Author + information
- Douglas Murrey,
- Jeffrey Forris Beecham Chick,
- Minhaj S. Khaja,
- Ravi Srinivasa,
- Bill S. Majdalany and
- Wael Saad
To describe the management and treatment of iatrogenic pseudoaneurysms (PSAs) by interventional radiology (IR) at a single institution.
Materials and Methods
50 patients with iatrogenic PSAs were identified from 2014 until 2016. Patients included 31 (62%) males and 19 (38%) females with mean age of 65 years (range: 34-92 years). Initial treatments were requested by cardiology (n=35), interventional radiology (n=9), vascular surgery (n=3), neurosurgery (n=1), the intensive care unit (n=1), and podiatry (n=1). Site, PSA volume, neck diameter, sheath size and closure device used during initial procedure, treating service, time from initial puncture to treatment, volume of thrombin used, number of treatment sessions required, advanced techniques used, clinical success, and complications were recorded.
PSAs were located in the common femoral (n=38), profunda femoris (n=5), external iliac (n=3), brachial (n=1), superficial femoral (n=1), popliteal (n=1), and dorsalis pedis (n=1) arteries. Mean pseudoaneurysm volume was 27 cm3 (range: 0.4-230 cm3). Mean pseudoaneurysm neck diameter was 0.4 cm (range: 0.06-2.3 cm). Mean sheath size used during inciting procedure was 7 French (range: 5-8 French). 36 (72%) patients had no closure device used, 7 (14%) had a closure device, and in 7 (14%) closure device usage was not documented. Mean time from initial puncture to treatment was 490, 267, and 206 hours by vascular surgery, cross-sectional radiology, and IR, respectively. Mean volume of thrombin required was 720 units. 11 patients had at least 2 interventions and 2 patients required 3 treatment sessions for a total of 62 patient encounters. Mean number of treatment sessions required was 1.5 (range: 1-3). 58 (94%) treatments were by IR, 3 (5%) by vascular surgery, and 1 (1%) by cross-sectional radiology service. Advanced interventional techniques were required in 13 patients including arteriography with balloon-assisted thrombin injection in 5, open surgery in 4, arteriography with stent deployment in 2, arteriography only in 1, and arteriography with coiling in 1. Clinical success was ultimately achieved in all patients. No minor or major complications occurred.
Interventional radiology provides rapid and effective management and treatment of iatrogenic pseudoaneurysms without complication.