ABSTRACT
An adverse consequence of the use of the femoral artery for the endovascular evaluation and treatment of arterial disease is the increased incidence of iatrogenic femoral pseudoaneurysms. Although surgical repair has traditionally been used to treat such aneurysms, less invasive modalities have emerged. The purpose of this study is to prospectively evaluate ultrasound-guided thrombin injection (UGTI) for the treatment of iatrogenic femoral pseudoaneurysms. A treatment protocol was approved and 30 stable patients (21 female; age range 43-85 years; mean 67 years) were prospectively enrolled from December 1997 through June 1999 to undergo UGTI on 30 iatrogenic femoral pseudoaneurysms. Pseudoaneurysms occurred after cardiac intervention (n = 22, 73%), peripheral intervention (n = 7, 23%), and after a femoral line placement (n = 1, 3%). They ranged in size from one to 5 cm with a time interval from intervention until UGTI of one to 132 days (median 3 days). Eleven patients (37%) were systematically anticoagulated at the time of UGTI. All pseudoaneurysms were treated using sterile technique and local anesthesia with ultrasound-guided injection via a 20-gauge spinal needle of 0.1 to 2 cm3 (median 0.6 cm3) of 1000 units/cm3 topical thrombin solution administered by one of six physicians. A period of bedrest for 4 to 6 hours after injection was followed by repeat groin duplex scan at 24 hours and a clinical follow-up at 30 days. There were no procedural deaths or nonvascular complications. Twenty-seven (90%) UGTIs resulted in successful pseudoaneurysm ablation with no recurrences at 24 hours or 30 days. Two (7%) UGTIs failed and one (3%) femoral artery embolic complication occurred; all were successfully treated with surgery. Success appeared to be independent of anticoagulation status, pseudoaneurysm age, size, or operator experience. We conclude that UGTI is a safe, easy, well-tolerated and effective noninvasive method for treatment of iatrogenic femoral pseudoaneurysms and should be considered in all stable patients before operative repair.
Subject(s)
Aneurysm, False/drug therapy , Femoral Artery/diagnostic imaging , Thrombin/administration & dosage , Adult , Aged , Aged, 80 and over , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Cardiac Catheterization , Catheterization, Peripheral , Female , Humans , Iatrogenic Disease , Injections, Intralesional , Male , Middle Aged , Prospective Studies , Treatment Outcome , Ultrasonography, Doppler, DuplexABSTRACT
Rarely, internal carotid artery (ICA) patency is maintained above a common carotid artery occlusion (CCAO) through collateral flow of the ipsilateral external carotid artery or an aberrant ICA branch. Several small series report excellent results of ICA revascularization in relieving cerebral ischemic symptoms in these patients. The natural history of CCAO with patent ICA in the asymptomatic patient, however, is unknown. The Greenville Memorial Hospital Vascular Teaching Service registry and all carotid duplex scans done in the Greenville Hospital System vascular laboratory from January 1994 through December 1997 were reviewed. Data collection included chart review, phone interviews, and the review of angiograms and duplex scans. This study suggests that carotid duplex is more sensitive for detecting ICA flow after CCAO than routine contrast angiography. It also suggests that while rare in presentation, asymptomatic patients with CCAO and a patent ICA appear to have a benign neurologic course and can probably be observed without a high risk of stroke.
Subject(s)
Carotid Stenosis/physiopathology , Carotid Artery, Common/physiopathology , Carotid Artery, Internal/physiopathology , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/therapy , Cerebral Revascularization , Collateral Circulation/physiology , Female , Humans , Male , Middle Aged , Ultrasonography, Doppler, Duplex , Vascular Patency/physiologyABSTRACT
To assess the emerging use of ultrasound-guided compression (USGC) to treat iatrogenic femoral artery pseudoaneurysm (PA), we reviewed the experience in the accredited vascular laboratory of a large community teaching hospital from June 1993 to August 1994. Femoral duplex ultrasonography was done on 94 consecutive patients suspected of having PA. Twenty-eight PAs were found in 27 patients (14 women and 13 men; mean age, 62 years). Causes included cardiac angiography (n = 9), coronary angioplasty (n = 4), coronary stent placement (n = 12), and peripheral angioplasty (n = 3). Aneurysms were identified 1 to 90 days (median, 6 days) after femoral procedures, and their size ranged from 0.9 cm to 8.0 cm (mean, 2.5 cm). Fifteen patients (53%) were receiving systemic anticoagulation, 7 (25%) had spontaneous resolution, 10 (36%) were treated by femoral stitch arteriorrhaphy, and 11 (39%) were treated by USGC. Compression included vascular surgery standby, identification of PA neck (channel to native artery), 10-minute compression intervals to obliterate flow with a 5 MHz duplex ultrasound probe, and restudy at 24 hours. This protocol resulted in successful thrombosis in 8 patients (73%) but failed in 3 patients (37%), who required operative repair. Large aneurysm size, PA neck size, and systemic anticoagulation did not influence successful compression of PAs. Advanced age of the PA and operator inexperience were factors believed to negatively influence success. These data suggest that USGC is safe and effective and causes less morbidity than traditional repair, and it has emerged as the initial treatment of choice for iatrogenic femoral pseudoaneurysms.
