XXXIII°°°°Congresso Nazionale della Società Italiana di Cardiologi a InvasivaPorto Antico di Genova, Centro Cogressi

3 ottobre 2012

Treatment of iatrogenic artery pseudoaneurysm

by ultrasound guided fibrin glue injection: a single

center experience

Francesca Faresin a; Francesca Franz a; Marco Zennaro b;

Enrico Favaretto b; Luigi Pedon b; Salvatore Ronsivalle a

aDivision of Vascular Surgery, bDivision of Cardiology,

Cittadella Hospital, Padua, Italy

Disclosure statement

The authors have nothing to disclose with regard to the conduction of this study.

Background

A pseudoaneurysm (PSA) is a contained rupture; disr uption in all 3 layers of the arterial wall.

Postcatheterization PSA is one of the most common va scular complication of cardiac and peripheral angiographic procedures.

Incidence of PSA: - after diagnostic catheterization: 0.05 – 2 %;- after coronary and peripheral intervention: 2.0 – 6 .0 %.

Causes: 1) after catheterization2) at the site of native artery and synthetic graft anastomosis (i.e. aortofemoral bypass graft)3) trauma4) infection (eg. Mycotic PSA)

Webber G et al. Circulation 2007

Background

Factors associated with PSA formation are: obesity; hypertension; peripheral arterial disease; CKD requiring hemodialysis; age ( >65 years); simultaneous artery and vein catheterization; large sheath size (> 8F); complex interventions; low or high puncture sites; poor pos tprocedural compression; antiplatelet and anticoagulation therapy;

Treatment:- Surgical management (vascular anastomosis; spontan eously occuringPSA; compression on underlying structures wich caus es claudication,neuropathy o critical ischemia)- Ultrasound-guided compression (USGC);- Ultrasound-guided thrombin injection (USGTI);- Other techniques (FemStop devices; coil insertion; fibrin adhesives; balloon occlusion)

Webber G et al. Circulation 2007

Objective

We sought to evaluate the safety and efficacy of th e treatment of

iatrogenic pseudoaneurysms by ultrasound guided fib rin glue

injection (USFGI) in the PSA chamber.

Methods

Between November 2009 to June 2011, 2450 coronary o r peripheral procedures were performed in our Division of Cardiology

All patients with symptomatic (pain or swelling in the groin) post-catheterization PSA were included in the study

Color-Doppler US examination (5- to 7-MHz linear tran sducer) at t=0, 1 day, 30 days

2450 patients underwenting coronary or peripheral p rocedures

US-guided compression

38 (58.5%) procedural unsucces27 (41.5%) procedural success

65 (2.65%) iatrogenic PSAs

3 (4.6%) surgical management

(PSA neck width >0.8 mm and/or

PSA neck length <10 mm)

36 (55.4%) USFGI

Methods

Color-Doppler US examination (5- to 7-MHz linear tran sducer) at t=0, 1 day, 30 days

ResultsBaseline clinical characteristics

Variable USFGI (n=36)Gender

Male, n (%) 19 (52.7%)Female, n (%) 17 (47.2%)

Mean age, years 63±±±±7.4Hypertension, n (%) 34 (94.4%)Hemodalysis, n (%) 0 (xx.x)Anticoagulation therapy, n (%) 11 (30.5%)Antiplatelet therapy, n (%) 35 (92.2%)Time to compression, days 3±±±±2

Side on which procedure was performedRight, n (%) 21 (58.3%)Left, n (%) 15 (41.7%)

ResultsBaseline clinical characteristics - 2

Variable USFGI (n=36)Catheterization type

Diagnostic, n (%) 6 (16.7%)Angioplasty, n (%) 30 (83.3%)Stent placement, n (%) 27 (75%)

Pseudoaneurysm siteFemoral 35 (97.2%)Omeral 1 (2.8%)

PseudoaneurysmChamber mean diameter, mm 30.3 ±±±±11.2Neck mean length, mm 15.2±±±±1.6Neck mean width, mm 0.4±±±±0.2

Number of lobes1 24 (66.7)>1 12 (33.3)

ResultsOutcomes

%

- 1 patient, with omeral PSA, had acute thrombosis of omeral artery �Fogarty’s thromboembolectomy- 2 pts experienced PSA sac refilling at 15 and 30 days �surgical Tx

Conclusions

Our results suggest that the treatment of iatrogeni c PSA by USGFI seems safe and effective, after an accurate pre-operative echo color Doppler ultrasound evaluation

PSAs with short and wide necks seem to be at higher risk of downstream embolization

Further, larger studies are needed to refine indica tions, limitations and complication of this technique

enrico.favaretto@gmail.comThank you for your attention