Outcomes of Iatrogenic Femoral Artery Lesions - Treatment Results Valuation

• Authors: Aleksander Łukasiewicz , Witold Hryncewicz , Marcin Rychter , Stanisław Molski
• Languages of publication: EN

Abstracts

EN

Percutaneous cardiac interventions are nowadays the most common cause of the femoral artery injury. In these cases, surgical intervention was for many years considered the treatment of choice. Satisfactory results of conservative and minimally invasive treatment has changed the state of art.The aim of the study was the analysis of treatment results in patients with iatrogenic femoral aneurysm.Material and methods. In the period of 3 years between 2004 and 2006 in 66 patients an iatrogenic, spure femoral artery aneurysm was recognized. There were 36 women and 30 men in this group. The mean age was 68.8 years. All patients were included prospectively in the study. According to aneurysm morphology, compression pliability and patient choice 45 individuals were assigned to OT group, remaining 21 were treated conservatively: US-guided compression in all patients and thrombin injection if compression failed.Results. There was one death in OT group due to underlying coronary disease and in our opinion unrelated to surgical treatment. Other major adverse events were one postoperative stroke in OT group and superficial femoral artery thrombosis in NT group. 8 patients experienced minor events and they all were operative wound complications. No other complications were observed in NT group. Post procedural stay was longer for the OT group (8.7 vs 3.8 days, p<0.05). Length of hospital stay was also significantly correlated with presence of complications (5.5 days for patients without complications and 16.9 days for the complicated cases, p<0.001). The procedure was successful in 95.2% and 100% in the groups of NT and OT respectively.Conclusions. Utilized criteria of patients' assignment to conservative and operative treatment allowed plausible treatment results. OT and complications significantly increase the length of hospitalization. It is mandatory to remember of possible thrombotic complications related to thrombin injections.

Keywords

EN

vascular surgery; PTA; complications

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2009
• Volume: 81
• Issue: 4
• Pages: 172-179

Dates

published

1 - 4 - 2009

online

14 - 5 - 2009

Contributors

author

Aleksander Łukasiewicz

• Department of General and Vascular Surgery, CM UMK in Toruń

author

Witold Hryncewicz

• Department of General and Vascular Surgery, CM UMK in Toruń

author

Marcin Rychter

• Department of Cardiology and Internal Diseases, CM UMK in Toruń

author

Stanisław Molski

• Department of General and Vascular Surgery, CM UMK in Toruń

References

• Messina LM, Brothers TE, Wakefield TW, et al.: Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: interventional versus diagnostic procedures. J Vasc Surg 1991; 13: 593-600.
• Topol EJ: Coronary-artery stents: gauging, gorging and gouging N Eng J Med 1998; 339: 1702-04.
• Lenartova M, Tahir T: Iatrogenic pseudoaneurysm of femoral artery: case report and literature review. Clin Med Res 2001; 1: 243-47.
• Corso R, Rampoldi A, Riolo F, et al.: Occlusion of postcatheterisation femoral pseudoaneurysms with percutaneous thrombin injection under ultrasound guidance. Radio Med 2004; 108: 385-93.
• Imsand D, Hayoz P: Current treatment options of femoral pseudoaneurysms. VASA 2007; 36: 91-95.[WoS]
• Fellmeth BD, Roberts AC, Bookstein JJ, et al.: Postangographic femoral artery injuries: non-surgical repair with US-guided compression. Radiology 1991; 178: 671-75.
• Paulson EK, Sheafor DH, Kliewer MA, et al.: Treatment of iatrogenic femoral arterial pseudoaneurysms: comparison of US-guided thrombin injection with compression repair. Radiology 2000; 215: 403-08.
• Bloom AI: Iatrogenic femoral pseudoaneurysms. Radiology 2002; 222: 292-93.
• Brophy DP, Sheiman RG, Amatulle P, et al. Iatrogenic femoral pseudoaneurysm: Thrombin injection after failed US-guided compression. Radiology 2000; 214: 278-82.
• Kabłak-Ziembicka A, Przewłocki T, Płazak W i wsp. Sposoby postępowania w tętniakach rzekomych po zabiegu angiografii wieńcowej. Kardiol Pol 2005; 62: 229-39.
• Liau CS, Ho FM, Chen MF, et al.: Treatment of iatrogenic femoral artery pseudoaneurysm with percutaneous thrombin injection. J Vasc Surg 1997; 26: 18-23.
• Danzi GB, Sesana M, Capuano C, et al.: Compression repair versus low-dose thrombin injection for the treatment of iatrogenic femoral pseudoaneurysm: a retrospective case-control study. Ital Heart J 2005; 6: 384-89.
• Bhat R, Chakreverty S: Femoral artery thrombosis following percutaneus treatment with thrombin injection of a femoral artery pseudoaneurysm: a case report. Cardiovasc Intervent Radiol 2007; 30: 789-92.
• Pawlaczyk K, Gabriel M, Juszkat R, et al.: Ultrasound assessment of the morphology of iatrogenic pseudoaneurysms as prognostic factor in compression therapy. Pol J Radiol 2008; 73: 16-21.
• Gabriel M, Pawlaczyk K, Waliszewski K, et al.: Location of femoral artery puncture site and the risk of postcatheterization pseudoaneurysm formation. Int J Cardiol 2007; 120: 167-71.
• Demirbas O, Guven A, Batyraliev T: Management of 28 consecutive iatrogenic femoral pseudoaneurysms with ultrasound-guided compression. Heart Vessels 2005; 20: 91-94.
• Kaźmierski M, Iwiński J, Kozakiewicz K, et al.: Tętniak rzekomy tętnicy udowej- występowanie i doświadczenia własne w leczeniu. Folia Cardiol Exc 2006; 1: 161-64.
• Gabriel M, Juszkat R, Pukacki F, et al.: Combined endovascular intervention and percutaneus injection in the treatment of iatrogenic pseudoaneurysm. Case report. Minerva Chir 2007; 62: 205-09.
• Rowe VL, Yellin AE, Weaver FA: Vascular injuries of the extremities. In: Vascular Surgery 6-th Edition, red. Rutherford RB, Elsevier Saunders, 2005: 1044-58.
• Baltacioglu F, Cimsit C, Cil Barbaros, et al.: Endovascular stent-graft applications in iatrogenic vascular injuries. Cardiovasc Intervent Radiol 2003; 26: 434-39.

Identifiers

DOI

10.2478/v10035-009-0026-9