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The inguinal region, specifically the femoral vasculature, is a commonly used site of injection for intravenous drug users (IVDU). Repeated puncture of the vessel wall results in breakdown and subsequent arterial pseudoaneurysm- dilatations or outpouching of blood vessels, which, if left untreated, can result in fatal complications such as rupture with hemorrhage, sepsis, or even limb loss. The current modalities for arterial pseudoaneurysms include Doppler ultrasound and computed tomography (CT) angiography, both of which play important roles in management and surgical planning. However, 3D cinematic rendering (CR), a novel CT post-processing technique, offers timely, highly detailed photorealistic images that more clearly display the relation of anatomical structures, allowing for greater diagnostic confidence and precise surgical planning, particularly useful in the emergency setting. In this pictorial review, we demonstrate role of 3D CR in diagnosis and management of femoral pseudoaneurysms in IVDU through 9 illustrative cases.
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Aneurisma Falso , Arteria Femoral , Imagenología Tridimensional , Abuso de Sustancias por Vía Intravenosa , Humanos , Aneurisma Falso/diagnóstico por imagen , Arteria Femoral/diagnóstico por imagen , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Medios de Contraste , Adulto , Masculino , FemeninoRESUMEN
OBJECTIVES: The study compared the outcomes between covered-stents grafting (CSG) and ligation of femoral artery (LFA) in the treatment of infected femoral pseudoaneurysm (IFP) caused by intravenous drug injection. METHODS: From 1st January 2016 to 30th November 2021, the clinical data of patients with IFP caused by intravenous drug injection who underwent CSG (n = 31, 55.4%) and LFA (n = 25, 45.4%) are retrospectively analyzed. We compared the baseline characteristics and clinical outcomes of the two groups, including early and late mortality and morbidity. RESULTS: A total of 56 patients were enrolled in the study, comprising 50 (89.3%) men and 6 (10.7%) women, with a mean age of 34.3 years. There was no significant difference observed between the two groups in terms of 30-day mortality (3.2% vs 0%, p = .365) and length of stay (9 [7, 12] vs 11 [8.5, 12.5] days, p = .236). However, group CSG exhibited a lower rate of intermittent claudication (0% vs 32%, p = .001), less blood loss (67.1 ± 22.5 mL vs 177.0 ± 59.8 mL, p < .001), and shorter surgery duration (57.5 ± 9.9 min vs 84.4 ± 22.8 min, p < .001) compared to group LFA. The LFA group were divided into subgroups according to the ligation site. The amputation rate of superficial femoral artery ligation group (0 vs 27.3%, p = .014) was significantly lower than common femoral artery ligation. CONCLUSIONS: Covered-stents grafting may be a preferable treatment to LFA for IFP due to intravenous drug abuse, particularly when the entry tear is located in the common femoral artery.
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BACKGROUND: Femoral pseudoaneurysm (PSA) is a severe complication after endovascular procedures. Ultrasound-guided manual compression (MC) and percutaneous thrombin injection (TI) are frequently used treatments. MC is less effective, TI may cause thromboembolic events. OBJECTIVE: Up to date, there is no data regarding impairment of microvascular tissue perfusion after PSA treatment. METHODS: In this single-center, prospective study 22 patients with PSA were included. We compared macro- and microcirculatory perfusion in the treated and untreated leg at baseline before, after and one day after treatment. Leg perfusion was assessed with ultrasound and ankle-brachial index (ABI). Microcirculatory perfusion of the feet was measured with a near-infrared spectroscopy (NIRS) camera generating StO2-tissue-maps. RESULTS: Successful PSA thrombosis was achieved in 16 (100%) patients in TI group and in 4 (66.7%) patients in MC group. There was no evidence of arterial thrombi on ultrasound and the ABI did not differ between groups. NIRS StO2-tissue-maps of the feet showed no significant difference in both groups concerning the treated (pâ=â0.121) or the untreated (pâ=â0.198) leg during follow up. CONCLUSIONS: In this small exploratory study, there was no evidence of micro- and macrovascular tissue perfusion impairment after treatment of postcatheterization femoral pseudoaneurysm with thrombin injection underscoring the safety of this approach.
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Aneurisma Falso , Trombina , Humanos , Estudios Prospectivos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Microcirculación , Ultrasonografía Intervencional/efectos adversos , Arteria Femoral/diagnóstico por imagen , Perfusión , Resultado del TratamientoRESUMEN
Background: Because femoral pseudoaneurysm (FPA) is a dangerous complication of interventional procedures with a risk of life-threatening bleeding, our aim was to develop a predictive nomogram for FPA after neurointervention, and to suggest the best method for early identification of FPA. Methods: We searched the PubMed database for literature addressing FPA after interventional procedures to analyze the risk factors, and we also reviewed the clinical data of patients from the Department of Neurosurgery who underwent neurointerventional procedures. Selected parameters were analyzed by univariate and multivariate logistic regression analysis. A nomogram was constructed using the independent risk factors by a multivariate regression model, and was validated by bootstrap resampling method, as well as receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and calibration curve. The influence on the detection rate of FPA with Doppler ultrasound was also analyzed with Fisher's exact test. Results: According to existing studies, female sex, diabetes and hypertension are major risk factors of FPA. Among 1,098 clinical patients, hypertension (P=0.044), higher body mass index (BMI) (P=0.020), larger sheath size (P=0.049), puncture site hematoma (P=0.011) and closure failure (P=0.003) were identified as independent risk factors. The nomogram including these factors showed robust discrimination [C-index, 0.916; 95% confidence interval (CI): 0.810-1.022] with an area under the curve of 0.916. DCA indicated clinical utility, and the calibration curves showed an acceptable consistency. A significant improvement in the detection rate occurred when Doppler ultrasound was utilized (P=0.031). Conclusions: The presented nomogram showed favorable predictive accuracy for FPA after neurointervention. We recommend ultrasound examination for patients at high risk of FPA evaluated by the nomogram.
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OBJECTIVE: This study aims to report a case series of anastomotic femoral pseudoaneurysms (PSA) treated with stent-grafting (SG) in patients at high-risk for the open surgical approach. METHODS: It is a retrospective, observational cohort study. Between 1 January 2002 and 1 April 2020, post-hoc analysis of the database including patients who received repair for femoral PSA identified those treated with SG. All but one patient were approached through a contralateral percutaneous transfemoral access, and the SG was always deployed from the common femoral artery to the profunda femoris artery. For this study, primary outcomes of interest were early (≤ 30 days) survival and patency rate. RESULTS: We identified 10/823 cases of the entire PSA cohort (1.2%). There were 9 men and 1 woman: the mean age was 76 years ± 9 (range: 64-92). Urgent intervention was performed in 4 patients. The median operative time was 30 min (IQR: 25-36). Access-related complication was never observed. In-hospital mortality occurred in 1 patient due to novel coronavirus-19-related pneumonia. Median follow-up was 24 months (IQR: 12-37); 5 patients died. At the last radiologic follow-up available, all SGs were patent without necessity of reintervention. CONCLUSION: Stent-graft repair for anastomotic femoral PSA may be considered a reasonable alternative for patients at high-risk for open surgical repair.
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Aneurisma Falso , Implantación de Prótesis Vascular , COVID-19 , Procedimientos Endovasculares , Masculino , Femenino , Humanos , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Implantación de Prótesis Vascular/efectos adversos , Estudios Retrospectivos , Stents/efectos adversos , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Resultado del Tratamiento , Procedimientos Endovasculares/efectos adversosRESUMEN
Fully percutaneous transfemoral transcatheter aortic valve replacement (TF-TAVR) is currently the standard of the catheter-based treatment of severe aortic stenosis patients. Even though experience, lower delivery catheters profile and improved vascular closure devices performances have resulted in an overall reduction of both vascular and bleeding complications after TAVR, femoral pseudoaneurysm due to incomplete local hemostasis may occur, prolonging the in-hospital length of stay, causing discomfort to the patient and potentially evolving in serious consequences affecting the outcome. We report two successful percutaneous ultrasound-guided closure of both the main and secondary femoral access pseudoaneurysm.
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Estenosis de la Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Humanos , Estudios Retrospectivos , Factores de Riesgo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del TratamientoRESUMEN
INTRODUCTION: A pseudoaneurysm (or false aneurysm) is a haematoma that communicates with an artery through a disruption in the arterial wall. The femoral artery is the most common injection site among drug users, and infected femoral pseudoaneurysms are the most common vascular complications. METHODS: A retrospective review of medical records of intravenous drug abusers (IVDAs) who presented with infected femoral pseudoaneurysms from January 2006 to December 2016 was carried out. Patients who had pseudoaneurysms due to other aetiologies or trauma were excluded. RESULTS: A total of 27 patients with infected femoral pseudoaneurysms were identified. The majority were male (92.6%) and of Malay ethnicity (55.6%). Median age was 50 (range 31-62) years. Commonly abused drugs were buprenorphine (or Subutex; 59.3%) and midazolam (or Dormicum; 51.9%). Groin pain and swelling (100.0%), fever (66.7%) and presence of a pulsatile mass (51.9%) were the most common presenting symptoms. Diagnosis was confirmed via computed tomography angiography in all patients. 25 patients underwent upfront arterial ligation with debridement, among whom three patients required concurrent surgical revascularisation. Only two patients underwent ultrasonography-guided thrombin injection - one eventually required surgery and the other was lost to follow-up. Postoperative complications included wound infection (42.3%), bleeding (11.5%) and necrotising fasciitis eventually resulting in limb loss (3.8%). There were no associated mortalities. CONCLUSION: Infected pseudoaneurysms in IVDAs pose a unique challenge to vascular surgeons. We found that simple ligation and debridement was a safe and effective option for such patients.
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Aneurisma Falso , Aneurisma Infectado , Consumidores de Drogas , Abuso de Sustancias por Vía Intravenosa , Adulto , Aneurisma Falso/epidemiología , Desbridamiento , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Singapur/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Resultado del TratamientoRESUMEN
OBJECTIVE: Infected femoral artery pseudoaneurysms (IFAPs) are a known complication of illicit intravenous drug injection. As the opioid crisis in our country continues to worsen, we will likely see more IFAPs and algorithms for management of these patients will need to be elucidated. The aim of this study was to describe the surgical management and outcomes of patients presenting with IFAPs treated with femoral artery ligation. METHODS: This is a single-center, retrospective study of consecutive patients presenting to our institution with IFAPs associated with illicit drug injection between 2004 and 2017 and treated with primary ligation. Primary end points included major adverse limb events (MALE) and death. Baseline demographics, clinical features, and long-term outcomes were recorded. RESULTS: Over the study period, 60 IFAPs were managed with arterial ligation in 58 patients. Fifty-two percent of patients underwent common femoral artery ligation, 30% of patients underwent a triple ligation (ligation of the common femoral artery, profunda femoris artery, and superficial femoral artery), and 18% of patients underwent ligation of the superficial femoral artery only. The average postoperative ankle-brachial index was 0.47. None of the patients underwent revascularization at the index procedure. In our early experience, four patients (6.6%) underwent delayed revascularization with a prosthetic bypass. Two of the patients subsequently re-presented with infected bypass grafts and required the only major amputations in our series. The mean follow-up was 51.3 months and four patients were lost to follow-up. No differences were identified in MALE between patients undergoing a femoral artery ligation vs a triple ligation. Nine patients (15%) died during the follow-up period and all deaths were unrelated to IFAP treatment; the mean survival from procedure to death was 28 months. CONCLUSIONS: We describe the largest series in the United States of IFAP related to illicit drug use treated with femoral artery ligation and found it is a safe procedure associated with low MALE. Reconstruction is not recommended and is associated with graft infection. Although the mortality rate in these patients was high, it was not related to the ligation procedure.
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Aneurisma Falso/cirugía , Aneurisma Infectado/cirugía , Arteria Femoral/cirugía , Abuso de Sustancias por Vía Intravenosa/complicaciones , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/cirugía , Adulto , Amputación Quirúrgica , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/mortalidad , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/mortalidad , Implantación de Prótesis Vascular , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/lesiones , Humanos , Ligadura , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/mortalidad , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidad , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/mortalidadRESUMEN
INTRODUCTION@#A pseudoaneurysm (or false aneurysm) is a haematoma that communicates with an artery through a disruption in the arterial wall. The femoral artery is the most common injection site among drug users, and infected femoral pseudoaneurysms are the most common vascular complications.@*METHODS@#A retrospective review of medical records of intravenous drug abusers (IVDAs) who presented with infected femoral pseudoaneurysms from January 2006 to December 2016 was carried out. Patients who had pseudoaneurysms due to other aetiologies or trauma were excluded.@*RESULTS@#A total of 27 patients with infected femoral pseudoaneurysms were identified. The majority were male (92.6%) and of Malay ethnicity (55.6%). Median age was 50 (range 31-62) years. Commonly abused drugs were buprenorphine (or Subutex; 59.3%) and midazolam (or Dormicum; 51.9%). Groin pain and swelling (100.0%), fever (66.7%) and presence of a pulsatile mass (51.9%) were the most common presenting symptoms. Diagnosis was confirmed via computed tomography angiography in all patients. 25 patients underwent upfront arterial ligation with debridement, among whom three patients required concurrent surgical revascularisation. Only two patients underwent ultrasonography-guided thrombin injection - one eventually required surgery and the other was lost to follow-up. Postoperative complications included wound infection (42.3%), bleeding (11.5%) and necrotising fasciitis eventually resulting in limb loss (3.8%). There were no associated mortalities.@*CONCLUSION@#Infected pseudoaneurysms in IVDAs pose a unique challenge to vascular surgeons. We found that simple ligation and debridement was a safe and effective option for such patients.
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Surgical repair of iatrogenic femoral pseudoaneurysms in the setting of distorted anatomy, multiple prior interventions, and ongoing hemorrhage requires extensive proximal and distal dissection for control. Furthermore, profunda femoral and other arterial branch control may not always be feasible and can lead to considerable blood loss at the time of surgical exploration. We present a simple, safe, and effective hybrid approach for inflow, outflow, and branch control for treatment of a proximally located, actively expanding, iatrogenic common femoral artery pseudoaneurysm recalcitrant to multiple sessions of percutaneous thrombin injection.
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BACKGROUND: This study aims to evaluate the effectiveness of ultrasound-guided thrombin injection versus ultrasound-guided compression repair in the management of iatrogenic femoral artery pseudoaneurysms. METHODS: Between June 2006 and December 2015, a total of 29 consecutive patients (15 males, 14 females; mean age 54 years; range 26 to 81 years) with a femoral pseudoaneurysm treated by ultrasound-guided thrombin injection were retrospectively analyzed. These patients were compared with a historical group of 36 patients (21 males, 15 females; mean age 44 years; range 32 to 65 years) who underwent ultrasound-guided compression repair between February 1999 and May 2006. Medical records and vascular laboratory findings of all patients were reviewed. Successful treatment was defined as complete cessation of flow into the false lumen with preservation of flow in the femoral artery. RESULTS: The ultrasound-guided thrombin injection showed a success rate of 100%, whereas ultrasound-guided compression repair had a success rate of 80.5%, which was possibly affected by anticoagulant therapy, hypertension, and an aneurysm size of >6 cm. However, none of these factors did not affect the success of thrombin injections. CONCLUSION: Ultrasound-guided thrombin injection is a highly successful, easy to perform, accepted, and well-tolerated method by patients. It is more effective compared to compression therapy in patients with hypertension, large aneurysms, and who are on anticoagulant therapy.
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BACKGROUND: Clinically evident arterial thrombosis is rare following thrombin injection therapy for femoral pseudoaneurysm. However, it is unclear to what extent injected thrombin may pass to the ipsilateral lower limb arteries. AIMS: To assess if technetium 99m injected at the time of thrombin injection for femoral artery pseudoaneurysm therapy passes into the adjacent lower limb arteries. METHODS: This was a prospective trial with institutional review board approval. Four consecutive patients with common femoral pseudoaneurysms and failed manual compression were enrolled. Under real-time colour flow doppler ultrasound, a mixture of 1000 IU thrombin and approximately 200 MBq technetium 99m was injected in 0.1-mL doses into the pseudoaneurysm until thrombosis occurred. Gamma camera imaging of the syringe before injection, the injected groin after thrombosis and the syringe after injection were performed. Analysis of the gamma camera information was performed to determine the amount of technetium 99m deposited in the arterial tree. RESULTS: All the procedures were technically successful. A mean of 33% (range 3-50%; SD 21) of the administered technetium 99m dose was deposited in the arterial circulation during pseudoaneurysm therapy. No clinically evident arterial thrombosis was identified. CONCLUSION: Technetium 99m is routinely deposited in the arterial circulation following injection of a mixture of thrombin and technetium for therapy of common femoral artery pseudoaneurysms. This suggests that arterial passage of thrombin is more common than clinically evident.
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Aneurisma Falso/tratamiento farmacológico , Terapia Combinada/métodos , Embolia/tratamiento farmacológico , Arteria Femoral/anomalías , Cintigrafía/métodos , Tecnecio/uso terapéutico , Trombina/uso terapéutico , Ultrasonografía Intervencional/métodos , Anciano , Femenino , Humanos , Masculino , Estudios Prospectivos , Tecnecio/farmacología , Trombina/farmacologíaRESUMEN
This study aimed to prospectively evaluate the safety and efficacy of a new developed method that uses percutaneous ultrasound-guided hematoma aspiration followed by targeted localized manual compression for treatment of femoral artery pseudoaneurysm after cardiac catheterization, which obviates thrombin use, surgery, and long-time compression.From January 2007 to July 2014, 32 patients (17 women; mean age, 55.3 ± 11.5 years) out of 8,725 consecutive cases undergoing cardiac catheterization via femoral access developed one pseudoaneurysm each ranging in size from 21 × 11 mm to 72 × 39 mm. Under ultrasound guidance, blood within the pseudoaneurysm was aspirated percutaneously using an 18-gauge needle, while the pseudoaneurysm neck and a nearby site over the pseudoaneurysm were manually compressed for 15 min. All patients underwent repeat ultrasound examination 24 hours later.Of the 32 pseudoaneurysms, 31 were successfully occluded, and 1 recurred in a patient with coexisting arteriovenous fistula, yielding an overall success rate of 96.9% (31/32). No further recurrence or procedure related complications were observed. The treatment approach is unlike open surgical repair with hematoma evacuation and arterial defect suturing, in that it entails hematoma aspiration and feeding flow blockage at the pseudoaneurismal neck.In this preliminary experience, combining percutaneous ultrasound-guided hematoma aspiration and manual compression appears safe and effective in treating femoral artery pseudoaneurysms after catheterization and avoids thrombin use, long-time compression, and surgery.
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Aneurisma Falso/cirugía , Cateterismo Cardíaco/efectos adversos , Arteria Femoral , Hematoma/diagnóstico por imagen , Hematoma/cirugía , Succión , Adulto , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Femenino , Hematoma/etiología , Humanos , Masculino , Persona de Mediana Edad , Palpación , UltrasonografíaRESUMEN
INTRODUCTION: Infected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to the optimum management of these patients. Whilst emergency revascularisation options are available, excision and ligation of the femoral artery remains the most common operative intervention but risks leaving the patient with critical ischaemia or intermittent claudication. This case series reviewed the outcomes of 4 patients who underwent excision-ligation without revascularisation of an infected femoral pseudoaneurysm at a district general hospital. PRESENTATION: Four patients (2 male, 2 female) with infected femoral pseudoaneurysms presented via the emergency room with diagnosis confirmed with contrast cross-sectional imaging. All patients underwent emergency excision and ligation of the pseudoaneurysm without revascularisation. One patient returned to theatre with critical ischaemia necessitating a hindquarter amputation. The remaining 3 patients were discharged without claudication symptoms. CONCLUSION: With the identification of suitable patients and pre-operative optimisation, revascularisation can be performed in the emergency setting with an extra-anatomical bypass appearing to confer the best results. Currently endovascular approaches appear to be used only as a bridge to a future definitive revascularisation procedure, however, there are several case reports documenting successful outcomes when using a stent graft alongside a prolonged course of antibiotics. For the majority of patients, excision-ligation without revascularisation is both safe and effective as few are left with symptoms of limb ischaemia.
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Objective To investigate the feasibility,safety and effectiveness of endovascular angioplasty with covered stent and embolization with spring coil in treating ruptured femoral artery pseudoaneurysm (FAP) associated with bleeding caused by injection of addictive drug.Methods The clinical data of 32 patients with ruptured FAP complicated by bleeding caused by injection of addictive drug,who were admitted to authors' hospital during the period from July 2012 to December 2015,were retrospectively analyzed.The average age of the patients was 36.5 years old,among them 25 patients were male (78.1％).Results Successful hemostasis was achieved in all 32 patients.The technical success rate of endovascular therapy was 100％,and no death occurred during perioperative period.Endovascular repair with covered stent was carried out in 25 patients (78.1％),embolization of femoral profound artery with spring coil in 9 patients (9.4％),and covered stent implantation together with embolization of femoral profound artery in 4 patients (12.5％).The patients were followed up for a mean of (17.5±11.6) months,with a follow-up rate being 93.8％ (30/32).The 3-year cumulative stent patency rate was 90.9％,and the 3-year overall survival rate was 91.3％.Conclusion For the treatment of ruptured FAP complicated by bleeding caused by injection of addictive drug,endovascular treatment is safe and effective with satisfactory mid-term clinical effect.This technique helps win the valuable time for critically ill patients to receive two-stage surgical debridement and vascular repair,as two-stage thorough debridement is an important means to control infection.
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The multiple exostosis is a hereditary bone tumour. Generally, its complications are benign and are related to compressing surrounding structures such as nerves and vessels. This is the case of a 52-year-old woman with a family history of multiple exostosis, which was complicated by a pseudoaneurysm of the right superficial femoral artery. The delay in diagnosis was allowed to develop this pseudoaneurysm which caused nervous and deep venous compression.
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Aneurisma Falso/complicaciones , Aneurisma Falso/diagnóstico , Exostosis Múltiple Hereditaria/complicaciones , Exostosis Múltiple Hereditaria/diagnóstico , Arteria Femoral , Síndromes de Compresión Nerviosa/etiología , Nervio Ciático , Trombosis de la Vena/etiología , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Exostosis Múltiple Hereditaria/cirugía , Femenino , Humanos , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/terapia , Osteotomía/métodos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos , Trombosis de la Vena/terapiaRESUMEN
Peripheral aneurysms typically present as asymptomatic incidental findings or may present with symptoms when there is local compression of other structures, such as nerves or veins, with ischemia, or rarely with rupture. Larger and symptomatic aneurysms should be repaired. Ultrasonography, computed tomography angiography, and magnetic resonance angiography can be used to define inflow and outflow and better characterize the aneurysm, particularly size and thrombus. Repair of peripheral aneurysms typically involves resection with interposition grafting, although certain anatomic sites may be amenable to endovascular approaches. Femoral pseudoaneurysms can be managed with observation, surgical repair, ultrasound-guided compression, or ultrasound-guided thrombin injection.
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Aneurisma/cirugía , Enfermedad Arterial Periférica/cirugía , Aneurisma/diagnóstico , Aneurisma/etiología , Aneurisma Falso/diagnóstico , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Axila/irrigación sanguínea , Arteria Braquial/cirugía , Arteria Femoral/cirugía , Humanos , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/etiología , Arteria Poplítea/cirugía , Ultrasonografía IntervencionalRESUMEN
Femoral pseudoaneurysm is a complication of cardiac catheterization and may be related to the use of anticoagulants, antiplatelet agents, larger diameter sheaths and prolonged duration of sheath insertion. The treatment ranges from direct compression with or without direct thrombin injection to surgical repair. The present report describes a unique scenario of postcardiac catheterization femoral artery pseudoaneursym in a patient with a pre-existing mechanical mitral valve requiring anticoagulation. The potential systemic effects of thrombin made the patient reluctant to undergo treatment and made thrombin administration a challenging proposition. The present report suggests that thrombin injection for treating femoral pseudoaneursym in patients with mechanical heart valves on chronic anticoagulation can be performed safely.