Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin

Abstract

The number and complexity of endovascular procedures performed via either arterial or venous access are steadily increasing. Albeit associated with higher morbidity compared to the radial approach, the traditional common femoral artery remains the preferred access site in a variety of cardiac, aortic, oncologic and peripheral vascular procedures. Both transarterial and venous cannulation (for electrophysiology, intravenous laser ablation and central catheterisation) at the groin may result in potentially severe vascular access site complications (VASC). Furthermore, vascular and soft-tissue groin infections may develop after untreated VASC or secondarily to non-sterile injections for recreational drug use. VASC and groin infections require rapid diagnosis and appropriate treatment to avoid further, potentially devastating harm. Whereas in the past colour Doppler ultrasound was generally used, in recent years cardiologists, vascular surgeons and interventional radiologists increasingly rely on pelvic and femoral CT angiography. Despite drawbacks of ionising radiation and the need for intravenous contrast, multidetector CT rapidly and consistently provides a panoramic, comprehensive visualisation, which is crucial for correct choice between conservative, endovascular and surgical management. This paper aims to provide radiologists with an increased familiarity with iatrogenic and self-inflicted VASC and infections at the groin by presenting examples of haematomas, active bleeding, pseudoaneurysms, arterial occlusion, arterio-venous fistula, endovenous heat-induced thrombosis, septic thrombophlebitis, soft-tissue infections at the groin, and late sequelae of venous injuries.Teaching Points• Complications may develop after femoral arterial or venous access for interventional procedures.• Arterial injuries include bleeding, pseudoaneurysm, occlusion, arteriovenous fistula, dissection.• Endovenous heat-induced thrombosis is a specific form of iatrogenic venous complication.• Iatrogenic infections include groin cellulitis, abscesses and septic thrombophlebitis.• CT angiography reliably triages vascular access site complications and groin infections.

Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology

“…Patients with obesity, pre-existing vascular disease, female gender (smaller vessels), and advanced age are at higher risk. 179 In general, ultrasound-guided puncture may be appropriate to reduce VASC in EP procedures. 180 , 181 Haemodynamic instability, swelling, pulsatile mass, bruits, neurological symptoms, unusual or protracted pain at the puncture site, pelvis or leg (femoral access), or a relevant haemoglobin drop (≥2 mg/dL) following a procedure should trigger urgent imaging of the region.…”

"Investigation of Oxidative Stress Index in Radial Angio Patients"

“…OSI (Arbitrary Unit)=TOS (mmol H2O2 Equiv./L)/TAS (µmol/L Trolox Equiv./L). Results are expressed as Arbitrary Units (AU).Today, Healthy Individuals is safely performed in a widespread disease group [1][2][3][4][5][6]. Oxidative stress, on the other hand, is evaluated in a wide range, and its relationship with many diseases is revealed with new research every day.…”

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

“…3 Computed tomography angiography can elucidate the specific location, extent, collateral conditions, and the relationships of complex lesions with surrounding tissues. 4 An FAP can cause compression of the surrounding nerves and tissues, rupture and bleeding of the aneurysm, and formation and dislodgement of thrombi, thus leading to distal limb embolism, tissue necrosis, and infection. Therefore, treatment of an FAP should commence immediately after diagnosis.…”

“…Color or spectral Doppler ultrasonography may help to identify these features and in the differential diagnosis of FAP from hematoma and arteriovenous fistula 3 . Computed tomography angiography can elucidate the specific location, extent, collateral conditions, and the relationships of complex lesions with surrounding tissues 4 . An FAP can cause compression of the surrounding nerves and tissues, rupture and bleeding of the aneurysm, and formation and dislodgement of thrombi, thus leading to distal limb embolism, tissue necrosis, and infection.…”