Delayed pseudoaneurysm repair: A case report

Abstract

Iatrogenic pseudoaneurysms are a complication of arterial catheterization performed for both diagnosis and intervention. Their incidence is approximately 1% following diagnostic catheterizations and 3.2% after interventional procedures. The symptoms of iatrogenic pseudoaneurysm are pain and swelling. The preferred method of treatment consists of thrombin injection under ultrasound guidance, although compression can be used. Most published research describes pseudoaneurysms that occurred close to the time of catheterization; the present case report describes a patient who presented two years postcatheterization with a symptomatic pseudoaneurysm.

Treatment of Iatrogenic Pseudoaneurysms Using Ultrasound-Guided Thrombin Injection over a 5-Year Period

“…Their incidence is 1% following diagnostic catheterizations and 3.2 to 7.7% after interventional procedures. 1 Diagnosis of iatrogenic pseudoaneurysms relies on a high index of suspicion by the clinician. They are diagnosed clinically with real-time duplex ultrasonography.…”

Pseudoaneurysms of the Peripheral Arteries

“…3 This modality has the advantage of being efficacious in both acute and chronic pseudoaneurysms as it can be used in pseudoaneurysms up to 2 years old. 14 UGTI is also not impacted by anticoagulation. Schneider et al demonstrated in their series of UGTI an overall 97% efficacy of thrombin injection in all of their patients, and their anticoagulation status (19% of the patients) had no impact on the efficacy of pseudoaneurysm thrombosis.…”

“…The success rate using ultrasound-guided compression therapy is only 60 to 93%. [14][15][16] The disadvantages of the procedure include increased time for the ultrasonographer, pain for the patient, prolonged hospital stay due to the need for multiple attempts, and postprocedure surveillance, and increased failure rates with anticoagulation. 14 Ultrasound-guided compression therapy has the advantage of a lower chance of occlusion of the native vessel due to thrombus propagation with thrombin administration and no risk of the side effects associated with the systemic injection of thrombin.…”

“…16 Most published reports of UGTI treatment is in the femoral arteries (common, profunda femoral, and superficial femoral). 1,3,14 However, Jargiełło et al, in their series of pseudoaneurysm treatments, did treat a small number of upper extremity pseudoaneurysms in the brachial and radial arteries with good success. 20 Generally, it is accepted that a reasonable neck, connection tract between the sac and source artery, needs to be present to perform UGTI.…”

“…(B) Thrombosed left common femoral artery pseudoaneurysm 24 hours after thrombin injection. Source: Franz and Hughart 14.…”