Combining Percutaneous Ultrasound-Guided Hematoma Aspiration and Compression Repair to Treat Femoral Artery Pseudoaneurysm after Cardiac Catheterization

Abstract

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.

Pseudoaneurysm Infection Ballooning Out of Control Following Sequential Cardiac Catheterizations: A Case Report

“…The mechanism of injury, in this case, is related to direct trauma to the arterial wall during the procedure, as well as underlying arterial disease and coagulopathy. Puncture sites have varying degrees of associated risk related to PSA formation, with femoral access procuring less risk than brachial access [ 1 , 2 ]. Manual compression has also been found to decrease the risk of PSA formation [ 2 , 6 ].…”

“…CT angiography may also be used as an imaging modality, as it provides more information on the anatomy of the affected area [ 8 ]. Treatment options include conservative management, compression therapy, thrombin injection, or surgical intervention, depending on the size and location of the PSA [ 1 , 7 , 9 ]. Ultrasound-guided compression repair and thrombin injection are preferred treatment options for non-complicated PSAs; however, surgical intervention is indicated in PSAs that are infected, progressively growing, compressing underlying structures, or causing skin necrosis [ 7 , 10 ].…”

“…The point of entry for vascular access is decided depending on the procedure, the patient's presentation, past history, and anatomical concerns. For cardiac catheterization, typical access sites are either the radial or femoral arteries [1][2][3]. Infection is a well-known risk of access for endovascular procedures and indwelling lines [3].…”

A patient with femoral artery pseudoaneurysm treated with ultrasound‐guided injection of an exogenous lyophilized human fibrin sealant

“…Jalaeian et al 9 reported one patient who was on long‐term hemodialysis who died due to an anaphylactic reaction to bovine thrombin. Although some studies reported the use of autologous thrombin or recombinant human thrombin to treat pseudoaneurysms in an effort to reduce the risk of anaphylaxis, Chen et al 10 reported this treatment did not reduce the risk of arterial thrombosis and was also expensive.…”

Iatrojenik Femoral Psodoanevrizmalarin Ultrason Esliginde Trombin Enjeksiyonu ile Tedavisi: Tek Merkez Sonuclari

“…Ancak bu çalışmada hastaların yaşının nispeten genç olması, psödoanevrizma kesesinin tek odacıklı olması gibi kısıtlamalardan bahsedilmiştir. Ayrıca daha yüksek vücut kitle indeksi olan hastalarda aspirasyon ve kompresyonun yetersiz olabileceği belirtilmiştir (23).…”