Percutaneous ultrasound guided thrombin injection for axillary artery pseudoaneurysm following stenting of the arterial duct in two infants: Case report with review of literature

Karmegaraj, Balaganesh; Prabhu, Nirmalkumar; Kappanayil, Mahesh; Kumar, Raman

doi:10.1002/ccd.28174

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…Treatments for AA-PSA reported in previous case reports and series include surgery, ultrasound-guided compression [ 10 ], percutaneous thrombin injection [ 11 ], and endovascular treatment (stent-graft placement and embolization) [ 8 ]. We opted for embolization over surgery owing to the high risk of intraoperative bleeding and anastomotic leak, as well as chronic nerve compression.…”

Section: Discussionmentioning

confidence: 99%

Coil embolization of a giant pseudoaneurysm associated with a disrupted axillary artery: a case report

Oka,

Kuriyama,

Ishisaka

2024

CVIR Endovasc

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Background Stent-graft placement is generally used to treat pseudoaneurysm (PSA) of the axillary artery (AA) trunk to maintain the patency of peripheral vessels. Coil embolization of a PSA associated with a disrupted AA trunk has rarely been reported. Case presentation A 54-year-old woman presented with swelling of her right shoulder. She had had a right proximal humeral fracture 12 years earlier. Contrast-enhanced computed tomography (CECT) and subsequent angiograms revealed a giant PSA at the disrupted, distal right AA. There were collateral flows to the brachial artery from the proximal to the right AA. To preserve collateral flows to the brachial artery, selective embolization of the inflow artery that derived from the distal AA was performed with hydrogel-coated coils. The post-embolization arteriogram showed no flow into the PSA, but collateral flows to the brachial artery we preserved. The post-embolization course was uneventful. The patient regained warmth in her right arm and hand on post-embolization day 4. Repeat CECT on post-embolization day 9 confirmed blood-flow to her right radial artery. Conclusions While a stent-graft should be used if the AA trunk can be preserved, coil embolization should be considered for PSA if the AA trunk is disrupted but collaterals are preserved.

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Section: Discussionmentioning

confidence: 99%

Coil embolization of a giant pseudoaneurysm associated with a disrupted axillary artery: a case report

Oka,

Kuriyama,

Ishisaka

2024

CVIR Endovasc

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“…In elective procedures, we think that if the AAA is not obtained from the second attempt, it is advisable to stop the intervention and try a couple of days later, reducing the odds of vascular injuries. The axillary approach is not risk-free and potential complications may occur as in any other arterial access ( 29 – 31 ). We observed that serious vascular complications occurred mainly in very low birth weight neonates with borderline-sized axillary arteries.…”

Section: Discussionmentioning

confidence: 99%

Systematic approach to obtain axillary arterial access for pediatric heart catheterizations

Haddad,

Karmustaji,

Alloush

et al. 2024

Front. Cardiovasc. Med.

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BackgroundAxillary arterial access (AAA) in pediatric heart catheterizations is undervalued.MethodsWe retrospectively reviewed children with congenital heart diseases (CHDs) who received trans-axillary arterial catheterizations between January 2019 and February 2023. We aimed ultrasound-guided punctures in the proximal two-thirds of axillary arteries with diameters ≥2 mm to insert 7 cm/4 Fr short introducers. We administrated intra-arterial verapamil (1.25 mg) and heparin (100 UI/kg). We infiltrated per-operatively 2% lignocaine (10 mg) for arterial spasms, long sheaths use (≥5 Fr), and ≥60 min procedures in <3 kg patients.ResultsWe identified 30 patients (66.7% males) with a median age of 1.1 months (IQR, 0.3–5.4), and a median weight of 3.1 kg (IQR, 2.7–3.7). 5/30 patients had six redo interventions after a median of 3.9 months (IQR, 1.7–5.1). Overall, 27/36 procedures were interventional, including 6 aortic valvuloplasties, 6 balloon angioplasties, and 15 stenting procedures. The median arterial axillary angiographic diameter was 2.6 mm (IQR, 2.4–3). Access was right-sided in 23/36 (63.9%) procedures and obtained using 21G/2.5 cm bevel needles in 25/36 (69.4%) procedures. No hemodynamical change occurred after introducing spasmolytic drugs. The median fluoroscopy time was 26.1 min (IQR, 19.2–34.8). There were two self-resolving arterial dissections, one sub-occlusive arterial thrombosis (resolved with 6 weeks of enoxaparin), and one occlusive arterial thrombosis (resolved with alteplase thrombolysis and 6 weeks of enoxaparin). Median follow-up was 11.7 months (IQR, 8–17.5). Four patients with complex univentricular hearts died from non-procedural causes at a median of 40 days (IQR, 31–161) postoperative.ConclusionSystematic approach for AAA is the key to success and unlocks the many potentials of trans-axillary pediatric cardiology interventions.

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Axillary artery aneurysms in pediatric patients: A narrative review

Palma,

Asciutto,

Usai

2023

Vascular

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Objectives Axillary artery aneurysms in children are rare and multifactorial. The presenting clinical picture can range from an incidental discovery to threatening symptoms, including loss of extremity function. With the present study we aim to give a comprehensive review of the existing literature focusing on the etiology and management of this rare but threatening pathology. Method A comprehensive review was made in a multi-staged manner. All identified studies have been categorized based on the type of lesions (true or false aneurysm) and their etiologies. Results The treatments differ from the extension of the lesions and from the etiology. Conclusions Open surgery repair with great saphenous vein is still the best long-term approach, but even endovascular, embolization, or conservative management can be considered.

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Percutaneous ultrasound guided thrombin injection for axillary artery pseudoaneurysm following stenting of the arterial duct in two infants: Case report with review of literature

Abstract: We report pseudoaneurysm of the axillary artery following stenting of the arterial duct in two infants. They were both successfully managed by ultrasound guided thrombin injection with preservation of native arterial flow. We also review the relevant literature.

Cited by 3 publications

References 21 publications

Coil embolization of a giant pseudoaneurysm associated with a disrupted axillary artery: a case report

Coil embolization of a giant pseudoaneurysm associated with a disrupted axillary artery: a case report

Systematic approach to obtain axillary arterial access for pediatric heart catheterizations

Axillary artery aneurysms in pediatric patients: A narrative review

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