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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 -
Surgical Endoscopy Jul 2014Peripancreatic pseudoaneurysms can arise in a number of different clinical settings but are associated mostly with pancreatitis and pancreatobiliary surgery. The aim of... (Review)
Review
BACKGROUND
Peripancreatic pseudoaneurysms can arise in a number of different clinical settings but are associated mostly with pancreatitis and pancreatobiliary surgery. The aim of this study is to review the current literature and to propose a management classification system based on the pathophysiological processes and the exact anatomical site of peripancreatic pseudoaneurysms.
METHODS
A systematic review of the literature from 1995 to 2012 was performed. Articles on studies describing peripancreatic pseudoaneurysms in the setting of pancreatitis or major hepatic or pancreatic surgery with more than ten patients were included. Seventeen eligible studies were identified and reviewed.
RESULTS
The demographic characteristics of the patients in all studies were similar with a predominance of males and a mean age of 55 years. The overall mortality rate varied greatly among the studies, ranging from 0 to 60%. Embolisation was the first line of management in the majority of the studies, with surgery reserved for failed embolisation or for haemodynamically unstable cases. Embolisation of the hepatic artery or its branches was associated with high rates of morbidity (56%) and hepatic failure (19%). More recent studies show that stents are used increasingly for vessels that cannot be embolised safely. Late bleeding, a major cause of mortality and morbidity, is generally underreported. The proposed classification system is based on three factors: (1) the type of artery from which the pseudoaneurysm arises, (2) whether communication with the gastrointestinal tract is present, and (3) whether there is high concentration of pancreatic juice at the bleeding site.
CONCLUSION
The management of peripancreatic pseudoaneurysms usually comprises a combination of interventional radiology and surgery and this may be assisted by a logical classification system.
Topics: Aged; Aneurysm, False; Embolization, Therapeutic; Female; Gastrointestinal Hemorrhage; Hepatic Artery; Humans; Male; Mesenteric Arteries; Middle Aged; Pancreas; Pancreatitis; Patient Selection; Postoperative Complications; Rupture; Splenic Artery; Stents
PubMed: 24519028
DOI: 10.1007/s00464-014-3434-9 -
Journal of Vascular Surgery Nov 2003Splenic artery pseudoaneurysm is uncommon. We report our institution's recent 18-year experience with these aneurysms and review the literature. (Review)
Review
INTRODUCTION
Splenic artery pseudoaneurysm is uncommon. We report our institution's recent 18-year experience with these aneurysms and review the literature.
METHODS
We reviewed the records for 37 patients with visceral artery pseudoaneurysm evaluated at our institution from 1980 to 1998. From this group we found only 10 patients (27%) with splenic artery pseudoaneurysm. We also reviewed 147 cases of splenic artery pseudoaneurysm reported in the English literature.
RESULTS
In this series of 10 patients, 5 were men. Mean age was 51.2 years (range, 35-78 years). Causes of aneurysm included chronic pancreatitis in 4 patients, trauma in 2 patients, iatrogenic cause in 1 patient, and unknown cause in 3. The most common symptom was bleeding in 7 patients and abdominal or flank pain in 5 patients; 2 patients had no symptoms. Aneurysm diameter was known for four pseudoaneurysms, and ranged from 0.3 to 3 cm (mean, 1.7 cm). Splenectomy and distal pancreatectomy were performed in 4 patients, splenectomy alone in 2 patients, endovascular transcatheter embolization in 2 patients, and simple ligation in 1 patient. One patient with a ruptured pseudoaneurysm died before any intervention could be performed; there were no postoperative deaths. Follow-up data were available for 7 patients, with a mean of 46.3 months (range, 4.5-120 months).
CONCLUSIONS
Splenic artery pseudoaneurysm is rare and usually is a complication of pancreatitis or trauma. Average aneurysm diameter in our series of 10 patients was smaller than previously reported (1.7 cm vs 5.0 cm). Although conservative management has produced excellent results in some reports, from our experience and the literature, we recommend repair of all splenic artery pseudoaneurysms.
Topics: Adult; Aged; Aneurysm, False; Female; Humans; Male; Pancreatitis; Retrospective Studies; Splenic Artery
PubMed: 14603202
DOI: 10.1016/s0741-5214(03)00710-9 -
Acta Ortopedica Mexicana 2021Aneurysms and pseudoaneurysms of the arteries of the foot and ankle are rare clinical entities. In most cases occur within months or years of the initial trauma,...
INTRODUCTION
Aneurysms and pseudoaneurysms of the arteries of the foot and ankle are rare clinical entities. In most cases occur within months or years of the initial trauma, complications in the aforementioned situations are very uncommon, however, they should be ruled out at medical check-ups. We will present a clinical case in which pseudoaneurysm of the Distal Peroneal Artery occurred as a result of a fracture- dislocation of the ankle.
CLINICAL CASE
Patient of 60 years of age with trauma in right ankle, his radiographic study of the right ankle evidencing fracture- dislocation of the same. Surgical treatment is decided four days after the injury. In the postoperative course with edema, circulatory changes of abnormal form that merited imaging complement and arteriography was performed which indicates the presence of pseudoaneurysm of approximately 28 × 30 mm in distal peroneal artery meriting specific treatment with adequate control of symptoms.
CONCLUSION
We believe that it is of the utmost importance the correct assessment and physical examination of patients undergoing ankle surgery in successive post-surgical controls to detect these types of complications early and treat them in time.
Topics: Aneurysm, False; Ankle Joint; Humans; Lower Extremity; Tibial Arteries
PubMed: 34921541
DOI: No ID Found -
PloS One 2018To present the various techniques used in the management of pancreatitis-related pseudoaneurysms of visceral vessels. (Review)
Review
OBJECTIVES
To present the various techniques used in the management of pancreatitis-related pseudoaneurysms of visceral vessels.
METHODS
The retrospective clinical study was carried out at the Department of Diagnostic and Interventional Radiology at Poznan University of Medical Sciences from 2011 to 2016. The fifteen patients included in the study were diagnosed with pseudoaneurysms of visceral arteries, as a complication of chronic pancreatitis. The diagnosis was made using contrast-enhanced computed tomography, followed by angiography. On admission, all patients were symptomatic, with varying degrees of abdominal pain. One patient was haemodynamically unstable. Treatments with endovascular techniques were analysed, along with their efficacy and outcomes. Coil embolisation was performed in 5 patients. Stent graft was used in 1 patient. Liquid embolic agents were used in 7 cases, of which 5 patients were treated with thrombin injection and 2 with Squid. A combination of techniques was used in 2 patients.
RESULTS
The most common artery affected by pseudoaneurysm formation was the splenic artery (7/15; 46.7%), and the size of the pseudoaneurysms ranged from 27 mm to 85 mm. Primary technical success was achieved in 14 out of 15 patients (93.3%). One patient required reintervention. Two patients required splenectomy after embolisation due to splenic ischemia. No recanalisation was present at the follow-up computed tomography performed after 1 to 3 weeks, and no mortality was observed within 30 days.
CONCLUSION
Vascular complications of pancreatitis require accurate diagnosis and immediate treatment. Endovascular intervention is highly effective and is the preferred treatment option. The technique used is determined based on vascular anatomy and the patient's haemodynamic status.
Topics: Aneurysm, False; Contrast Media; Humans; Pancreatitis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 29377944
DOI: 10.1371/journal.pone.0191998 -
European Journal of Vascular and... Mar 2022
Topics: Aneurysm, False; Aorta; Humans; Surgical Instruments
PubMed: 34972628
DOI: 10.1016/j.ejvs.2021.11.017 -
European Journal of Vascular and... Apr 2022
Topics: Aneurysm, False; Foot; Humans; Thigh; Tibial Arteries
PubMed: 35144893
DOI: 10.1016/j.ejvs.2021.12.017 -
Cirugia Y Cirujanos 2022Upper extremity arterial aneurysms are not common clinical conditions. It may causes ischemic gangrene or limb losses as a result of thromboembolic events due to...
BACKGROUND
Upper extremity arterial aneurysms are not common clinical conditions. It may causes ischemic gangrene or limb losses as a result of thromboembolic events due to endothelial damage. In this study, we aimed to investigate the etiology, management, and long-term outcome.
METHODS
A total of 55 upper extremity aneurysms between January 2009 and April 2018 were retrospectively investigated. The mean age was 41 ± 13 years, and the women and men were 13 (23.6%) and 42 (76.4%). The mean follow-up was 43 ± 18 months.
RESULTS
The incidence of pseudoaneurysm was higher than the true aneurysm (64.5% vs. 35.5%). 30 (84%) patients who had pseudoaneurysm repaired primerely and 6 (16%) patients had patchplasty. About 58% of the true aneurysm caused by blunt trauma. 4 (21%) true brachial aneurysm patients were required emergency intervention due to distal ischemia. 16 (84.2%) patients operated using by saphenous vein graft. The primary and secondary patency was 87.5% and 93.8%. No limb or life loss occurred during follow-up.
CONCLUSION
Pseudoaneurysms are more common among upper limb aneurysms and they occur mostly by iatrogenic causes. Blunt trauma can be main cause of the true aneurysm. Surgical resection of the aneurysm and interposition of saphenous vein graft provides excellent results in the long-term.
Topics: Adult; Aneurysm; Aneurysm, False; Female; Humans; Ischemia; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Upper Extremity; Wounds, Nonpenetrating
PubMed: 35944426
DOI: 10.24875/CIRU.21000068 -
Ugeskrift For Laeger Sep 2014Development of a hepatic pseudoaneurysm (HPA) is a well-known, yet rare complication after liver trauma. We found 135 cases reported in the literature since 1965.... (Review)
Review
Development of a hepatic pseudoaneurysm (HPA) is a well-known, yet rare complication after liver trauma. We found 135 cases reported in the literature since 1965. Ruptured HPAs may have severe consequences with sudden massive haemorrhage and death. A clear strategy towards diagnosis and management of HPA post liver trauma is needed and outlined in this paper. We recommend early detection and definitive treatment before enlargement and rupture.
Topics: Algorithms; Aneurysm, False; Angiography; Humans; Liver; Wounds, Nonpenetrating
PubMed: 25294204
DOI: No ID Found -
Canadian Association of Radiologists... Feb 2013
Review
Topics: Abdomen; Aneurysm, False; Contrast Media; Diagnosis, Differential; Diagnostic Imaging; Hemorrhage; Humans; Pelvis
PubMed: 22406135
DOI: 10.1016/j.carj.2011.10.001