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Erschienen in: Wiener klinische Wochenschrift 11-12/2016

01.06.2016 | original article

Percutaneous instillation of physiological saline solution for the treatment of femoral pseudoaneuryms

verfasst von: Georgiana-Aura Giurgea, Irene Mlekusch, Matthias Hoke, Alexandra Carls, Schila Sabeti-Sandor, Erich Minar, Prof. Dr. Wolfgang Mlekusch

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 11-12/2016

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Summary

Objective

To investigate the efficacy of para-aneurysmal saline injection for closure of postcatheterization pseudo-aneurysm (PA) at the vascular access site.

Methods

Fifty-one consecutive patients with postcatheterization PA at the vascular access site were included to undergo percutaneous para-aneurysmal saline injection. In case of technical failure the day after, PA were treated by bovine thrombin injection. Anatomical properties of the PA were recorded as were details to injection.

Results

Initially all patients exhibited success which was reduced to 43 % at day one. A saline volume of median 7 ml (interquartile range 6–8 ml) has been injected. The amount of injected saline was not different in patients with and without treatment success at day one (P = 0.6). Several anatomical properties of the PA exhibited marked differences in patients with or without success. The length (10.3 mm (7.8–12.0) vs. 12.5 mm (10.3–15.0); P = 0.009) and the angulation (110° (100–118) vs. 140° (129–146); P < 0.001) of the fistula/vessel axis was statistically different between groups. The peak systolic velocity failed to show significance with a tendency to higher values in the ineffective study group (P = 0.07). No peripheral complications occurred.

Conclusion

Para-aneurysmal saline injection may be a therapeutic alternative to percutaneous thrombin injection in patients exhibiting favorable anatomical properties.
Literatur
1.
Zurück zum Zitat Funovics MA, Wolf F, Philipp MO, Kee S, Tichy B, Dirisamer A, Rand T, Lammer J. Feasibility study of NeoMend, a percutaneous arterial closure device that uses a nonthrombogenic bioadhesive. Am J Roentgenol. 2003;180:533–8.CrossRef Funovics MA, Wolf F, Philipp MO, Kee S, Tichy B, Dirisamer A, Rand T, Lammer J. Feasibility study of NeoMend, a percutaneous arterial closure device that uses a nonthrombogenic bioadhesive. Am J Roentgenol. 2003;180:533–8.CrossRef
2.
Zurück zum Zitat Dick P, Barth B, Mlekusch W, Sabeti S, Amighi J, Schlager O, Koppensteiner R, Minar E, Schillinger M. Complications after peripheral vascular interventions in octagenerians. J Endovasc Ther. 2008;15:383–9.CrossRefPubMed Dick P, Barth B, Mlekusch W, Sabeti S, Amighi J, Schlager O, Koppensteiner R, Minar E, Schillinger M. Complications after peripheral vascular interventions in octagenerians. J Endovasc Ther. 2008;15:383–9.CrossRefPubMed
3.
Zurück zum Zitat Wyman RM, Safian RD, Portway V, Skillman JJ, McKay RG, Baim DS. Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol. 1988;12:1400–6.CrossRefPubMed Wyman RM, Safian RD, Portway V, Skillman JJ, McKay RG, Baim DS. Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol. 1988;12:1400–6.CrossRefPubMed
4.
Zurück zum Zitat Popma JJ, Satler LF, Pichard AD, Kent KM, Campbell A, Chuang YC, Clark C, Merritt AJ, Bucher TA, Leon MB. Vascular complications after balloon and new device angioplasty. Circulation. 1993;88:1569–78.CrossRefPubMed Popma JJ, Satler LF, Pichard AD, Kent KM, Campbell A, Chuang YC, Clark C, Merritt AJ, Bucher TA, Leon MB. Vascular complications after balloon and new device angioplasty. Circulation. 1993;88:1569–78.CrossRefPubMed
5.
Zurück zum Zitat Katzenschlager R, Uguruoglu A, Ahmadi A, Hülsmann M, Koppensteiner R, Larch E, Maca T, Minar E, Stümpflen A, Ehringer H. Incidence of pseudoaneurysm after diagnostic and therapeutic angiography. Radiology. 1995;195:463–6.CrossRefPubMed Katzenschlager R, Uguruoglu A, Ahmadi A, Hülsmann M, Koppensteiner R, Larch E, Maca T, Minar E, Stümpflen A, Ehringer H. Incidence of pseudoaneurysm after diagnostic and therapeutic angiography. Radiology. 1995;195:463–6.CrossRefPubMed
6.
Zurück zum Zitat Gurm HS, Hosman C, Share D, Moscucci M, Hansen BB. Comparative safety of vascular closure devices and manual closure among patients having percutaneous coronary intervention. Ann Intern Med. 2013;159:660–6.CrossRefPubMed Gurm HS, Hosman C, Share D, Moscucci M, Hansen BB. Comparative safety of vascular closure devices and manual closure among patients having percutaneous coronary intervention. Ann Intern Med. 2013;159:660–6.CrossRefPubMed
7.
Zurück zum Zitat Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Reilly JM, Anderson CB, Flye MW, Sicard GA, Sullivan TM. Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. J Vasc Surg. 1997;25:803–9.CrossRefPubMed Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Reilly JM, Anderson CB, Flye MW, Sicard GA, Sullivan TM. Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. J Vasc Surg. 1997;25:803–9.CrossRefPubMed
8.
Zurück zum Zitat Kent KC, McArdle CR, Kennedy B, Baim DS, Anninos E, Skillman JJ, Perry MO, Smith RB, Cox GS, McCann RL, Kresowik TF, Hye RJ. A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture. J Vasc Surg. 1993;17:125–33.CrossRefPubMed Kent KC, McArdle CR, Kennedy B, Baim DS, Anninos E, Skillman JJ, Perry MO, Smith RB, Cox GS, McCann RL, Kresowik TF, Hye RJ. A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture. J Vasc Surg. 1993;17:125–33.CrossRefPubMed
9.
Zurück zum Zitat Coley BD, Roberts AC, Fellmeth BD, Valji K, Bookstein JJ, Hye RJ. Postangiographic femoral pseudoaneurysms: further experience with US-guided compression repair. Radiology. 1995;194:307–11.CrossRefPubMed Coley BD, Roberts AC, Fellmeth BD, Valji K, Bookstein JJ, Hye RJ. Postangiographic femoral pseudoaneurysms: further experience with US-guided compression repair. Radiology. 1995;194:307–11.CrossRefPubMed
10.
Zurück zum Zitat Krueger K, Zaehringer M, Söhngen FD, Gossmann A, Schulte O, Feldmann C, Strohe D, Lackner K. Femoral pseudoaneurysms: management with percutaneous thrombin injections—success rates and effects on systemic coagulation. Radiology. 2003;226:452–8.CrossRef Krueger K, Zaehringer M, Söhngen FD, Gossmann A, Schulte O, Feldmann C, Strohe D, Lackner K. Femoral pseudoaneurysms: management with percutaneous thrombin injections—success rates and effects on systemic coagulation. Radiology. 2003;226:452–8.CrossRef
11.
Zurück zum Zitat Reeder SB, Widlus DM, Lazinger M. Low-dose thrombin injection to treat latrogenic femoral artery pseudoaneurysms. Am J Roentgen. 2001;177:595–8.CrossRef Reeder SB, Widlus DM, Lazinger M. Low-dose thrombin injection to treat latrogenic femoral artery pseudoaneurysms. Am J Roentgen. 2001;177:595–8.CrossRef
12.
Zurück zum Zitat Paulson EK, Nelson RC, Mayes CE, Sheafor DH, Sketch MH Jr, Kliewer MA. Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution. Am J Roentgenol. 2001;177:309–16.CrossRef Paulson EK, Nelson RC, Mayes CE, Sheafor DH, Sketch MH Jr, Kliewer MA. Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution. Am J Roentgenol. 2001;177:309–16.CrossRef
13.
Zurück zum Zitat Bronisz M, Rosc D, Bronisz A, Manitius J, Nartowicz E. The role of intrinsic fibrinolytic system activation in pathogenesis of hemostasis disturbances in hemodialyzed patients with chronic renal failure. Ren Fail. 2004;26:223–9.CrossRefPubMed Bronisz M, Rosc D, Bronisz A, Manitius J, Nartowicz E. The role of intrinsic fibrinolytic system activation in pathogenesis of hemostasis disturbances in hemodialyzed patients with chronic renal failure. Ren Fail. 2004;26:223–9.CrossRefPubMed
14.
Zurück zum Zitat Finkelstein A, Bazan S, Halkin A, Herz I, George J, Miller HI, Keren G, Banai S. Treatment of post-catheterization femoral artery pseudo-aneurysm with para-aneurysmal saline injection. Am J Cardiol. 2008;101:1418–22.CrossRefPubMed Finkelstein A, Bazan S, Halkin A, Herz I, George J, Miller HI, Keren G, Banai S. Treatment of post-catheterization femoral artery pseudo-aneurysm with para-aneurysmal saline injection. Am J Cardiol. 2008;101:1418–22.CrossRefPubMed
15.
Zurück zum Zitat Gehling G, Ludwig J, Schmidt A, Daniel WG, Werner D. Percutaneous occlusion of femoral artery pseudoaneurysm by para-aneurysmal saline injection. Cath Cardiovasc Interv. 2003;58:500–4.CrossRef Gehling G, Ludwig J, Schmidt A, Daniel WG, Werner D. Percutaneous occlusion of femoral artery pseudoaneurysm by para-aneurysmal saline injection. Cath Cardiovasc Interv. 2003;58:500–4.CrossRef
16.
Zurück zum Zitat ElMahdy MF, Kassem HH, Ewis EB, Mahdy SG. Comparison between ultrasound-guided compression and para-aneurysmal saline injection in the treatment of postcatheterization femoral artery pseudoaneurysms. Am J Cardiol. 2014;113:871–6.CrossRefPubMed ElMahdy MF, Kassem HH, Ewis EB, Mahdy SG. Comparison between ultrasound-guided compression and para-aneurysmal saline injection in the treatment of postcatheterization femoral artery pseudoaneurysms. Am J Cardiol. 2014;113:871–6.CrossRefPubMed
17.
Zurück zum Zitat Sheldon PJ, Oglevie SB, Kaplan LA. Prolonged generalized urticarial reaction after percutaneous thrombin injection for treatment of a femoral artery pseudoaneurysm. J Vasc Interv Radiol. 2000;11:759–61.CrossRefPubMed Sheldon PJ, Oglevie SB, Kaplan LA. Prolonged generalized urticarial reaction after percutaneous thrombin injection for treatment of a femoral artery pseudoaneurysm. J Vasc Interv Radiol. 2000;11:759–61.CrossRefPubMed
18.
Zurück zum Zitat Périard D, Rey Meyer MA, Hayoz D, Cook S. Sealing pseudo-aneurysms of the femoral artery with saline injection: a new technique. EuroIntervention. 2012;7:1206–9.CrossRefPubMed Périard D, Rey Meyer MA, Hayoz D, Cook S. Sealing pseudo-aneurysms of the femoral artery with saline injection: a new technique. EuroIntervention. 2012;7:1206–9.CrossRefPubMed
Metadaten
Titel
Percutaneous instillation of physiological saline solution for the treatment of femoral pseudoaneuryms
verfasst von
Georgiana-Aura Giurgea
Irene Mlekusch
Matthias Hoke
Alexandra Carls
Schila Sabeti-Sandor
Erich Minar
Prof. Dr. Wolfgang Mlekusch
Publikationsdatum
01.06.2016
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 11-12/2016
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-016-0979-8

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