Fatal Complication after Thrombin Injection for Post-Catheterization Femoral Pseudoaneurysm

Gabrielli, Roberto; Rosati, M.; Vitale, Silvio; Millarelli, M; Chiappa, Roberto; Siani, Andrea; Irace, L; Caselli, Giovanni

doi:10.1055/s-0030-1270837

Cited by 15 publications

(14 citation statements)

References 16 publications

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“…Although the effectiveness of thrombin injection is widely reported, 11) fatal complications following thrombin injection have also been reported. 23) Furthermore, thrombin injection is not allowed for pseudoaneurysms as per the instructions in Japan. Therefore, we could not assess whether thrombin injection is effective for brachial pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Postcatheterization Pseudoaneurysm between Brachial Access and Femoral Access

et al. 2019

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Postcatheterization pseudoaneurysm is a serious complication following diagnostic or therapeutic catheterization. Because radial access is unsuitable in some situations, there is still a need to use femoral or brachial access for arterial catheterization. The aim of this study was to compare the incidence and clinical characteristics of pseudoaneurysm between brachial and femoral access. We identified patients who underwent arterial catheterization from our cardiac catheter records. A total of 5,990 cardiac catheter records and discharge summaries were reviewed, and 23 pseudoaneurysm cases were identified. Those pseudoaneurysm cases were divided into a brachial pseudoaneurysm group (n = 9) and a femoral pseudoaneurysm group (n = 14). The incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access (odds ratio: 4.16, 95% confidence interval: 1.80-9.65; P < 0.001). Successful manual compression was frequently achieved in both the brachial (77.8%) and the femoral (92.9%) pseudoaneurysm groups (P = 0.295). Surgical intervention was more frequently performed in the brachial pseudoaneurysm group (22.2%) than in the femoral pseudoaneurysm group (0%) without reaching statistical significance (P = 0.07). Moreover, neurological disorders were observed only in the brachial pseudoaneurysm group (22.2%). In conclusion, the incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access, indicating the potential risk of brachial access. Successful manual compression was frequently achieved in both groups, but neurological disorders were observed only in brachial access, suggesting the greater risk of brachial pseudoaneurysms.

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Section: Discussionmentioning

confidence: 99%

Comparison of Postcatheterization Pseudoaneurysm between Brachial Access and Femoral Access

et al. 2019

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“…Edgerton and Moore describe a patient with tibial-fibular trunk who required immediate surgical embolectomy [2]. Gabrielli et al published a case of a patient suffering from popliteal artery thrombosis and was treated with targeted fibrinolysis [12]. Horn et al describe two patients with complications of embolism who required immediate surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Safety evaluation of percutaneous ultrasound-guided thrombin injection into pseudoaneurysms

2019

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Summary Introduction: common application of endovascular procedures is frequently connected with increasing risk of pseudoaneurysm at the site of the artery puncture. The most frequent method of treatment of aneurysms is percutaneus ultrasound-guided thrombin injection. The aim of this research was safety evaluation of treatment of pseudoaneurysm by thrombin injection based on own experience . Methods and materials: 70 people (53% women, 43% men, average age 67.9 ±10.5) with pseudoaneurysm and under ultrasound-guided thrombin injection treatment carried out between 2007 and 2018 in the Department of General and Vascular Surgery of Pirogow Hospital in Lodz were analysed. Patients were qualified to treatment based on aneurysm and channel morphology in ultrasound examination. Before application of medicine blood supply to the limb was clinically assessed and examined using sonography. The tip of the needle was imaged into the lumen of the aneurysm. Results: in the research group, average aneurysm diameter was 29.9mm (± 17.2) within a range from 10mm to 96mm. Multi-chamber aneurysm was detected in 21% of patients. Mean channel length was 12mm (±7.7), mean width 3.5mm (±1.4), mean thrombin injected 1.7ml (±0.7) within range from 0.5 to 4ml. The treatment was successful in 94% of cases. Complications after thrombin injection occurred in 7% of cases (1 patient suffered from shock, 1 from thrombus in the saphenous vein, 3 from thrombus moving from aneurysm neck to femoral artery). No deterioration of blood supply in a limb was detected after obliteration of aneurysm. No relevant differences in aneurysm and channel dimensions were detected between groups with and without complications (p > 0.05). Conclusions: obliteration of the pseudoaneurysm by percutaneous ultrasound-guided thrombin injection is a highly effective method. This method is considered as safe, however, it requires experience. Its application may cause complications of which some are clinically significant and may lead to health and life threatening situations. In some specific cases surgical treatment of choice should be considered.

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“…У каждого из перечисленных методов есть недостатки. Лечение аневризм посредством прямой инъекции тромбина сопряжено с риском дистальной эмболии и, как следствие, тромбоза артерий нижних конечностей, вплоть до фатального исхода [10].…”

Section: оригінальні дослідженняunclassified

Experience of endovascular treatment of common femoral artery pseudoaneurysm with usage Angio-Seal Closure Device

Cherednichenko

2020

Endovasc. Neurorad.

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One case of successful treatment of the common femoral artery pseudoaneurysm with usage of modified technique of pseudoaneurysm neck sealing with Angio-Seal with retrograde access percutaneously is presented.A 52-year-old man was admitted in the recovery period of ischemic stroke in the left carotid basin. A total subtraction cerebral angiography was performed, which revealed severe stenosis in the bulb of the left internal carotid artery with ulcerated contour and severe stenosis in the ostium of the left vertebral artery. Hemostasis was performed by compression. A pressure dressing was applied for a day. The puncture site was without any problems on the next day. The patient received double antiplatelet therapy 5 days before endovascular surgery. Before surgery, palpation in the right inguinal region determines a rounded painful compaction. Carotid stenting on the left side, stenting of the left vertebral artery and control angiography of arteries of the right lower limb were performed by left-side femoral access. Pseudoaneurysm in the bifurcation of the right common femoral artery with a narrow neck was verified. Attempts to cure it by manual compression under angiographic control and ultrasound control were unsuccessful.After 6 days, endovascular treatment of pseudoaneurysms of the right common femoral artery with closure of the pseudoaneurysm neck was performed. The right common femoral artery was catheterized with left radial access with diagnostic catheter on a hydrophilic wire 0.035ʺ. This wire was carefully advanced into pseudoaneurysm through a defect in the common femoral artery and subsequently served as a marker. The pseudoaneurysm was punctured with miniaccess needle, then the 0.018ʺ wire passed through the pseudoaneurysm neck into the femoral artery retrogradly, focusing on the “marker” wire. A 6F radial introducer is introduced along 0.018ʺ wire. Further, this access was used to close the pseudoaneurysm neck with the Angio-Seal Closure Device 6F according to the standard method. In a control angiograms, a pseudoaneurysm did not contrast, arteries are passable without stenosis and signs of dissection. Hemostasis at the site of puncture of the radial artery was performed with a hemostatic bracelet. The patient was discharged from the clinic to continue treatment in a rehabilitation neurological center.This technique of endovascular treatment of postcatheterization pseudoaneurysms of the common femoral artery is quite simple, causing minimal discomfort for the patient. The closure is immediate and angiographically controled. The use of radial access instead of contralateral femoral access for introducing of a “marker” wire and angiographic control reduces the risk of local complications at the access site.

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Fatal Complication after Thrombin Injection for Post-Catheterization Femoral Pseudoaneurysm

Cited by 15 publications

References 16 publications

Comparison of Postcatheterization Pseudoaneurysm between Brachial Access and Femoral Access

Comparison of Postcatheterization Pseudoaneurysm between Brachial Access and Femoral Access

Safety evaluation of percutaneous ultrasound-guided thrombin injection into pseudoaneurysms

Experience of endovascular treatment of common femoral artery pseudoaneurysm with usage Angio-Seal Closure Device

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