Balloon-assisted ultrasound-guided direct percutaneous embolization of a peripheral pseudoaneurysm with n-butyl cyanoacrylate

Aytekin, Cüneyt; Boyvat, Fatih; Gebedek, Önder; Çoşkun, Mehmet

doi:10.1007/s00330-002-1374-6

Cited by 10 publications

(10 citation statements)

References 17 publications

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“…Arterial pseudoaneurysms in patients with radio-cephalic AVFs have previously been treated with balloon assisted techniques via a retrograde puncture of the distal radial artery [7]. The distal radial artery in this case branched after a low AVF anastomosis and was not suitable for percutaneous access, especially if a 7Fr sheath had been required for covered stent insertion.…”

Section: Discussionmentioning

confidence: 99%

Balloon Assisted, Ultrasound Guided Percutaneous Thrombin Injection of a Large Radial Artery Pseudoaneurysm Using a Trans-Venous Approach via an Ipsilateral Arteriovenous Fistula.

Gregory

Guest

Abdeen

et al. 2021

Preprint

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Background: Pseudoaneurysm formation is known to complicate arteriovenous haemodialysis access. Ultrasound guided thrombin injection is a recognised treatment option, but is not possible in pseudoaneurysms with no measurable neck. Balloon assisted techniques have been described in such cases, which transiently obstruct flow out of the pseudoaneurysm and thereby prevent non-target embolization during ultrasound guided percutaneous thrombin injection. We describe a novel balloon assisted technique for the treatment of a radial artery pseudoaneurysm, via retrograde access from the draining cephalic vein of an arteriovenous fistula. Method: A 61 year old male with a radio-cephalic fistula was found on duplex ultrasound to have a large radial artery pseudoaneurysm with no measurable neck, as well as a juxta-anastomotic cephalic vein stenosis. Endovascular treatment was selected over open surgery. Retrograde cephalic venous access was established, which allowed for concurrent treatment of both the venous stenosis and the arterial pseudoaneurysm. After balloon dilation of the juxta-anastomotic stenosis, a percutaneous transluminal angioplasty balloon catheter was advanced across the arteriovenous anastomosis and inflated across the neck of the radial artery pseudoaneurysm, to transiently obstruct blood flow. This allowed for safe injection of thrombin into the pseudoaneurysm by direct ultrasound guided sac puncture; thereby achieving thrombosis. Conclusions: Balloon assisted ultrasound guided thrombin injection is an endovascular treatment option that can obviate the need for open surgery in cases involving pseudoaneurysms with no measurable neck. The novel technique described allowed both concurrent treatment of a juxta-anastomotic venous stenosis and treatment of an arterial pseudoaneurysm from a single venous puncture. This technique avoided arterial access and its inherent complications.

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Section: Discussionmentioning

confidence: 99%

Balloon Assisted, Ultrasound Guided Percutaneous Thrombin Injection of a Large Radial Artery Pseudoaneurysm Using a Trans-Venous Approach via an Ipsilateral Arteriovenous Fistula.

Gregory

Guest

Abdeen

et al. 2021

Preprint

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“…Arterial pseudoaneurysms in patients with radio-cephalic AVFs have previously been treated with balloon assisted techniques via a retrograde puncture of the distal radial artery (Aytekin et al 2002 ). The distal radial artery in this case branched after a low AVF anastomosis and was not suitable for percutaneous access, especially if a 7Fr sheath had been required for covered stent insertion.…”

Section: Discussionmentioning

confidence: 99%

Balloon assisted, ultrasound guided percutaneous thrombin injection of a large radial artery pseudoaneurysm using a trans-venous approach via an Ipsilateral Arteriovenous Fistula

et al. 2021

View full text Add to dashboard Cite

Background Pseudoaneurysm formation is known to complicate arteriovenous haemodialysis access. Ultrasound guided thrombin injection is a recognised treatment option, but is not possible in pseudoaneurysms with no measurable neck. Balloon assisted techniques have been described in such cases, which transiently obstruct flow out of the pseudoaneurysm and thereby prevent non-target embolization during ultrasound guided percutaneous thrombin injection. We describe a balloon assisted technique for the treatment of a radial artery pseudoaneurysm, via retrograde access from the draining cephalic vein of an arteriovenous fistula. Method A 61-year-old male with a radio-cephalic fistula was found on duplex ultrasound to have a large radial artery pseudoaneurysm with no measurable neck, as well as a juxta-anastomotic cephalic vein stenosis. Endovascular treatment was selected over open surgery. Retrograde cephalic venous access was established, which allowed for concurrent treatment of both the venous stenosis and the arterial pseudoaneurysm. After balloon dilation of the juxta-anastomotic stenosis, a percutaneous transluminal angioplasty balloon catheter was advanced across the arteriovenous anastomosis and inflated across the neck of the radial artery pseudoaneurysm, to transiently obstruct blood flow. This allowed for safe injection of thrombin into the pseudoaneurysm by direct ultrasound guided sac puncture; thereby achieving thrombosis. Conclusions Balloon assisted ultrasound guided thrombin injection is an endovascular treatment option that can obviate the need for open surgery in cases involving pseudoaneurysms with no measurable neck. The technique described allowed both concurrent treatment of a juxta-anastomotic venous stenosis and treatment of an arterial pseudoaneurysm from a single venous puncture. This technique avoided arterial access and its inherent complications.

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“…Current treatment options consist of minimally invasive techniques: laparoscopic operations and endovascular or percutaneous embolisations. For percutaneous vascular occlusive procedures, a variety of devices and agents can be used: metal coils, detachable coils, gelfoam, PVA, thrombin, onyx, n-butyl cyanoacrylate (NBCA), stent grafts, and the combination of stent with coils [7–10, 16–18]. The prerequisites for a safe endovascular embolisation involve the stable position of the tip of the catheter in the target artery, clear view of the afferent and possibly efferent pseudoaneurysm arteries, the relationship of the targeted artery and adjacent arteries to minimize the risk of inadvertently embolisations, and the appearance of the pseudoaneurysm “wall,” especially because of a possible percutaneous embolisation (i.e., thrombin) [17].…”

Section: Discussionmentioning

confidence: 99%

“…This proximity prevented us from using the “sandwich technique” (isolation of PSAN) with coils or the use of liquid embolisation materials, and stent-graft as a method of treatment [10, 11, 19]. Although this was the case of a tight neck pseudoaneurysm, we did not rule out percutaneous pseudoaneurysm embolisation with NBCA with simultaneous neck occlusion by balloon catheter, which has been described in the literature [18]. However, the latter procedure was not our first method of choice.…”

Section: Discussionmentioning

confidence: 99%

Embolisation of Posttraumatic Superior Mesenteric Artery Pseudoaneurysm in a Patient with Short Bowel Syndrome Preceding Bowel Transplantation

Vidjak

Novačić

Slavica

2011

Case Reports in Radiology

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Penetrating abdominal trauma often causes bowel injuries which may lead to “short bowel syndrome” which is a potential indication for bowel transplantation. Posttraumatic pseudoaneurysms of abdominal arteries are often a result of penetrating abdominal trauma. We report a successful embolisation of posttraumatic superior mesenteric artery (SMA) branch pseudoaneurysm using microcoil, in a patient with short bowel syndrome who was successfully transplanted three months after embolisation.

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Balloon-assisted ultrasound-guided direct percutaneous embolization of a peripheral pseudoaneurysm with n-butyl cyanoacrylate

Cited by 10 publications

References 17 publications

Balloon Assisted, Ultrasound Guided Percutaneous Thrombin Injection of a Large Radial Artery Pseudoaneurysm Using a Trans-Venous Approach via an Ipsilateral Arteriovenous Fistula.

Balloon Assisted, Ultrasound Guided Percutaneous Thrombin Injection of a Large Radial Artery Pseudoaneurysm Using a Trans-Venous Approach via an Ipsilateral Arteriovenous Fistula.

Balloon assisted, ultrasound guided percutaneous thrombin injection of a large radial artery pseudoaneurysm using a trans-venous approach via an Ipsilateral Arteriovenous Fistula

Embolisation of Posttraumatic Superior Mesenteric Artery Pseudoaneurysm in a Patient with Short Bowel Syndrome Preceding Bowel Transplantation

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