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Hand (New York, N.Y.) May 2024Use of radial and ulnar access has increased due to its perceived benefits over femoral access. Ulnar artery catheterization can place patients at risk of significant...
BACKGROUND
Use of radial and ulnar access has increased due to its perceived benefits over femoral access. Ulnar artery catheterization can place patients at risk of significant complications, including pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve injury, and critical hand ischemia. The purpose of this study was to describe complications specific to ulnar artery catheterization.
METHODS
After obtaining institutional review board approval, a retrospective review was performed on all patients who underwent ulnar artery catheterization at our institution between 2019 and 2021. Complications were assessed, and complication rates were compared with previously published studies on ulnar artery catheterization for coronary angiography (percutaneous coronary intervention).
RESULTS
A total of 41 patients were available for review with a mean age of 59 years. Of these, 17 patients (41%) sustained complications in the immediate postprocedural period. These complications included hematoma (12 patients, 29%), pseudoaneurysm (1 patient, 2%), ulnar artery thrombosis (1 patient, 2%), ulnar neuropathy (3 patients, 7%), arterial damage requiring repair (2 patients, 5%), transient ischemia (3 patients, 7%), and compartment syndrome (2 patients, 5%). Three of these patients (7%) required operative intervention, and several were admitted to the hospital for an additional period of observation.
CONCLUSIONS
This series highlights the significant risks associated with ulnar artery catheterization for percutaneous procedures. Complications include pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve damage, and critical hand ischemia. Several of these patients required urgent or emergent surgical intervention, with some patients experiencing ongoing ulnar nerve symptoms.
Topics: Humans; Ulnar Artery; Middle Aged; Retrospective Studies; Male; Female; Aneurysm, False; Hematoma; Catheterization, Peripheral; Coronary Angiography; Aged; Compartment Syndromes; Ulnar Neuropathies; Ischemia; Thrombosis; Adult; Hand
PubMed: 36168743
DOI: 10.1177/15589447221124241 -
The Journal of Thoracic and... Jul 2023
Topics: Humans; Aortic Dissection; Aortic Aneurysm, Thoracic; Blood Coagulation; Anticoagulants; Blood Vessel Prosthesis Implantation; Treatment Outcome; Retrospective Studies; Endovascular Procedures; Acute Disease; Vascular Patency
PubMed: 34666909
DOI: 10.1016/j.jtcvs.2021.09.055 -
Radiographics : a Review Publication of... Jul 2023Transcatheter tricuspid valve interventions (TTVIs) comprise a variety of catheter-based interventional techniques for treatment of tricuspid regurgitation (TR) in...
Transcatheter tricuspid valve interventions (TTVIs) comprise a variety of catheter-based interventional techniques for treatment of tricuspid regurgitation (TR) in patients at high surgical risk and those with failed previous surgeries. Several TTVI devices with different mechanisms of action are either currently used or in preclinical evaluation. Echocardiography is the first-line modality for evaluation of tricuspid valve disease that provides information on tricuspid valve morphology, mechanism of TR, and hemodynamics. Cardiac CT and MRI have several advantages for a comprehensive preprocedure evaluation. CT and MRI provide complementary information to that of echocardiography on the mechanism and cause of TR. MRI can quantify the severity of TR using indirect or direct techniques that involve two-dimensional or four-dimensional flow sequences. MRI and CT can also accurately quantify right ventricular volumes and function, which is crucial for timing of intervention. CT provides comprehensive three-dimensional information on the morphology of the valve, annulus, subvalvular apparatus, and adjacent structures. CT is the procedure of choice for evaluation of several device-specific measurements, including tricuspid annulus dimensions, annulus-to-right coronary artery distance, leaflet morphology, coaptation gaps, caval dimensions, and cavoatrial-to-hepatic vein distance. CT allows evaluation of the vascular access as well as optimal procedure fluoroscopic angles and catheter trajectory. Postprocedure CT and MRI are useful in detection of complications such as paravalvular leak, pseudoaneurysm, thrombus, pannus, infective endocarditis, and device migration. RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Topics: Humans; Tricuspid Valve; Magnetic Resonance Imaging; Heart Valve Diseases; Aneurysm, False; Echocardiography
PubMed: 37384544
DOI: 10.1148/rg.220153 -
European Heart Journal. Case Reports Jan 2024Cardiac pseudoaneurysms are a potentially life-threatening pathology with a variety of non-specific clinical manifestations. This case series uniquely shares a...
BACKGROUND
Cardiac pseudoaneurysms are a potentially life-threatening pathology with a variety of non-specific clinical manifestations. This case series uniquely shares a collection of rare pathologies with differing preceding risk factors and presentations, with an emphasis on the utility of multi-modality imaging in diagnosis and management.
CASE SUMMARY
We present three cases of cardiac pseudoaneurysms. Case 1 is a 27-year-old woman with delayed presentation of a traumatic left ventricular pseudoaneurysm (LVP). Case 2 is a 73-year-old man with post-myocardial infarction LVP. Case 3 is a 38-year-old man with left ventricular outflow tract pseudoaneurysm after aortic valve replacement.
DISCUSSION
Cardiac pseudoaneurysms are rare and important to diagnose in a timely manner. Advances in non-invasive imaging modalities have improved our ability to distinguish pseudoaneurysms from other pathologies, leading to more timely management.
PubMed: 38213869
DOI: 10.1093/ehjcr/ytad636 -
Open Access Emergency Medicine : OAEM 2024Epistaxis is a frequent presenting complaint in the Emergency Department (ED). Roughly 60% of the population will suffer from epistaxis in their lifetime. The most...
BACKGROUND
Epistaxis is a frequent presenting complaint in the Emergency Department (ED). Roughly 60% of the population will suffer from epistaxis in their lifetime. The most common causes of epistaxis include nose picking, facial trauma, foreign bodies, and coagulopathies. There are other causes that are much less common, such as intracranial pseudoaneurysms. There are multiple causes that precipitate intracranial pseudoaneurysm formation, with head trauma accounting for less than 1% of inciting events.
CASE REPORT
A 24-year-old female with history of traumatic brain injury with associated skull fractures due to a gunshot wound to the head 6 months prior presented to the ED in hemorrhagic shock secondary to epistaxis. After stabilization with the administration of blood products, Computed Tomography with Angiography (CTA) imaging of the head and neck was obtained and revealed a 3.1 × 2.2 × 2.5 cm pseudoaneurysm of the cavernous portion of the right internal carotid artery penetrating through the base of the skull into the ethmoidal sinus. The patient was taken for formal angiography by interventional radiology-and a partially thrombosed daughter sac of the initial aneurysm was identified and believed to be the source of the hemorrhage. The aneurysm was successfully coiled and occluded using ONYX embolization. Postoperatively, the patient returned to her baseline mental status without any acute complaints. The patient was discharged back to her nursing home 2 days later with a 3-week follow-up CTA revealing persistent occlusion of the aneurysm and a patent internal carotid artery.
CONCLUSION
Awareness and consideration of intracranial vascular etiology for common complaints in the emergency room, such as Epistaxis, especially in patients with any history of head injury/trauma, known intracranial aneurysms or prosthetic devices from prior surgery may help guide decision-making in managing critically ill patients.
PubMed: 38659614
DOI: 10.2147/OAEM.S449026 -
PloS One 2024The use of three-dimensional(3D) printing is broadly across many medical specialties. It is an innovative, and rapidly growing technology to produce custom anatomical...
BACKGROUND
The use of three-dimensional(3D) printing is broadly across many medical specialties. It is an innovative, and rapidly growing technology to produce custom anatomical models and medical conditions models for medical teaching, surgical planning, and patient education. This study aimed to evaluate the accuracy and feasibility of 3D printing in creating a superficial femoral artery pseudoaneurysm model based on CT scans for endovascular training.
METHODS
A case of a left superficial femoral artery pseudoaneurysm was selected, and the 3D model was created using DICOM files imported into Materialise Mimics 22.0 and Materialise 3-Matic software, then printed using vat polymerization technology. Two 3D-printed models were created, and a series of comparisons were conducted between the 3D segmented images from CT scans and these two 3D-printed models. Ten comparisons involving internal diameters and angles of the specific anatomical location were measured.
RESULTS
The study found that the absolute mean difference in diameter between the 3D segmented images and the 3D printed models was 0.179±0.145 mm and 0.216±0.143mm, respectively, with no significant difference between the two sets of models. Additionally, the absolute mean difference in angle was 0.99±0.65° and 1.00±0.91°, respectively, and the absolute mean difference in angle between the two sets of data was not significant. Bland-Altman analysis confirmed a high correlation in dimension measurements between the 3D-printed models and segmented images. Furthermore, the accuracy of a 3D-printed femoral pseudoaneurysm model was further tested through the simulation of a superficial femoral artery pseudoaneurysm coiling procedure using the Philips Azurion7 in the angiography room.
CONCLUSIONS
3D printing is a reliable technique for producing a high accuracy 3D anatomical model that closely resemble a patient's anatomy based on CT images. Additionally, 3D printing is a feasible and viable option for use in endovascular training and medical education. In general, 3D printing is an encouraging technology with diverse possibilities in medicine, including surgical planning, medical education, and medical device advancement.
Topics: Aneurysm, False; Printing, Three-Dimensional; Humans; Femoral Artery; Models, Anatomic; Feasibility Studies; Tomography, X-Ray Computed; Endovascular Procedures; Imaging, Three-Dimensional
PubMed: 38829913
DOI: 10.1371/journal.pone.0304506 -
Cardiovascular Revascularization... Jul 2023Despite early and currently effective epicardial coronary recanalization, the mortality rate after mechanical complication (MC) remains high, especially in cardiogenic...
BACKGROUND
Despite early and currently effective epicardial coronary recanalization, the mortality rate after mechanical complication (MC) remains high, especially in cardiogenic shock. There is an increase in the use of mechanical circulatory support in patients with cardiogenic shock and MC, however, evidence is still scarce and most studies exclude patients with mechanical complications.
METHODS
Using the National Inpatient Sample database from 2015 to 2018 to identify patients with AMI, we aimed to determine the predictors and outcomes of patients with MC, subtypes and the use of MCS.
RESULTS
We identified 2,427,315 patients with AMI; 2345 (0.1 %) developed MC and of them 1320 (56.3 %) received MCS. Regarding subtypes, 960 (40.9 %) had ventricular septal rupture (VSR), 540 (23.0 %) papillary muscle rupture (PMR), 530 (22.6 %) pseudoaneurysm, and 315 (13.4 %) free wall rupture (FWR). Mortality was 12 times higher (OR: 11.663, CI: 10.582-12.855, p < 0.001) in patients with MC compared to patients without MC (49.7 % vs. 4.6 %, p < 0.001) and all subtypes of MC showed a significant increase in mortality. The use of MCS was associated with decreased mortality in PMR (46.2 % to 34.8 %, p = 0.009) and pseudoaneurysm (64.7 % to 42.1 %, p < 0.001), however, with higher mortality in VSR.
CONCLUSIONS
The incidence of MC after an AMI is very low, nonetheless the in-hospital mortality rate remains very high. It tends to occur more in older patients and with fewer comorbidities. The subtype with the highest frequency and highest mortality was VSR. The use of mechanical circulatory support was associated with better survival in PMR and pseudoaneurysm, but not overall survival.
Topics: Humans; Aged; Shock, Cardiogenic; Aneurysm, False; Risk Factors; Myocardial Infarction; Ventricular Septal Rupture; Heart Valve Diseases; Retrospective Studies
PubMed: 36849312
DOI: 10.1016/j.carrev.2023.02.004 -
Archivos de Bronconeumologia Mar 2024
Topics: Humans; Aneurysm, False; Pulmonary Artery
PubMed: 38331624
DOI: 10.1016/j.arbres.2024.01.010 -
The Journal of Craniofacial SurgeryPseudoaneurysm formation in the occipital artery, post radical neck dissection, leading to a bulging mass, is a rare but potentially fatal occurrence. The authors...
Pseudoaneurysm formation in the occipital artery, post radical neck dissection, leading to a bulging mass, is a rare but potentially fatal occurrence. The authors treated a patient with pseudoaneurysm of occipital artery, post radical neck dissection, presenting with pain and swelling after 17 days of surgery. A pseudoaneurysm involving occipital artery was revealed by digital subtraction angiography and treated by endovascular micro-coil embolization.
Topics: Humans; Aneurysm, False; Neck Dissection; Stents; Embolization, Therapeutic; Carotid Artery, Internal
PubMed: 37622540
DOI: 10.1097/SCS.0000000000009663 -
World Neurosurgery Aug 2023A 39-year-old male presented to our institution after sustaining a gunshot wound to the face. He was initially unresponsive with bleeding from the nares bilaterally and...
A 39-year-old male presented to our institution after sustaining a gunshot wound to the face. He was initially unresponsive with bleeding from the nares bilaterally and was intubated for airway protection. A computed tomography angiogram of the head and neck demonstrated multiple foci of active extravasation in the left maxillary sinus. The patient was taken for emergent neuroendovascular intervention, during which a large, 6.1 mm × 6.4 mm pseudoaneurysm of the left pterygoid artery was discovered and embolized with Onyx liquid embolic agent, with subsequent complete obliteration of the pseudoaneurysm. Embolization immediately halted the bleeding. The patient was neurologically intact at his most recent follow-up appointment. This case demonstrates the importance of obtaining an emergent computed tomography angiography for patients with ballistic facial trauma and early involvement of endovascular neurosurgery for treatment of intractable sinonasal bleeding.
Topics: Male; Humans; Adult; Wounds, Gunshot; Aneurysm, False; Angiography; Carotid Artery, Internal; Hemorrhage; Embolization, Therapeutic
PubMed: 37068607
DOI: 10.1016/j.wneu.2023.04.025