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Internal Medicine (Tokyo, Japan) Jan 2022
Topics: Abdomen; Aortic Dissection; Aneurysm, False; Humans; Stomach
PubMed: 34275985
DOI: 10.2169/internalmedicine.7715-21 -
Cardiovascular and Interventional... Jan 2022To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm.
PURPOSE
To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm.
MATERIALS AND METHODS
A retrospective analysis of patients who had undergone endovascular treatment of hepatic artery pseudoaneurysms between 2011 and 2020 was performed. Medical records were examined to obtain patients' surgical histories and to screen for active bleeding. Angiographic data on vascular access, target vessel, material used and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, were collected. Vessel patency at follow-up CT was analyzed and classified as short-term (< 6 weeks), mid-term (between 6 weeks and 1 year), and long-term patency (> 1 year). In case of stent occlusion, collateralization and signs of hepatic hypoperfusion were examined.
RESULTS
In total, 30 patients were included and of these, 25 and 5 had undergone stent graft implantation and coiling, respectively. In patients with implanted stent grafts, technical success was achieved in 23/25 patients (92%). Follow-up CT scans were available in 16 patients, showing stent graft patency in 9/16 patients (56%). Short-term, mid-term, and long-term short-term stent patency was found in 81% (13/16), 40% (4/10), and 50% (2/4). In patients with stent graft occlusion, 86% (6/7) exhibited maintenance of arterial liver perfusion via collaterals and 14% (1/7) exhibited liver abscess during follow-up.
CONCLUSION
Stent graft provides an effective treatment for hepatic artery pseudoaneurysms. Even though patency rates decreased as a function of time, stent occlusion was mainly asymptomatic due to sufficient collateralization.
Topics: Aneurysm, False; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Follow-Up Studies; Hepatic Artery; Humans; Retrospective Studies; Stents; Treatment Outcome; Vascular Patency
PubMed: 34734334
DOI: 10.1007/s00270-021-02993-0 -
JACC. Cardiovascular Interventions Feb 2021
Topics: Aneurysm, False; Humans; Mammary Arteries; Sternotomy; Treatment Outcome
PubMed: 33516689
DOI: 10.1016/j.jcin.2020.11.037 -
Anales de Pediatria Sep 2022
Topics: Aneurysm, False; Child; Humans
PubMed: 35279392
DOI: 10.1016/j.anpede.2021.09.002 -
The Neuroradiology Journal Apr 2017Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of... (Review)
Review
Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases. Patients and methods Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed. Results In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery. The radiological examination additionally revealed delayed filling and retention of contrast medium. These findings were the same as previously reported cases. One patient underwent direct clipping of the true aneurysm. For the other three patients with aneurysms at the basilar and anterior communicating arteries, the true portion of the aneurysm was embolized with platinum coils. During the procedures, care was taken not to insert the coils into the distal pseudoaneurysm portion to prevent rupture. The review of 24 cases revealed that the location of the aneurysms was most frequent in the anterior communicating artery (41.7%), and 86.7% of patients were in a severe stage of SAH (>Grade 3 in WFNS or Hunt & Kosnik grading) implying abundant SAH. Conclusions Pseudoaneurysm formation in SAH after non-traumatic aneurysm rupture is rare. However, in cases with an irregular-shaped aneurysm cavity, pseudoaneurysm formation should be taken into consideration.
Topics: Adult; Aged; Aged, 80 and over; Aneurysm, False; Aneurysm, Ruptured; Computed Tomography Angiography; Databases, Bibliographic; Humans; Imaging, Three-Dimensional; Intracranial Aneurysm; Middle Aged
PubMed: 28059632
DOI: 10.1177/1971400916684667 -
Diagnostic and Interventional Imaging 2015Following interventional radiology procedures, bleeding can occur in 0.5 to 4% of the cases. Risk factors are related to the patient, to the procedure, and to the end... (Review)
Review
Following interventional radiology procedures, bleeding can occur in 0.5 to 4% of the cases. Risk factors are related to the patient, to the procedure, and to the end organ. Bleeding is treated usually by interventional radiologists and consists mainly of embolization. Bleeding complications are preventable: before the procedure by checking hemostasis, during the procedure by ensuring the accurate puncture site (with ultrasound or fluoroscopy guidance) or by treating the puncture path using gelatin sponge, curaspon(®), biological glue or thermocoagulation, and after the procedure by carefully monitoring the patients.
Topics: Aged; Aneurysm, False; Biopsy; Catheter Ablation; Catheterization; Chemoembolization, Therapeutic; Embolization, Therapeutic; Female; Femoral Artery; Hemorrhage; Humans; Male; Punctures; Radiology, Interventional; Risk Factors; Tomography, X-Ray Computed
PubMed: 26138359
DOI: 10.1016/j.diii.2015.06.009 -
Methodist DeBakey Cardiovascular Journal 2024Left ventricular assist devices (LVAD) are surgically implanted mechanical support devices utilized with increasing frequency as a bridge to myocardial recovery,...
Left ventricular assist devices (LVAD) are surgically implanted mechanical support devices utilized with increasing frequency as a bridge to myocardial recovery, destination therapy, and heart transplantation. While the use of such devices in patients with advanced heart failure has shown significant survival benefits and improved quality of life, they bear their own risks and complications. Bleeding, infection, pump thrombosis, and stroke are just some of the serious complications associated with LVADs. LVAD-associated pseudoaneurysms are rare, with prior reports of occurrence at the left ventricular apex and at the anastomosis site of the outflow graft to the ascending aorta. Typically, this device-related complication requires surgical repair and, if at all feasible, heart transplantation. However, in cases of difficult anatomy, unfavorable position, and significant comorbidities, surgery may be contraindicated due to high surgical risk. This case portrays a patient suffering from a left ventricular pseudoaneurysm after HeartMate-III implantation that was not amenable to surgical repair due to heightened surgical risk. We document the first pseudoaneurysm associated with the HeartMate-III in available literature and describe a novel management strategy of documented nonoperative course of LVAD-associated pseudoaneurysm, with the patient surviving 56+ months with medical optimization and management.
Topics: Humans; Conservative Treatment; Aneurysm, False; Heart-Assist Devices; Quality of Life; Aorta
PubMed: 38250571
DOI: 10.14797/mdcvj.1301 -
Cirugia Pediatrica : Organo Oficial de... Apr 2022Splenic and hepatic pseudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture,...
INTRODUCTION
Splenic and hepatic pseudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA.
MATERIAL AND METHODS
A retrospective study of patients under 15 years of age with blunt abdominal trauma associated with splenic and/or hepatic injury treated from 2012 to 2020 was carried out. PA formation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also control contrast-enhanced ultrasonography (CEUS) in the first week following trauma. If PA was confirmed, angiography ± percutaneous embolization were performed.
RESULTS
A total of 32 patients with blunt trauma were included. Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patients were male. Median trauma grade was grade III (grades II-IV). 33.3% (n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) of patients developed hepatic PA, with mean diagnostic time being 3.7 ± 3 (3-8) days. PA formation was associated with higher severity scores, with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). All PA cases - except for one, which required urgent splenectomy - were treated with embolization (85.7%) (n = 5/6).
CONCLUSION
Visceral PA is underdiagnosed, with an incidence higher than reported. Imaging studies (CEUS) are required prior to discharge in the presence of severe trauma. Treatment remains controversial, but we recommend percutaneous embolization, with splenectomy being reserved for unstable patients.
Topics: Abdominal Injuries; Aneurysm, False; Child; Child, Preschool; Female; Humans; Male; Retrospective Studies; Spleen; Wounds, Nonpenetrating
PubMed: 35485756
DOI: 10.54847/cp.2022.02.16 -
The British Journal of Radiology Jun 2019Evaluate the factors associated with pseudoaneurysm development and morphology. Measure ultrasound-guided thrombin injection (UGTI) and surgical treatment outcomes for...
OBJECTIVE
Evaluate the factors associated with pseudoaneurysm development and morphology. Measure ultrasound-guided thrombin injection (UGTI) and surgical treatment outcomes for pseudoaneurysms, and the necessity for post-primary intervention (reintervention).
METHODS
Retrospective analysis of ultrasound scans and CT angiography of peripheral pseudoaneurysm interventions from February 2011 to April 2017. 99 patients (61.6% female) were identified; median age 72 years (range 12-89). Multivariate analysis of patient demographics, including pre-intervention anticoagulant and antiplatelet medication was performed.
RESULTS
Primary intervention for peripheral pseudoaneurysms (62.6% common femoral artery) included 93 UGTI and 6 surgical repairs; with 12 reinterventions (9 UGTI and 3 surgical). Pseudoaneurysm incidence for vascular interventional radiology (VIR) was 0.48% (31/6451) and cardiology was 0.24% (60/25,229). Rates for primary success, immediate complications, 30-day mortality and reintervention were measured respectively for UGTI (98.9%, 3.0%, 2.0%, and 11.8%) and surgical repair (100%, 0.0%, 22.2% and 16.7%). Reintervention risk factors included pre-intervention thrombocytopaenia (<150 × 10/L) ( = 0.025) and pseudoaneurysms following vascular surgery ( = 0.033). Other positive associations for reintervention (non-significant) included use of a sheath size > 6 Fr ( = 0.108) or arterial closure device ( = 0.111) during the pseudoaneurysm causative procedure. The pre-intervention warfarin subgroup developed a larger mean pseudoaneurysm sac size (4.21 cm, range 0.9-7.6), compared to no treatment ( = 0.003), aspirin ( = 0.005) and clopidogrel ( = 0.026) subgroups. UGTI dosage for thrombosis had a positive correlation with incremental sac size increase ( < 0.001).
CONCLUSION
The main reintervention risk factor was pre-intervention thrombocytopaenia, with additional positive associations including pseudoaneurysms caused by surgery, increased sheath size and arterial closure devices. Warfarinized patients developed larger sac-sized pseudoaneurysms compared with other pre-intervention regimens, with positive correlation of higher UGTI dosage required for thrombosis.
ADVANCES IN KNOWLEDGE
Patients with pre-intervention thrombocytopaenia and pseudoaneurysms attributed to vascular surgery are subgroups that may benefit from post-intervention imaging surveillance due to significant reintervention risk.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, False; Anticoagulants; Cardiac Surgical Procedures; Child; Computed Tomography Angiography; Female; Hemostatics; Humans; Injections, Intralesional; Male; Middle Aged; Peripheral Arterial Disease; Platelet Aggregation Inhibitors; Postoperative Complications; Reoperation; Retrospective Studies; Thrombin; Ultrasonography; Ultrasonography, Interventional; Young Adult
PubMed: 30982331
DOI: 10.1259/bjr.20180893 -
JPMA. the Journal of the Pakistan... Apr 2023To review institutional experience about the effectiveness and safety of percutaneous trans-arterial renal artery embolization in the treatment of iatrogenic renal...
OBJECTIVES
To review institutional experience about the effectiveness and safety of percutaneous trans-arterial renal artery embolization in the treatment of iatrogenic renal bleeding.
METHOD
The prospective study was conducted from December 2019 to December 2021 at Ain Shams University Hospital and Kafrelsheikh University Hospital, Egypt, and comprised patients of either gender who underwent renal artery embolization for iatrogenic arterial renal bleeding caused by percutaneous nephrolithotomy, renal biopsy and percutaneous nephrostomy. Diagnostic renal angiography was done to detect pseudoaneurysm and arteriovenous fistula. Embolization was done with either micro-coils or glue. Success of the procedure was defined astotal occlusion of the bleeding artery proved by post-embolization angiogram.
RESULTS
Of the 15 patients, 9(60%) were males and 6(40%) were females. The overall mean age was 35+/-14 years. Percutaneous nephrolithotomy was the main cause 8(53.3%), followed by renal biopsy 5(33.3%) and percutaneous nephrostomy 2(13.2%). There were 9(50%) cases of pseudoaneurysm and 6(40%) of arteriovenousfistula. Embolization was done with micro-coils in 5(33.3%) cases and with glue in 10(66.6%). The technical success rate was 15(100%). No major complicationsrequiring intensive care orsurgical intervention were encountered, and there was no significant differences in estimated glomerular infiltration rate or renal function after renal artery embolization (p>0.05).
CONCLUSIONS
Percutaneous endovascular renal artery embolization was found to be a safe and effective technique in the management of iatrogenic renal arterial injury.
Topics: Male; Female; Humans; Young Adult; Adult; Middle Aged; Renal Artery; Aneurysm, False; Prospective Studies; Kidney; Stroke; Iatrogenic Disease; Retrospective Studies
PubMed: 37482877
DOI: 10.47391/JPMA.EGY-S4-59