Ultrasound-Guided Nonsurgical Closure of Postangiographic Femoral Pseudoaneurysm

Khera, Pushpinder Singh; Asbeutah, Akram M.; Ramadan, Abdullah H. Al

doi:10.1177/154431671103500103

Cited by 1 publication

(1 citation statement)

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“…TI of a PSA with a concomitant AVF could conceivably put the patient at risk for venous thromboembolism (VTE) or death. 7,11 It would be advantageous if this could be performed safely in a patient with a PSA and associated AVF. An alternative to open surgical repair of a PSA with an associated AVF in an elderly high-risk patient is described.…”

Section: Introductionmentioning

confidence: 99%

Common Femoral Artery Pseudoaneurysm Associated with Arteriovenous Fistula

Bulauitan

McKean

Cook

2014

Journal for Vascular Ultrasound

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Background Thrombin injection (TI) is a common modality for the treatment of femoral artery pseudoaneurysm (PSA) of arterial access sites. It has decreased the need for open repair in this cohort of patients who often have increased surgical risk. Deep venous thrombosis and venous thromboembolism (VTE) have been reported after TI for PSA in the presence of an arteriovenous fistula (AVF). A combined treatment modality using ultrasound-guided TI with concomitant balloon occlusion of the AVF is described. Patient A high cardiac risk patient presented with a large pulsatile right groin mass after cardiac catheterization. Ultrasound identified a PSA arising from the right common femoral artery. The anatomy was suitable for TI; however, a large AVF also was present. The patient was a poor surgical candidate because of cardiac morbidity and body habitus. Methods The patient was taken to the hybrid vascular operative suite. Conscious sedation was administered. Venous access was obtained via the right internal jugular vein. Venography identified the AVF in the right common femoral vein. Thrombin was injected into the right groin PSA using direct ultrasound visualization. Simultaneous fluoroscopic-guided balloon inflation was used to occlude the common femoral vein and prevent flow through the AVF. Postinjection venography and Doppler examination of the femoral vessels were performed. Results The PSA was successfully occluded. There was no identifiable venous thrombus. Doppler examination also showed resolution of the AVF. There were no clinical signs or symptoms of pulmonary embolism. Conclusion TI of femoral artery PSA associated with AVF has increased risk of VTE. Concomitant venous occlusion during TI of a PSA may decrease the risk of VTE in the setting of a large AVF. This has the potential to expand the indications for TI in the high-risk surgical patient.

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Section: Introductionmentioning

confidence: 99%