotherapy is effective in abolition of superficial venous reflux and may contribute to similar ulcer healing and long-term recurrence rates to superficial venous surgery. Foam sclerotherapy is an attractive alternative to surgery in this group of patients.

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.

A Case of Deep Vein Thrombosis Following Ultrasound-Guided Compression of a Pseudoaneurysm

Correspondence to Sung Il Choi, M.D. Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri 471-701, Korea Tel: +82-31-560-2599, Fax: +82-31-560-2598, E-mail: saint536@hanmail.net Copyrightc 2013 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 가성동맥류의 초음파 유도 압박법 시행 후 발생한 심부정맥 혈전증 1예

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.

Successful Use of Ultrasound-Guided Compression for a Princeps Pollicis Artery Pseudoaneurysm: Case Report

A 73-year-old man receiving heparin developed a large hematoma in the first web after a routine blood draw. Color Doppler ultrasound demonstrated a pseudoaneurysm of the princeps pollicis artery. Ultrasound-guided compression resulted in successful thrombosis of the pseudoaneurysm.

Anatomical Resection of Segment 8 by Means of Ultrasound-Guided Vessel Compression

Anatomical resection is the gold standard for liver resection in patients with hepatocellular carcinoma (HCC). Bimanual hepatic vessel compression has been already described, although segmental and subsegmental resection of segment 8 (S8) remain challenging by this technique. We demonstrate how to obtain a S8 demarcation by means of ultrasound-guided vessel compression. Two patients with HCC with hepatitis C virus-related cirrhosis partially or fully located in S8 without portal thrombosis underwent liver resection. In the first patient with a HCC fed by subsegmental glissonian pedicles to S4 superior (P4sup) and S8 ventral (P8v), the resection area was disclosed by direct compression of the aforementioned feeding pedicles. A second patient had a HCC located in S8 ventral with a satellite in S8 dorsal; the patient had a pedicle to the right anterior sector originating from the left portal vein. The resection area was obtained by means of direct compression of the P8d and countercompression of the left portal vein (peripherally to the origin of the pedicle to the anterior sector), and P5. Countercompression was needed because of the peculiar trajectory of P8v passing across the middle hepatic vein. In neither case was there a congested area. In the first patient, hepatic veins were not exposed because it was a resection conducted in a subsegmental fashion. There was no morbidity, and no blood transfusions were needed. Patients were both discharged on day 8 after surgery. Disclosure of subsegmental portions of S8 by means of intraoperative ultrasound-guided compression technique is feasible and confirms the reliability of this approach.

Color Doppler ultrasound‐guided transducer compression of post biopsy bleeding of kidney transplants

Color Doppler ultrasound (CDUS) has a potential of early detection of post biopsy bleeding. We describe CDUS guidance in planning, acquisition, and, in the case of bleeding, compression of the needle tract in biopsy procedures of kidney transplants. Eighty-three kidney transplant biopsy procedures performed on clinical indication were performed in 71 adult patients, 25 women, mean age 51 years, using CDUS and 18-G biopsy needles. Bleeding needle tracts were compressed using CDUS guidance. CDUS immediately detected blood leakage and facilitated compression of the bleeding needle tract in 34 (41%) of the 83 procedures, including 53 (25%) of 215 needle passes. In 34 bleeding procedures, the mean duration of the longest bleeding time after a needle pass was 124 seconds (median, 20 seconds; range, 3-1440 seconds). In 12 of these procedures (35%), the bleeding time was 30 seconds or more. In six procedures (18%), a bleeding of 120 seconds or more was observed. Complications included seven small hematomas. Five hematomas developed in procedures where the longest duration CD bleeding was 120 seconds or more. CDUS detects bleeding and facilitates direct transducer compression of the needle tract in a substantial portion of biopsy procedures of kidney transplants. Only minor hematomas occurred.

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.

Pseudoaneurysm of the genicular artery after wound closure using a skin stapler in a child

A 9-year-old child with a left humerus fracture also had minor skin cuts on the right knee, which were closed with a skin stapler. After 1 week, a medial superior genicular artery pseudoaneurysm developed, which was treated by ultrasound-guided compression. This case illustrates a unique complication of the use of a skin stapler device.

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.

An undiagnosed pseudoaneurysm found during arterial catheterization in a Takayasu arteritis patient

An undiagnosed pseudoaneurysm found during arterial catheterization in a Takayasu arteritis patient