Ten-Year Experience of Vascular Surgeon Management of Iatrogenic Pseudoaneurysms: Do Anticoagulant and/or Antiplatelet Medications Matter?

Stone, Patrick A.; Martínez, María Alejandra; Thompson, Stephanie; Masinter, David; Campbell, John E.; Campbell, James; AbuRahma, Ali F.

doi:10.1016/j.avsg.2015.06.068

Cited by 17 publications

(10 citation statements)

References 9 publications

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“…For hematomas, observation is usually recommended, while arteriovenous fistulas are normally treated with an open surgery. Many various PA treatment techniques are described in the literature, such as ultrasound-guided (US-guided) compression, percutaneous US-guided thrombin injection, percutaneous US-guided collagen injection, compression by injection of saline around the neck of the PA, percutaneous fluoroscopically guided n-butyl cyanoacrylate (NBCA) injection, PA neck occlusion with closure devices, coiling or surgical arterial suture (2–6) . Our paper presents the results of 10 years’ experience with US-guided thrombin injection.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access

et al. 2018

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Aim: The purpose of this paper was to evaluate the efficacy of ultrasound-guided percutaneous thrombin injection as a treatment method for arterial access site pseudoaneurysm. Materials and methods: A total of 148 patients with iatrogenic arterial access site pseudoaneurysms were treated in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Of those, 142 pseudoaneurysms were located in the common femoral artery, 3 in the brachial artery and the remaining 3 in the radial artery. The study included 77 woman and 71 men (mean age 64.5 ± 14 years). Patients were qualified for percutaneous thrombin injection after Doppler examination during which pseudoaneurysm size and morphology were assessed as well as the presence of arteriovenous fistula was excluded. Results: In the reported study, 94.8% (128/135) of patients were successfully treated during the initial thrombin injection. Additional 400 IU dose of thrombin after 24 hours was effective in 5 out of 7 patients with recanalization during the follow-up. A total of 98.5% (133/135) of patients were successfully treated with a percutaneous ultrasound-guided thrombin injection. Conclusions: The 10-year experience presented in this study as well as literature reports prove that percutaneous ultrasound-guided thrombin injection is an effective and safe treatment method for iatrogenic arterial access site pseudoaneurysm.

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Section: Introductionmentioning

confidence: 99%

Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access

et al. 2018

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“…Although treatment is required to prevent complications in large symptomatic pseudoaneurysms, a close follow-up is needed for patients with pseudoaneurysms of <2 cm. [9] Stone et al [10] conservatively followed 167 patients with pseudoaneurysms of <3 cm and reported the need for additional intervention in 16% of these patients. Recently, methods other than surgery, such as ultrasound-guided compression, ultrasound-guided thrombin injection, biodegradable collagen injection, coil embolization, and placement of covered stents/ endoluminal prostheses have become popular for the treatment of pseudoaneurysms which develop after catheterization.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of iatrogenic pseudoaneurysms

Kara¹

2019

Turk J Vasc Surg

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Objectives: This study aims to present the results of surgical treatment of femoral and brachial artery pseudoaneurysms after cardiac catheterization. Patients and methods: This retrospective study included a total of 28 patients (10 males, 18 females; mean age 76.5±11.5 years; range, 52 to 90 years) who were diagnosed with pseudoaneurysms between January 2012 and December 2018. Diagnosis of pseudoaneurysm was made based on physical examination and arterial Doppler ultrasonography findings in all patients. The patients with a pseudoaneurysm of ≥2 cm in diameter underwent surgery. Results: Two patients developed a brachial pseudoaneurysm, while 26 patients developed a femoral pseudoaneurysm. The location of the femoral pseudoaneurysm was the superficial femoral artery in 19 (73.07%), common femoral artery in five (19.23%), and deep femoral artery in two (7.69%) patients. No complications were observed during follow-up. Conclusion: Various treatment modalities can be used for iatrogenic pseudoaneurysms. Surgical treatment of iatrogenic pseudoaneurysms is a simple and successful method.

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“…6,14 Compression therapy alone is also more likely to fail in patients taking anticoagulation, often necessitating reversal before treatment. [15][16][17][18] In contrast, several studies report that UGTI outcomes are unaffected by anticoagulation use, abrogating the need for reversal. [15][16][17][18] Thus, at our institution, for FAP between 1 and 6.5 cm in size in the stable patient, UGTI is used as first-line therapy.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17][18] In contrast, several studies report that UGTI outcomes are unaffected by anticoagulation use, abrogating the need for reversal. [15][16][17][18] Thus, at our institution, for FAP between 1 and 6.5 cm in size in the stable patient, UGTI is used as first-line therapy. Furthermore, our study reiterates the safety of UGTI, as we had no postprocedural thrombotic or embolic complications.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese

Yoo

Starr

et al. 2017

Vasc Endovascular Surg

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Introduction Ultrasound guided thrombin injection (UGTI) is a well-established practice for treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure. We aim to evaluate the safety and efficacy of UGTI to treat femoral artery pseudoaneurysm in the morbidly obese. Methods This is a retrospective cohort study in which all patients who underwent UGTI at The Ohio State University Ross Heart Hospital from 2009 to 2014 were analyzed for patient characteristics and stratified by body mass index (BMI). Patients with BMI ≥ 35 were considered morbidly obese and were compared to patients with a BMI < 35. Outcome was failed treatment resulting in residual pseudoaneurysm. Results Our cohort consisted of 54 patients who underwent thrombin injection. There were 41 non-morbidly obese, and 13 morbidly obese patients. Mean age was 64.5 years. The cohort was 44.4% male. There were 6 failures of which 1 underwent successful repeat injection, and 5 underwent open surgical repair. There was no statistically significant difference in failure between non-morbidly obese, and morbidly obese patients (9.8% vs. 15.4%, p=0.45). There were no embolic/thrombotic complications. Conclusion UGTI is a safe and effective therapy in the morbidly obese for the treatment of femoral artery pseudoaneurysm. In the hands of experienced sonographers and surgeons with adequate visualization of the pseudoaneurysm sac, ultrasound guided thrombin injection should remain standard therapy in the morbidly obese.

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Ten-Year Experience of Vascular Surgeon Management of Iatrogenic Pseudoaneurysms: Do Anticoagulant and/or Antiplatelet Medications Matter?

Cited by 17 publications

References 9 publications

Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access

Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access

Surgical treatment of iatrogenic pseudoaneurysms

Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese

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