Hepatic artery aneurysms are rare, but potentially life-threatening vascular pathologies. They are usually discovered incidentally during imaging diagnostics of different pathologies. The study presented a rare case of hepatic artery pseudoaneurym with a fistula to the left branch of the portal vein.
Common use of venipuncture on upper and lower limbs for diagnostic purposes (such as coronarography or arteriography), and also during the course of treatment (angioplasty), very often bares a complication in the form of pseudoaneurysms. According to various reports, the incidence of pseudoaneurysms ranges from 0.005% to 0.5% of all vascular procedures requiring arterial cannulation (Common Femoral Artery, Brachial Artery, Radial Artery). The use of Bio Trombina® 400 in the embolization of pseudoaneurysms allows minimally invasive and effective treatment. The aim of the study was to evaluate the efficacy of pseudoaneurysm embolization with the use of Trombina 400, authors’ own experience. Material and methods. In the years 2011 - 2013, the authors of this study performed 38 vascular interventional procedures involving pseudoaneurysms as complications of venipuncture in upper and lower limbs for diagnostic and treatment purposes. All procedures involved the direct injection of thrombin into the chamber of the pseudoaneurysm under the guidance of USG Doppler (6.2 MHz linear head). 34 cases presented single chamber pseudoaneurysms while 4 cases involved multi- chamber pseudoaneurysms, which required several thrombin reinjections (Bio Trombina® 400) into each of the chambers. Pseudoaneurysm maximum size of 4 cm was set as an inclusion criterion for the embolization procedure. Furthermore, all pseudoaneurysms with a significantly wide tract in transverse dimensions were treated as an exclusion criterion because of high risk of the peripheral arteries embolization. Results. Initial success was observed in 36 patients (94.73%) in the first day after the procedure, 1 patient (2.63%) underwent thrombin reinjection procedure in the second day after the first embolization. Another patient (2.63%) underwent an open procedure in which the Common Femoral Artery was accessed, the clot evacuated, and CFA was sutured with continuous suture Prolene 6-0. Conclusions. 1. Embolization of pseudoaneurysms with USG Doppler-guided thrombin injection is an effective course of treatment for complications of cannulation. 2. The safety of pseudoaneurysm embolization depends on a surgeon’s experience. It is also crucial to keep in mind the inclusion and exclusion criteria for this type of procedure (the size of a pseudoaneurysm, the width of its base). 3. Furthermore, its cost effectiveness and short hospitalization period make pseudoaneurysm embolization an effective and valuable alternative to the classic approach.
Introduction: common application of endovascular procedures is frequently connected with increased risk of pseudoaneurysm at the site of the artery puncture. The most frequent method of treatment of aneurysms is percutaneous ultrasound-guided thrombin injection. The aim: The aim of this research was the safety evaluation of treatment of pseudoaneurysm by thrombin injection based on own experience. Methods and materials: 70 people (57% women, 43% men, average age 67,9 ± 10,5) with pseudoaneurysm and under ultrasound-guided thrombin injection treatment carried out between 2007 and 2018 in the Department of General and Vascular Surgery of Pirogow Hospital in Lodz were analyzed. Patients were qualified to treatment based on the aneurysm and channel morphology in ultrasound examination. Before application of medicine blood supply to the limb was clinically assessed and examined using sonography. The tip of the needle was imaged into the lumen of the aneurysm. Results: In the research group, the average aneurysm diameter was 29,9 mm (± 17,2 mm) within a range from 10 mm to 96 mm. The multi-chamber aneurysm was detected in 21% of patients. Mean channel length was 12 mm (±7,7 mm), mean width 3,5 mm (±1,4 mm), mean thrombin injected 1,7 ml (±0,7 mm) within the range from 0,5 ml to 4 ml. The treatment was successful in 94% of cases. Complications after thrombin injection occurred in 7% of cases (1 patient suffered from shock, 1 from thrombus in the saphenous vein, 3 from thrombus moving from aneurysm neck to femoral artery). No deterioration of blood supply in a limb was detected after the obliteration of the aneurysm. No relevant differences in aneurysm and channel dimensions were detected between groups with and without complications (p >0,05). Conclusions: Obliteration of the pseudoaneurysm by percutaneous ultrasound-guided thrombin injection is a highly effective method. This method is considered safe, however, it requires experience. Its application may cause complications of which some are clinically significant and may lead to health and life-threatening situations. In some specific cases, surgical treatment of choice should be considered.
Pseudocysts account for approximately 70% of all cystic lesions of the pancreas. One of the most dangerous complications of pancreatic pseudocysts is bleeding into the cystic lumen; the most common cause of the bleeding is a splenic artery pseudoaneurysm rupture. This paper presents the case of a 37-year-old man treated surgically for a massive intra–abdominal haemorrhage caused by a splenic artery pseudoaneurysm rupture into the lumen of a tail of pancreas pseudocyst with its subsequent perforation into the abdominal cavity and retroperitoneal space. Peripheral resection of the pancreas together with the cyst and spleen resection was performed. There were no postoperative complications.
Renal artery pseudoaneurysms and arteriovenous fistulae most often occur as an iatrogenic complication. The article discusses a case of a patient diagnosed with an arteriovenous fistula and a pseudoaneurysm. A 64-year-old woman was admitted to the hospital due to nonspecific pain in the lumbar region. Imaging showed a typical picture of clear cell renal carcinoma. The patient was qualified for surgical treatment. After tumor resection, the patient developed microhematuria. Arteriovenous fistula and renal pseudoaneurysm were diagnosed using Doppler and computed tomography scans. The patient was qualified for arteriography with simultaneous embolization of the lesion. A follow-up evaluation confirmed the exclusion of aneurysm and fistula. Treatment outcomes were monitored using Doppler ultrasound. Doppler ultrasonography is the first method of choice in detecting and monitoring renal artery irregularities. Safety, non-invasiveness and easy access to this tool make it play a key role in the diagnosis of renal artery fistulas and pseudoaneurysms.
PL
Pseudotętniaki tętnic nerkowych i przetoki tętniczo-żylne nerek pojawiają się najczęściej jako powikłania jatrogenne. W pracy omówiono przypadek chorej, u której w badaniu ultrasonograficznym i tomografii komputerowej rozpoznano przetokę tętniczo-żylną i tętniaka rzekomego, zlokalizowane w nerce prawej, a następnie leczonej metodami wewnątrznaczyniowymi. Sześćdziesięcioczteroletnia kobieta została przyjęta do szpitala z powodu niespecyficznych dolegliwości bólowych w okolicy lędźwiowej. Badania obrazowe wykazały typowy obraz dla jasnokomórkowego raka nerki. Chorą zakwalifikowano do leczenia chirurgicznego. Po resekcji klinowej u pacjentki obserwowano okresowy krwinkomocz. Za pomocą badania dopplerowskiego i tomografii komputerowej zdiagnozowano przetokę tętniczo-żylną i tętniaka rzekomego nerki prawej. Chorą zakwalifikowano do arteriografii z równoczasową embolizacją. Po zabiegu embolizacji badania kontrolne potwierdziły wyłączenie tętniaka i przetoki z krążenia. Wyniki leczenia monitorowano za pomocą badań dopplerowskich. Ultrasonografia dopplerowska jest metodą z wyboru w wykrywaniu i monitorowaniu nieprawidłowości tętnic nerkowych. Bezpieczeństwo, nieinwazyjność i dostępność badania sprawiają, że odgrywa ono kluczową rolę w diagnozowaniu przetok tętnic nerkowych i pseudotętniaków.
Aim: The purpose of this paper was to evaluate the efficacy of ultrasound-guided percutaneous thrombin injection as a treatment method for arterial access site pseudoaneurysm. Materials and methods: A total of 148 patients with iatrogenic arterial access site pseudoaneurysms were treated in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Of those, 142 pseudoaneurysms were located in the common femoral artery, 3 in the brachial artery and the remaining 3 in the radial artery. The study included 77 woman and 71 men (mean age 64.5 ± 14 years). Patients were qualified for percutaneous thrombin injection after Doppler examination during which pseudoaneurysm size and morphology were assessed as well as the presence of arteriovenous fistula was excluded. Results: In the reported study, 94.8% (128/135) of patients were successfully treated during the initial thrombin injection. Additional 400 IU dose of thrombin after 24 hours was effective in 5 out of 7 patients with recanalization during the follow-up. A total of 98.5% (133/135) of patients were successfully treated with a percutaneous ultrasound-guided thrombin injection. Conclusions: The 10-year experience presented in this study as well as literature reports prove that percutaneous ultrasound-guided thrombin injection is an effective and safe treatment method for iatrogenic arterial access site pseudoaneurysm.
PL
Cel pracy: Celem pracy była ocena skuteczności przezskórnego wstrzyknięcia trombiny pod kontrolą ultrasonografii jako sposobu leczenia tętniaka rzekomego w miejscu dostępu tętniczego. Materiał i metody: W Zakładzie Radiologii Zabiegowej i Neuroradiologii Uniwersytetu Medycznego w Lublinie leczeniu poddano 148 pacjentów z jatrogennymi tętniakami rzekomymi w miejscu dostępu tętniczego, przy czym 142 pseudotętniaki były umiejscowione w tętnicy udowej wspólnej, 3 w tętnicy ramiennej oraz pozostałe 3 w tętnicy promieniowej. W badaniu udział wzięło 77 kobiet i 71 mężczyzn (średni wiek 64,5 ± 14 lat). Pacjentów kwalifikowano do przezskórnego wstrzyknięcia trombiny po wykonaniu badania ultrasonograficznego z funkcją dopplera w celu oceny wielkości i morfologii tętniaka rzekomego oraz wykluczenia obecności przetoki tętniczo-żylnej. Wyniki: W przedstawionym badaniu skuteczność leczenia po pierwszym wstrzyknięciu trombiny uzyskano u 94,8% (128/135) pacjentów. Dodatkowa dawka trombiny wynosząca 400 j.m. podana po upływie 24 godzin okazała się skuteczna u 5 na 7 pacjentów, u których podczas badania kontrolnego stwierdzono rekanalizację. Skuteczność leczenia metodą przezskórnego wstrzyknięcia trombiny pod kontrolą ultrasonografii uzyskano u 98,5% (133/135) badanych. Wnioski: Z przedstawionego w niniejszej pracy 10-letniego doświadczenia oraz doniesień z piśmiennictwa wynika, że przezskórna podaż trombiny pod kontrolą ultrasonografii stanowi skuteczną i bezpieczną metodę leczenia jatrogennych tętniaków rzekomych w miejscu dostępu tętniczego.
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