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Orthopaedic Surgery Jul 2022To compare the efficacy of open surgery (OS), endovascular interventions (EIs), and ultrasound-guided thrombin injection (UGTI) for the treatment of peripheral arterial... (Comparative Study)
Comparative Study
OBJECTIVE
To compare the efficacy of open surgery (OS), endovascular interventions (EIs), and ultrasound-guided thrombin injection (UGTI) for the treatment of peripheral arterial pseudoaneurysms (PAs).
METHODS
From January 1, 2001, to February 10, 2021, 38 patients diagnosed with traumatic and iatrogenic PAs treated with OS, EI, and UGTI were retrospectively analyzed. There were 18 females and 20 males, with an age of 56.47 ± 14.08 years (range,17-87 years). Anesthesia modality, operation duration, blood transfusion, duration of hospital stay, primary and secondary success rates, and complication rate were used to evaluate the surgical outcomes.
RESULTS
There were 11 cases under regional anesthesia and 4 under general anesthesia in OS group, 9 under regional anesthesia and 1 under general anesthesia in EI group, and no regional or general anesthesia was required in UGTI group. There was no significant differences between any two groups (χ = 39.80, p < 0.05). The blood tranfusion amount (units) were 3.6 ± 6.0, 0.8 ± 2.5, 0.0 ± 0.0 for OS, EI, and UGTI groups, respectively, with significant difference between OS and UGTI groups (F = 3.03, p < 0.05). The operation duration (minutes) of OS, EI, and UGTI groups were 80.0 ± 41.9, 56.0 ± 8.4, and 22.7 ± 5.3, respectively, with significant difference between any two groups (F = 15.69, p < 0.05). The duration of hospital stay (days) were 47.7 ± 39.0, 31.5 ± 17.6, and 16.3 ± 9.5, repectively, with significant difference between any two groups (F = 47.73, p < 0.05). The primary clinical success rates were 80% (12/15), 90% (9/10), and 92.3% (12/13) in OS,EI, and UGTI groups, respectively, with no significant difference between any two groups (χ = 0.34, p > 0.05). The secondary clinical success rates were 100% for all three groups. The overall complication rates of OS, EI, and UGTI groups were 20% (3/15), 10% (1/10), and 7.7% (1/13), respectively, with no significant difference between any two groups (χ = 1.00, p > 0.05). The infection rates were 13.3% (2/15), 10% (1/10), and 0% (0/13) in OS, EI, and UGTI groups respectively, with no significant difference between any two groups (χ = 1.80, p > 0.05). The reintervention rates were 6.7% (1/15), 0% (0/10), 7.7% (1/13) in OS, EI, and UGTI groups, respectively, with no significant difference between two groups (χ = 0.95, p > 0.05). Neuralgia was relieved in all patients.
CONCLUSIONS
OS, EI, and UGTI are efficacious and safe options for the treatment of appropriate patients with traumatic and iatrogenic PAs. UGTI would be considered as a first-line therapy for this condotion.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, False; Female; Femoral Artery; Humans; Iatrogenic Disease; Male; Middle Aged; Retrospective Studies; Thrombin; Treatment Outcome; Ultrasonography, Interventional; Young Adult
PubMed: 35678135
DOI: 10.1111/os.13315 -
BMC Cardiovascular Disorders Feb 2023Aortic pseudoaneurysm is a life-threatening clinical condition, and thoracic endovascular aortic repair (TEVAR) has been reported to have a relatively satisfactory...
BACKGROUND
Aortic pseudoaneurysm is a life-threatening clinical condition, and thoracic endovascular aortic repair (TEVAR) has been reported to have a relatively satisfactory effect in aortic pathologies. We summarized our single-centre experience using chimney TEVAR for aortic arch pseudoaneurysms with inadequate landing zones.
METHODS
A retrospective study was conducted from October 2015 to August 2020, 32 patients with aortic arch pseudoaneurysms underwent chimney TEVAR to exclude an aortic lesion and reconstruct the supra-aortic branches, including 3 innominate artery, 12 left common carotid arteries and 29 left subclavian arteries. Follow-up computed tomography was suggested before discharge; at 3, 6, 12 months and yearly thereafter.
RESULTS
The median age of 32 patients was 68.0 years (range, 28-81) with the mean max diameter of aneurysm of 47.9 ± 12.0 mm. Forty-four related supra-aortic branches were well preserved, and the technical success rate was 100%. The Type Ia endoleaks occurred in 3 (9%) patients. Two patients were lost to follow-up and 4 patients died during the follow-up period. The mean follow-up times was 46.5 ± 14.3 months. One patient died due to acute myocardial infarction just 10 days after chimney TEVAR and the other 3 patients passed away at 1.5 months, 20 months, and 31 months with non-aortic reasons. The 4.5-year survival estimate was 84.4%. The primary patency rate of the target supra-arch branch vessels was 97.7% (43/44), and no other aorta-related reinterventions and severe complications occurred.
CONCLUSION
For aortic arch pseudoaneurysms with inadequate landing zones for TEVAR, the chimney technique seems to be feasible, with acceptable mid-term outcomes, and it could serve as an alternative minimally invasive approach to extend the landing zone. Slow flow type Ia endoleak could be treated conservatively after chimney TEVAR. Additional experience is needed, and the long-term durability of chimney TEVAR requires further follow-up.
Topics: Humans; Adult; Middle Aged; Aged; Aged, 80 and over; Aorta, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Aneurysm, False; Retrospective Studies; Treatment Outcome; Risk Factors; Endovascular Procedures; Aortography; Time Factors; Endoleak; Stents
PubMed: 36782127
DOI: 10.1186/s12872-023-03091-4 -
Journal of Cardiothoracic Surgery Apr 2022Pseudoaneurysm with a shunt to the right ventricle after aortic repair for acute aortic dissection is an extremely rare and life-threatening condition. Surgical...
BACKGROUND
Pseudoaneurysm with a shunt to the right ventricle after aortic repair for acute aortic dissection is an extremely rare and life-threatening condition. Surgical treatment is unavoidable, but surgery is complicated, and there are some pitfalls. This study describes the reoperation performed in a patient at a high surgical risk by clarifying the shunt site using multimodality imaging before surgery.
CASE PRESENTATION
A 69-year-old woman with a history of systemic lupus erythematosus (SLE) and Sjogren's syndrome presented with a pseudoaneurysm 1 year after emergency surgery for acute type A aortic dissection. Eight years after the first surgery, she experienced sudden chest pain and presented to the emergency department. Her dyspnea worsened; therefore, echocardiography and three-dimensional computed tomography (3DCT) were performed, and a pseudoaneurysm and shunt to the right ventricle were identified. The medical team attempted to close the shunt with a percutaneous catheter but was unsuccessful, and she was referred to our department for surgical treatment. The pseudoaneurysm originating from the proximal side of the aorta was large (diameter = 55 mm), and echocardiography-gated 3DCT identified the shunt from the pseudoaneurysm to the right ventricle. First, extracorporeal circulation was initiated, and resternotomy was performed. We could not insert the left ventricular venting tube from the right side because of the pseudoaneurysm size. Instead, the tube was inserted from the left atrial appendage. We found a half-circumferential disengaged anastomosis around the proximal anastomosis, which formed the large pseudoaneurysm leading to a fistula in the right ventricle. We closed the fistula and performed a Bentall operation. The patient had a good postoperative course and was discharged on postoperative day 21. She continued treatment for SLE and Sjogren's syndrome, and her inflammatory reaction improved.
CONCLUSIONS
We performed a Bentall operation and fistula closure with resternotomy in a patient with type A aortic dissection with SLE and Sjogren's syndrome. Multimodal imaging is essential in defining the pseudoaneurysm and the fistula surrounding the anatomy while ensuring their resolution and guiding the approach for operation.
Topics: Aged; Aortic Dissection; Aneurysm, False; Female; Fistula; Heart Ventricles; Humans; Lupus Erythematosus, Systemic; Sjogren's Syndrome
PubMed: 35477534
DOI: 10.1186/s13019-022-01827-5 -
JNMA; Journal of the Nepal Medical... Mar 2022Spontaneous femoral artery pseudoaneurysm in a young person with no comorbidity is a rare occurrence. A 30 years old gentleman presented to our hospital with complaints...
UNLABELLED
Spontaneous femoral artery pseudoaneurysm in a young person with no comorbidity is a rare occurrence. A 30 years old gentleman presented to our hospital with complaints of painful swelling of spontaneous onset in the right inguinal region for 15 days. He had undergone incision and drainage of the contents of the swelling five days back but he suffered from a recurrence of the painful right inguinal swelling and persistent bleeding from the incision site for four days. Computed tomography showed a pseudoaneurysm of the right common femoral artery. It was treated surgically by emergency exploration, hematoma evacuation, removal of pseudoaneurysm, and repair of the defect in the right common femoral artery. In this case, we were fortunate that inadvertent incision of the pseudoaneurysm didn't result in a massive haemorrhage. This serves as a reminder that the possibility of a femoral artery pseudoaneurysm should be considered when evaluating a swelling of the inguinal region.
KEYWORDS
case report; common femoral artery; misdiagnosis; pseudoaneurysm; vascular surgery.
Topics: Adolescent; Adult; Aneurysm, False; Femoral Artery; Humans; Male; Tomography, X-Ray Computed
PubMed: 35633270
DOI: 10.31729/jnma.6948 -
Polish Archives of Internal Medicine Apr 2024
Topics: Humans; Male; Aneurysm, False; Adult
PubMed: 38391140
DOI: 10.20452/pamw.16685 -
Annals of Vascular Surgery May 2020In recent years, endovascular treatment of subclavian artery pseudoaneurysm (SAP) has been recommended by many experts. The aim of this study is to evaluate the safety...
BACKGROUND
In recent years, endovascular treatment of subclavian artery pseudoaneurysm (SAP) has been recommended by many experts. The aim of this study is to evaluate the safety and efficacy of the endovascular treatment of SAP, and to introduce our experience in the diagnosis and treatment of SAP.
METHODS
A total of 8 consecutive patients with SAP were treated with endovascular treatment in our hospital between 2010 and 2018. We retrospectively reviewed the patients' clinical characteristics, physical examinations findings, diagnostic imaging results, endovascular treatment, clinical outcome, and follow-up results.
RESULTS
All the 8 patients received endovascular treatment with covered stents initially. The technical success rate was 87.5% (7/8). In 1 patient with severe tortuosity of the proximal subclavian artery, the stent could not be released through the femoral artery approach in the primary operation but was successfully released via the brachial artery approach in the secondary operation. No complications occurred in the perioperative period. All the symptoms and signs were significantly relieved. During a follow-up of 4.5-84.5 months (average 31.5 months), 1 patient developed an endoleak 4 months after operation and reintervention was attempted but failed. No adverse events occurred in other patients during the follow-up period.
CONCLUSIONS
Endovascular treatment of SAP is safe and effective, and should be used as a first-line treatment. Stent placement through the brachial artery approach is recommended for SAP with severe proximal vascular tortuosity.
Topics: Adult; Aged; Aneurysm, False; Endovascular Procedures; Female; Humans; Male; Middle Aged; Retrospective Studies; Stents; Subclavian Artery; Time Factors; Treatment Outcome
PubMed: 31705990
DOI: 10.1016/j.avsg.2019.10.096 -
Revue Medicale de Liege Apr 2022Arterial aneurysms of visceral branches are rare, even more if they occur on the superior mesenteric artery and its branches (among which ileal branches). Rupture is its...
Arterial aneurysms of visceral branches are rare, even more if they occur on the superior mesenteric artery and its branches (among which ileal branches). Rupture is its major complication, thus rapid treatment is mandatory. CT angiography is the gold standard for diagnosis and therapeutic planification. Usual treatment is surgical, even though percutaneous embolization can be safely and precisely performed. Use of coils with sandwich technique is preferred.
Topics: Aneurysm; Aneurysm, False; Embolization, Therapeutic; Humans; Mesenteric Artery, Superior; Treatment Outcome
PubMed: 35389001
DOI: No ID Found -
Turkish Journal of Medical Sciences Oct 2021Evaluate the risk factors associated with pseudoaneurysms' development after the percutaneous interventional procedures performed by cardiology, interventional radiology...
BACKGROUND/AIM
Evaluate the risk factors associated with pseudoaneurysms' development after the percutaneous interventional procedures performed by cardiology, interventional radiology (IR), and the other clinics.
MATERIALS AND METHODS
We retrospectively analyzed the ultrasound scans in the hospital database and picture archiving system (PACS) and enrolled a total of 132 patients during the period from October 2015 and December 2019. We evaluated the maximum diameter and volume of the pseudoaneurysm with the patient and procedure-related factors with univariate analysis.
RESULTS
We found that the patients with hypertension and without peripheric artery disease (PAD) had greater sac diameter (p = 0.010 and p = 0.016) and increased sac volume (p = 0.029 and p = 0.007). However, the sac volume increased in patients with diabetes than those without (p = 0.003). Both the increased maximum diameter and the volume of the pseudoaneurysm sac were in the patients in whom the procedure was applied in the common femoral artery (CFA) and with the venous intervention (p < 0.010 and p < 0.016; p = 0.004 and p = 0.001, respectively). We found that platelet count correlated negatively with the sac's maximum diameter and the volume (r = –0.383, p < 0.001 and r = –0.486, p < 0.001, respectively) duration of intervention correlated positively with the sac's maximum diameter and the volume (r = 0.205, p = 0.019 and r = 0.320, p < 0.001).
CONCLUSION
Our study reveals that prolonged procedure duration, simultaneous arterial and venous accesses, peripheral artery disease, thrombocytopenia, and puncture site are the aggressive risk factors of pseudoaneurysms size after angiographic procedures.
Topics: Aged; Aneurysm, False; Angiography; Catheters; Female; Femoral Artery; Humans; Male; Middle Aged; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Ultrasonography, Doppler, Duplex
PubMed: 33932972
DOI: 10.3906/sag-2012-60 -
BMC Women's Health Aug 2021The formation of a uterine artery pseudoaneurysm is rare and isolated cases have been reported in the existing literature following caesarean sections, curettages and...
BACKGROUND
The formation of a uterine artery pseudoaneurysm is rare and isolated cases have been reported in the existing literature following caesarean sections, curettages and cone biopsies. There has been no report of pseudoaneurysm formation following a loop electrosurgical excision procedure. Vaginal bleeding could potentially be life threatening if this diagnosis is not considered following cervical instrumentation or surgery. Management options range from haemostatic sutures, image-guided embolisation to surgical repair. We report the diagnosis and management of a case of uterine artery pseudoaneurysm after a loop electrosurgical excision procedure.
CASE PRESENTATION
A 37-year-old woman was diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) and underwent a therapeutic loop electrosurgical excision procedure. One month after the procedure, the patient presented to the emergency department with repeated episodes of sudden-onset heavy vaginal bleeding associated with hypotension and syncope. A computed tomography angiogram was performed, which demonstrated a pseudoaneurysm of the right uterine artery. Following the diagnosis, image-guided embolisation was performed successfully. Post-embolisation angiograms showed successful embolisation of the pseudoaneurysm and the patient had no further episodes of bleeding.
CONCLUSIONS
Loop electrosurgical excision procedures are generally safe but rarely, can be complicated by the formation of uterine artery pseudoaneurysms. The depth of the loop electrosurgical excision procedure and vascular anatomy should be considered to prevent such complications. A computed tomography angiogram appears to be ideal for diagnosis. Image-guided embolisation is safe and effective as a therapeutic measure, with minimal morbidity.
Topics: Adult; Aneurysm, False; Electrosurgery; Female; Humans; Pregnancy; Uterine Artery; Uterine Cervical Neoplasms; Uterine Hemorrhage
PubMed: 34399742
DOI: 10.1186/s12905-021-01446-7 -
BMC Pediatrics Jan 2023Pseudoaneurysm is a known complication of penetrating arterial injuries such as catheterization, gunshot wounds, and open fractures. Vaccination is an effective method...
BACKGROUND
Pseudoaneurysm is a known complication of penetrating arterial injuries such as catheterization, gunshot wounds, and open fractures. Vaccination is an effective method for preventing multiple, serious, infectious diseases in children. Common adverse reactions related to vaccination include fever, swelling, redness, and pain. Brachial pseudoaneurysm after vaccination has not been previously reported.
CASE PRESENTATION
Herein we describe a novel case of brachial pseudoaneurysm after vaccination in a child aged 1 year and 3 months. A pulsatile mass was formed in the medial left arm of the infant 10 days after vaccination at a community hospital and gradually grew larger. Preoperative images depicted an eccentric aneurysm in the brachial artery and a swirling flow pattern in the mass. The pseudoaneurysm was excised, and vein graft interpositioning was successfully performed. There were no short-term or long-term complications during the follow-up period.
CONCLUSIONS
Brachial pseudoaneurysm is a rare complication of vaccination via intramuscular injection. Medical staff should avoid puncture wounds to the brachial artery during vaccination, especially in infants.
Topics: Child; Humans; Infant; Aneurysm, False; Brachial Artery; Wounds, Gunshot; Upper Extremity; Vaccination
PubMed: 36600189
DOI: 10.1186/s12887-022-03793-2