Top

CardioVascular and Interventional Radiology

Published in:

01-06-2013 | Clinical Investigation

Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing

Authors: Andrea Del Corso, Giuseppe Vergaro

Published in: CardioVascular and Interventional Radiology | Issue 3/2013

Abstract

Purpose

Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA.

Material and Methods

During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up.

Results

PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 ± 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary.

Conclusion

PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.

Biancari F, D’Andrea V, Di Marco C et al (2010) Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J 159(4):518–531PubMedCrossRef

Demirbas O, Batyraliev T, Eksi Z et al (2005) Femoral pseudoaneurysm due to diagnostic or interventional angiographic procedures. Angiology 56(5):553–556PubMedCrossRef

Bangalore S, Bhatt DL (2011) Femoral arterial access and closure. Circulation 124(5):e147–e156PubMedCrossRef

Hanson JM, Atri M, Power N (2008) Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: doppler features and technical tips. Br J Radiol 81(962):154–163PubMedCrossRef

Morgan R, Belli AM (2003) Current treatment methods for post catheterization pseudoaneurysms. J Vasc Interv Radiol 14(6):697–710PubMedCrossRef

Ferguson JD, Whatling PJ, Martin V et al (2001) Ultrasound guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms after coronary angiography and intervention. Heart 85(4):4–5CrossRef

Krueger K, Zaehringer M, Strohe D et al (2005) Post catheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 236(3):1104–1110PubMedCrossRef

Hung B, Gallet B, Hodges TC (2002) Ipsilateral femoral vein compression: a contraindication to thrombin injection of femoral pseudoaneurysms. J Vasc Surg 35(6):1280–1283PubMedCrossRef

Webber GW, Jang J, Gustavson S et al (2007) Contemporary management of postcatheterization pseudoaneurysms. Circulation 115(20):2666–2674PubMedCrossRef

10.

Edgerton JR, Moore DO, Nichols D et al (2002) Obliteration of femoral artery pseudoaneurysm by thrombin injection. Ann Thorac Surg 74(4):1413–1415CrossRef

11.

Grewe PH, Mügge A, Germig A et al (2004) Occlusion of pseudoaneurysms using human or bovine thrombin contrast-enhanced ultrasound guidance. Am J Cardiol 93(12):1540–1542PubMedCrossRef

12.

Paulson EK, Nelson RC, Mayer CE et al (2001) Sonographically guided thrombin injection of iatrogenic femoral pseudoanerurysms: further experience of a single institution. Am J Roentgenol 177(2):309–316CrossRef

13.

Sackett WR, Taylor SM, Coffey CB et al (2000) Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: a prospective analysis. Am Surg 66(10):937–940PubMed

14.

Kang SS, Labropoulos N, Mansour MA et al (1998) Percutaneous ultrasound guided thrombin injection: a new method for treating post catheterization femoral pseudoaneurysms. J Vasc Surg 27(6):1032–1038PubMedCrossRef

15.

Oholow MA, Secknus MA, Von Korn H et al (2008) Percutaneous thrombin injection for treatment of iatrogenic femoral artery pseudoaneurysms: a case for caution. Angiology 59(3):372–375CrossRef

16.

Aytekin C, Firat A, Gültekin B et al (2003) A US-guided glue injection in the treatment of femoral pseudoaneurysms. Tani Girisim Radyol 9(2):257–259PubMed

17.

Montanaro L, Arciola CR, Cenni E et al (2001) Cytotoxicity, blood compatibility and antimicrobial activity of two cyanoacrylate glues for surgical use. Biomaterials 22(1):59–66PubMedCrossRef

18.

Heye S, Maleux G, Wilms G (2006) Pain experience during internal spermatic vein embolization for varicocele: comparison of two cyanoacrylate glues. Eur Radiol 16(1):132–136PubMedCrossRef

19.

Righini M (2007) Post-catetherization false femoral aneurysms. Rev Med Suisse 3(97):341–345PubMed

20.

Hajarizadeh H, La Rosa CR, Cardullo P et al (1995) Ultrasound-guided compression of post-catheterization femoral pseudoaneurysm failure, recurrence, and long-term results. J Vasc Surg 22(4):425–433PubMedCrossRef

21.

La Perna L, Olin JW, Goined D et al (2000) Ultrasound-guided thrombin injection for the treatment of post catheterization pseudoaneurysms. Circulation 102(19):2391–2395PubMedCrossRef

22.

Saad NE, Saad WE, Davies MG et al (2005) Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics 25:173–189CrossRef

23.

Stone PA, Abu Rahma AF, Flaherty SK et al (2006) Femoral pseudoaneurysms. Vasc Endovasc Surg 40(2):109–117CrossRef

24.

Mohler ER III, Mitchell ME, Carpenter JP et al (2001) Therapeutic thrombin injection of pseudoaneurysms: a multicenter experience. Vasc Med 6(4):241–244PubMedCrossRef

25.

Paulson EK, Sheafor DH, Kliewer MA et al (2000) Treatment of iatrogenic femoral arterial pseudoaneurysms: comparison of US-guided thrombin injection with compression repair. Radiology 215(2):403–408PubMed

26.

Aytekin C, Firat A, Yildirim E et al (2004) Ultrasound-guided glue injection as alternative treatment of femoral pseudoaneurysms. Cardiovasc Intervent Radiol 27(6):612–615PubMedCrossRef

Title: Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing
Authors: Andrea Del Corso
Giuseppe Vergaro
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 3/2013
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-012-0502-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing

Abstract

Purpose

Material and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Material and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2013

Vascular Perforation by Enterprise Stent During Stent-Assisted Coil Embolization for Intracranial Aneurysm

Efficacy and Safety of Transarterial Radioembolization Versus Chemoembolization in Patients With Hepatocellular Carcinoma

Temporary Arterial Balloon Occlusion as an Adjunct to Yttrium-90 Radioembolization

Percutaneous CT-Guided Biopsy of C3 Vertebral Body: Modified Approach for an Old Procedure

Portal Vein Embolization: From Evidence to Expert Opinion?

Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis