Ultrasound-guided Manual Compression Research Articles

Microvascular tissue perfusion after postcatheterization pseudoaneurysm treatment.

Femoral pseudoaneurysm (PSA) is a severe complication after endovascular procedures. Ultrasound-guided manual compression (MC) and percutaneous thrombin injection (TI) are frequently used treatments. MC is less effective, TI may cause thromboembolic events. Up to date, there is no data regarding impairment of microvascular tissue perfusion after PSA treatment. In this single-center, prospective study 22 patients with PSA were included. We compared macro- and microcirculatory perfusion in the treated and untreated leg at baseline before, after and one day after treatment. Leg perfusion was assessed with ultrasound and ankle-brachial index (ABI). Microcirculatory perfusion of the feet was measured with a near-infrared spectroscopy (NIRS) camera generating StO2-tissue-maps. Successful PSA thrombosis was achieved in 16 (100%) patients in TI group and in 4 (66.7%) patients in MC group. There was no evidence of arterial thrombi on ultrasound and the ABI did not differ between groups. NIRS StO2-tissue-maps of the feet showed no significant difference in both groups concerning the treated (p = 0.121) or the untreated (p = 0.198) leg during follow up. In this small exploratory study, there was no evidence of micro- and macrovascular tissue perfusion impairment after treatment of postcatheterization femoral pseudoaneurysm with thrombin injection underscoring the safety of this approach.

Successful treatment of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression.

Pseudoaneurysm is a well-recognized complication seen in arteriovenous fistula (AVF) which usually involves the venous segments. Ultrasound-guided manual compression (UGMC) is a non-invasive and effective treatment for the management of pseudoaneurysms involving the venous segment. Pseudoaneurysm of the arterial segment of AVF is rare complication which usually needs surgical intervention. We report the first successful treatment case of a brachial artery pseudoaneurysm in a brachiobasilic arteriovenous fistula using ultrasound-guided manual compression. The patient presented with a 30 × 30mm pulsatile swelling below the cubital fossa after second session of hemodialysis using an AVF created 8weeks earlier. Ultrasound doppler demonstrated a brachial artery pseudoaneurysm in the non-transposed brachiobasilic fistula. Complete occlusion of the cavity with thrombus formation was accomplished after 55min of compression and the psuedoaneurysm did not recur. UGMC can be an alternative treatment option for select cases of arterial segment pseudoaneurysm in AVF.

The Importance of Ultrasound-Guided Manual Compression in Iatrogenic Pseudoaneurysm Treatment: The Sooner the Better

Objective: Although ultrasound-guided manual compression is a safe and cost-effective method in the treatment of pseudoaneurysm, there are many factors affecting the success of the procedure. This study aimed to determine the factors affecting the success of ultrasound-guided manual compression. Methods: The records of patients who developed iatrogenic femoral artery pseudoaneurysm in the cardiology department between 2017 and 2020 were retrospectively analyzed. Data regarding patients, procedural and aneurysm-related factors were evaluated by univariate and multivariate logistic regression analysis. Results: Seventy-five patients who underwent ultrasound-guided manual compression were included in our study. In study population, the rate of successful ultrasound-guided manual compression is 72%. As a result of the univariate analysis, hypertension, diabetes mellitus, sheath size, the length of aneurysm sac, the width of aneurysm sac, compression duration, aneurysm detection time> 24 hours parameters were found to be significant predictors for failed ultrasound-guided manual compression. In the multivariate analysis, it was found that the independent predictors associated with failed ultrasound-guided manual compression were the aneurysm detection time longer than 24 hours and the length of aneurysm sac (odds ratio: 5.908; 95% CI 1.136-30.720; P=.035 and odds ratio: 1.042; 95% CI 1.008-1.100; P=.045). In receiver operating characteristic (ROC) curve analysis, the length of the pseudoaneurysm sac of 34 mm and above had 90% sensitivity and 57% specificity for failed ultrasoundguided manual compression. Conclusions: Ultrasound-guided manual compression is an effective method in the treatment of pseudoaneurysm. However, early detection and size of pseudoaneurysm are important for the success of this treatment. Checking the operation site within the first 24 hours after catheterization is important for early diagnosis and treatment of possible complications. In addition, it should be considered that treatment success is low in length of pseudoaneurysm sacs longer than 34 mm.

Coil Embolization of Iatrogenic Femoral Artery Pseudoaneurysm

<h3>Introduction and Objective</h3> Femoral pseudoaneurysms are not uncommon after cardiac catheterizations. Multiple methods are used to treat pseudoaneurysms including ultrasound guided thrombin injection, direct pressure, stent grafting, open surgical repair and endovascular coil embolization. We describe a patient with severe comorbidities with complicated femoral pseudoaneurysm treated with emergent coil embolization via radial access. <h3>Case Report</h3> An obese 77-year-old female with multiple comorbidities, who was deemed a prohibitive risk for cardiac surgery, was taken to the cardiac cath lab for percutaneous coronary intervention. She underwent balloon valvuloplasty of the aortic valve in addition to placement of drug-eluting stents in the left main, LAD, diagonal and circumflex arteries. This was accomplished through a 10 French sheath placed in the left common femoral artery. The groin was closed with two Perclose devices. An immediate hematoma developed in the left groin. Manual pressure was held until the patient was stable. She was then transported to the ICU. Shortly after arrival in the ICU, the patient developed hypotension. She was taken back to the cardiac cath lab where she underwent an arteriogram via the left radial artery. Contrast extravasation was noted from the left femoral artery. Several attempts to control hemorrhage with balloon occlusion were unsuccessful. Urgent vascular surgery consultation was obtained. Patient was emergently moved to the endovascular operating room. Left femoral arteriography via left radial access revealed active contrast extravasation from the femoral bifurcation into a large pseudoaneurysm cavity. A vertebral catheter was used to advance a glide wire into the pseudoaneurysm. A microcatheter was then advanced into the pseudoaneurysm cavity. The pseudoaneurysm was embolized with two detachable 6 × 12 Penumbra Ruby coils. Post embolization, there was minimal flow into the pseudoaneurysm. Duplex ultrasound performed the next day revealed minimal flow in the pseudoaneurysm cavity with a maximal flow lumen of 1 cm. This was observed and it spontaneously thrombosed. The patient ultimately recovered and returned to her baseline medical status. <h3>Discussion</h3> A variety of methods are available for the treatment of pseudoaneurysms. Traditional treatment options include ultrasound-guided manual compression, thrombin injection and open surgery. With the development and evolution of endovascular techniques, less invasive options such as stent graft coverage and coil embolization can be successfully utilized. There are few case reports of coil embolization of femoral pseudoaneurysms. In selected patients, coil embolization may be an effective alternative to surgical treatment and can be offered by the vascular surgeon.

Pseudoaneurysma nach transradialer Punktion bei systemischer Lyse einer Basilaristhrombose

Because of neurological symptoms as a result of thrombotic occlusion of the basilar artery, a successful revascularization after systemic Actilyse application was performed in a 78 year old patient. Later, it came to the formation of a pseudoaneurysm at the radial artery, punctured for invasive blood pressure measurement. After oscillographic respectively ultrasound detection of a 2 cm wide pseudoaneurysm from the radial artery, the surgical resection of the aneurysm sac was performed. An ultrasound-guided manual compression due to the localization of a thrombus close to the aneurysm neck could not be conducted. The further clinical course was unremarkable. With an increasing number of pseudoaneurysms as a complication of transradial puncture occuring more frequently in the context of intensive care supply and rising outpatient cardiac catheterization (coronary angiography and PCI), the knowledge of care options of vascular complications are of particular importance before practical application.

Remote Telementored Ultrasound-Directed Compression to Potentially Accelerate Hemostasis in Exsanguinating Junctional Vascular Injuries.

Bleeding to death has been identified as the leading cause of potentially preventable injury-related death worldwide. Temporary hemorrhage control could allow the patient to be transported to a site capable of damage- control surgery. A novel device that may offer a fast and effective means of controlling nontruncal bleeding (junctional and extremity) is the iTClamp (Innovative Trauma Care; http://innovativetraumacare.com). This case study demonstrated that a motivated and intelligent, but untrained, first responder could successfully localize the actual anatomic site of an exsanguinating bleed and then could relatively easily compress this site to control the bleeding site by using ultrasound-guided manual-compression techniques.

Cardiologist Operated Ultrasound Guided Thrombin Injection as a Safe and Efficacious First Line Treatment for Iatrogenic Femoral Artery Pseudoaneurysms

To assess the efficacy and safety of ultrasound guided thrombin injection (UGTI) as a first line treatment for post arterial cannulation iatrogenic femoral artery pseudoaneurysms (IFAP). IFAPs complicate up to 1% of diagnostic and 8% of interventional cardiac catheterisation procedures. UGTI remains a second line or non-attempted treatment after ultrasound guided manual compression (UGMC) and surgical repair in many centres. A retrospective review was undertaken of 121 consecutive patients who received UGTI as a first line treatment for IFAPs following cardiac diagnostic, interventional or catheter ablation procedures between 1999 and 2011 at our centre. The mean patient age was 70.7 years and 63% were male. At the time of injection, 89% were on at least one antiplatelet or anticoagulant. Pseudoaneurysms had a mean maximum dimension of 26.7mm (range 10-122mm) and 25% were multilobed. UGTI was performed by an interventional cardiologist with a mean bovine thrombin dose of 648 IU (range 50-5000 IU). Primary success, defined as immediate IFAP thrombosis with UGTI, was achieved in 111 (92%) patients. Recurrence occurred in seven patients, three of whom required surgical repair. Multilobed IFAPs had significantly lower primary success rates than unilobed IFAPs (80% vs. 96%, p=0.016). Antiplatelet and anticoagulant use and IFAP size did not significantly affect outcomes. UGTI was not associated with any serious complications (such as thromboembolism, aneurysm rupture, venous thrombosis or abscess formation). Interventional cardiologist operated UGTI should be considered as a first line therapy for uncomplicated IFAPs following interventional and diagnostic cardiac procedures. Despite high rates of concomitant antiplatelet and antithrombotic therapy, initial thrombosis rates exceeded 90% and we did not experience serious complications.

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.

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

Post-traumatic pseudoaneurysm of radial artery: Percutaneous treatment with thrombin injection

Most peripheral pseudoaneurysms are iatrogen or, less commonly, post-traumatic. A post-traumatic pseudoaneurysm is a localized haematoma with a persistent communication with the native artery via a narrow neck. Pseudoaneurysms have typical findings such as a pulsatile palpable mass, a ‘‘yin/yang’’ sign on colour flow imaging and the typical ‘‘to and fro’’ sign on Doppler waveform analysis. Pseudoaneurysm can arise from the venous segments or from the artery. Venous pseudoaneurysms have a low complication rate, but arterial pseudoaneurysms have an unpredictable natural history and complications include expansion, rupture, arterial thrombosis and the radial steal syndrome. The diagnosis can be easily confirmed using colour duplex ultrasound. Ultrasound-guided manual compression is the usual method for the obliteration of a pseudoaneurysmbut it is often timeconsuming, uncomfortable for the patient and staff, and not always successful. Percutaneous ultrasound-guided thrombin injection has been reported for femoral artery pseudoaneurysms, the commonest site of iatrogenic trauma,

Posttraumatic Pseudoaneurysm in Scalp Treated by Direct Puncture Embolization Using N-Butyl-2-Cyanoacrylate: a Case Report

Here, we report a case of scalp pseudoaneurysm which was treated by direct puncture embolization using n-butyl-2-cyanoacrylate. The patient had a history of blunt trauma in the previous two months. Ultrasound-guided manual compression was initially attempted, but the results were unsatisfactory. Direct puncture embolization was then performed, and the pseudoaneurysm was completely obliterated. Non-surgical treatment options for pseudoaneurysm are briefly discussed.

Thrombin injection for treatment of false aneurysms after failed compression therapy in patients on full-dose antiplatelet and heparin therapy.

The aim of this study was to gauge the effectiveness of thrombin injection after failed manual compression in patients with false aneurysms receiving full-dose antiplatelet and heparin therapy. In consecutive patients with failed manual compression therapy (ultrasound-guided manual compression, compression bandage, or both), thrombin was injected under ultrasound guidance. In 23 patients, thrombin was injected into the false aneurysm (100-2,000 units; mean, 895 +/- 520 units). All patients were on aspirin (median dose, 100 mg/day), clopidogrel (median dose, 75 mg/day), and either heparin (n = 3) with a partial thromboplastin time (PTT) > 55 sec or weight-adjusted enoxaparine (0.1 ml per 10 kg; maximum, 1 ml/b.i.d.). Twelve patients had received an i.v. GB IIIb/IIa antagonist 11-72 hr prior to diagnosis of the aneurysm. The mean width of the false aneurysms was 20.8 +/- 3.2 mm (range, 8.0-52.0 mm), length 29.7 +/- 32.6 mm (range, 9.0-147 mm), and depth 19 +/- 9.1 mm (range, 5.1-35.5 mm). Thrombosis after thrombin injection occurred in 21 patients within seconds. One patient required a second injection the next day, one patient underwent surgery. Overall success rate was 96%. No in-hospital complications occurred. In patients with false aneurysms and failed compression therapy under full-dose aspirin, clopidogrel, and heparin, selective thrombin injection is highly effective and safe.