RESUMO
OBJECTIVES: Heparin-induced thrombocytopenia is a known complication of heparin exposure with potentially life-threatening sequelae. Direct thrombin inhibitors can be substituted for heparin in patients with heparin-induced thrombocytopenia that require anticoagulation. However, the use of direct thrombin inhibitors as a substitute for heparin has not been widely reported in the neuroendovascular literature. MATERIALS AND METHODS: Here we report the first use of the direct thrombin inhibitor bivalirudin in a neuroendovascular procedure as a substitute for heparin in a patient with a ruptured pseudoaneurysm and heparin-induced thrombocytopenia, and review the literature on the use of bivalirudin and argatroban for such patients. RESULTS: Bivalirudin was safely and effectively used in the case reported, with no thrombotic or hemorrhagic complications. Our literature review revealed a paucity of studies on the use of heparin alternatives, including bivalirudin, in neuroendovascular procedures in patients with heparin-induced thrombocytopenia. CONCLUSIONS: Heparin-induced thrombocytopenia is an important iatrogenic disease process in patients undergoing neuroendovascular procedures, and developing protocols to diagnose and manage heparin-induced thrombocytopenia is important for healthcare systems. While further research needs to be done to establish the full range of anticoagulation options to substitute for heparin, our case indicates bivalirudin as a potential candidate.
Assuntos
Anticoagulantes , Antitrombinas , Heparina , Hirudinas , Fragmentos de Peptídeos , Proteínas Recombinantes , Trombocitopenia , Humanos , Masculino , Pessoa de Meia-Idade , Falso Aneurisma/cirurgia , Falso Aneurisma/tratamento farmacológico , Aneurisma Roto/cirurgia , Aneurisma Roto/diagnóstico por imagem , Anticoagulantes/efeitos adversos , Antitrombinas/efeitos adversos , Antitrombinas/uso terapêutico , Substituição de Medicamentos , Procedimentos Endovasculares/efeitos adversos , Heparina/efeitos adversos , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/tratamento farmacológico , Fragmentos de Peptídeos/uso terapêutico , Fragmentos de Peptídeos/efeitos adversos , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico , Trombocitopenia/tratamento farmacológico , Resultado do TratamentoRESUMO
Pseudoaneurysms of the scalp are rare. Most common etiology is trauma. The patients usually present clinically with persistent painful swelling in the scalp few days after the trauma. The lesion may or may not be pulsatile clinically. Ultrasonography (US) is the best modality to assess these pseudoaneurysms. It not only helps in the diagnosis, but also to trace the offending arterial branch and helps in treatment. We present two cases of post-traumatic scalp pseudoaneurysms which were diagnosed with US and were managed by US-guided thrombin injection. Follow up US showed complete resolution. We highlight the importance of US scan in diagnosis, management, and follow up of scalp pseudoaneurysms.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Hemostáticos/administração & dosagem , Couro Cabeludo/lesões , Artérias Temporais/diagnóstico por imagem , Trombina/administração & dosagem , Ultrassonografia de Intervenção , Assistência ao Convalescente/métodos , Idoso de 80 Anos ou mais , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/etiologia , Hemostáticos/uso terapêutico , Humanos , Injeções , Masculino , Couro Cabeludo/irrigação sanguínea , Couro Cabeludo/diagnóstico por imagem , Trombina/uso terapêuticoRESUMO
Gluteal artery pseudoaneurysms are a rare cause of buttock pain, with few cases reported in the recent literature. Although small pseudoaneurysms are usually asymptomatic, larger can be painful and require treatment. Most of these cases are pseudoaneurysms resulting from local trauma. We report in this case a patient with a gluteal artery pseudoaneurysm. The pseudoaneurysm was successfully thrombosed using ultrasound-guided thrombin injection. This article reviews the literature, discusses the imaging diagnostics and the treatment of gluteal artery aneurysms.
Assuntos
Falso Aneurisma/fisiopatologia , Nádegas/irrigação sanguínea , Fluxo Pulsátil , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Injeções Intra-Arteriais , Fluxo Sanguíneo Regional , Trombina/administração & dosagem , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: Iatrogenic femoral artery pseudoaneurysm (IFP) incidence is increasing with increase in diagnostic and therapeutic angiography, and so, the less invasive percutaneous thrombin injection (PTI) is the most widely used treatment. Moreover, studies that minimize PTI complications and highlight therapeutic effects are lacking. OBJECTIVES: This study performed in vitro thrombosis modeling of pseudoaneurysms and analyzed thrombosis within and thromboembolism outside the sac during thrombin injection. METHODS: We evaluated PTI in terms of thrombin injection location (at the junction of the IFP sac and neck, the center, and the dome, located farthest from the neck of the sac), thrombin injection time (5 and 8 seconds), and blood flow rate (ranging from 210 mL/min to 300 mL/min). Porcine blood was used as the working fluid in this study. RESULTS: Thrombin injection at the junction of the IFP sac and the pseudoaneurysm neck led to less thrombosis within the sac but substantial thrombi consistently outside the sac, whereas thrombin injected at the sac center mostly led to complete thrombosis within the sac, preventing further blood flow into the sac and reducing likelihood of thrombi outside the sac. A longer thrombin injection time enhanced the therapeutic effect and decreased the possibility of thromboembolism. Thromboembolism occurred more frequently at flow rates of >240 mL/min. CONCLUSION: The thrombin injection site in a pseudoaneurysm significantly influences thrombogenesis within and thromboembolism outside the sac. Thus, slow and deliberate injection of thrombin into the center of the sac could potentially reduce complications and enhance treatment efficacy.
Assuntos
Falso Aneurisma , Artéria Femoral , Trombina , Trombose , Trombina/administração & dosagem , Falso Aneurisma/tratamento farmacológico , Animais , Trombose/tratamento farmacológico , Trombose/etiologia , Suínos , Injeções Intra-Arteriais , Fatores de Tempo , Humanos , Tromboembolia/tratamento farmacológico , Tromboembolia/prevenção & controle , Tromboembolia/etiologia , Doença IatrogênicaRESUMO
INTRODUCTION: With the development of vascular intervention, pseudoaneurysm complications are increasing. Ultrasound-guided thrombin injection (UGTI) is currently the treatment of choice for pseudoaneurysm, but the pharmacological properties of thrombin may trigger acute thrombosis within the vessel lumen. Despite a very low incidence, this type of primary arterial thrombosis is a serious complication of UGTI, and cases involving multiple branches of the lower limb arteries are particularly rare. CASE PRESENTATION: Here, we report a case of a 65-year-old male who underwent UGTI for the treatment of an iatrogenic pseudoaneurysm of the femoral artery complicated by acute thrombosis of multiple arteries in the lower limbs, and the patient ultimately underwent a successful thrombectomy. CONCLUSION: We reviewed the case and analyzed the possible etiologic causes, providing a reference for future clinical work.
Assuntos
Falso Aneurisma , Trombose , Masculino , Humanos , Idoso , Trombina/uso terapêutico , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/etiologia , Resultado do Tratamento , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/complicações , Extremidade Inferior/diagnóstico por imagem , Doença Iatrogênica , Ultrassonografia de Intervenção/efeitos adversosRESUMO
Percutaneous thrombin injection has been described in case reports as an alternative to surgical intervention for the treatment of hepatic artery pseudoaneurysms associated with high-grade liver lacerations in adults. However, there is limited description in the literature of this technique being applied in children, particularly in preadolescents, and no published literature describes its use in infants. The procedure can be performed by pediatric radiologists and pediatric interventional radiologists skilled in ultrasound-guided aspiration techniques. We report successful application of percutaneous thrombin injection in an infant to treat a pseudoaneurysm of a left hepatic arterial branch in an 11-month-old girl with a grade IV liver laceration after superselective transcatheter arterial embolization failed to achieve thrombosis.
Assuntos
Traumatismos Abdominais/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Embolização Terapêutica , Artéria Hepática/efeitos dos fármacos , Trombina/administração & dosagem , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/diagnóstico , Feminino , Hemostáticos/administração & dosagem , Humanos , Lactente , Injeções Subcutâneas , Radiografia , Falha de Tratamento , Resultado do Tratamento , Ferimentos não Penetrantes/diagnósticoRESUMO
Pseudoaneurysms of the thyrocervical trunk or its branches are extremely rare. They are often the result of a penetrating injury and commonly iatrogenic in origin. Pseudoaneurysm formation following blunt trauma has twice been reported in the English-language literature. We report a case of a 56-year-old man involved in a motor vehicle collision who presented with a slowly growing mass over the course of 4 months. A magnetic resonance (MR) examination was requested to evaluate the cause of this slowly growing mass. Our case is unique in that MR imaging correctly diagnosed the lesion, which was subsequently treated with ultrasound-guided percutaneous thrombin injection. Our case is the only published instance of treatment of a thyrocervical trunk pseudoaneurysm by direct ultrasound-guided percutaneous thrombin injection.
Assuntos
Falso Aneurisma/diagnóstico , Falso Aneurisma/tratamento farmacológico , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/tratamento farmacológico , Trombina/administração & dosagem , Ultrassonografia de Intervenção/métodos , Hemostáticos/administração & dosagem , Humanos , Injeções Intralesionais/métodos , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagem , Resultado do TratamentoRESUMO
A femoral artery pseudoaneurysm (FAP) is a serious complication of arterial injury. It can cause compression of the surrounding nerves and tissues, rupture and bleeding of the aneurysm, and formation and dislodgement of thrombi, and can lead to distal limb embolism, tissue necrosis, and infection. Computed tomography angiography and ultrasonography are the preferred techniques for diagnosis of FAP. This report describes the successful treatment of an FAP using an ultrasound-guided percutaneous intracavitary injection of a lyophilized human fibrin sealant. This treatment was safe, associated with minimal pain and complications, and clinically effective.
Assuntos
Falso Aneurisma , Artéria Femoral , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Diálise Renal/efeitos adversos , Trombina , Resultado do Tratamento , Ultrassonografia , Ultrassonografia de IntervençãoRESUMO
We present a rare case of a distal anastomotic pseudoaneurysm after bypass grafting to a porcelainized peroneal artery. Successful management was achieved by percutaneous thrombin injection. This case illustrates the value of nonsurgical intervention for this rare but difficult problem.
Assuntos
Falso Aneurisma/tratamento farmacológico , Extremidade Inferior/irrigação sanguínea , Veia Safena/transplante , Trombina/administração & dosagem , Calcificação Vascular/cirurgia , Enxerto Vascular/efeitos adversos , Anastomose Cirúrgica , Falso Aneurisma/etiologia , Angiografia Digital , Humanos , Injeções , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagemRESUMO
Ultrasound-guided thrombin injection (UGTI) has emerged as the preferred treatment modality for pseudoaneurysms occurring as a result of percutaneous femoral arterial interventions. UGTI is safe and effective, with few complications. Native arterial thrombosis has been rarely reported in the literature following UGTI and has usually been attributed to excessive thrombin injection. We report a case of femoral arteria thrombosis occurring following UGTI of a 4 cm postcatherization pseudoaneurysm with a wide, short neck successfully treated by surgical intervention. The large size of the neck of this pseudoaneurysm likely contributed to the development of this complication.
Assuntos
Falso Aneurisma/tratamento farmacológico , Arteriopatias Oclusivas/induzido quimicamente , Artéria Femoral/efeitos dos fármacos , Hemostáticos/efeitos adversos , Trombina/efeitos adversos , Trombose/induzido quimicamente , Ultrassonografia Doppler em Cores , Ultrassonografia de Intervenção , Doença Aguda , Idoso , Falso Aneurisma/diagnóstico por imagem , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/terapia , Artéria Femoral/diagnóstico por imagem , Hemostáticos/administração & dosagem , Humanos , Injeções Intralesionais , Isquemia/etiologia , Isquemia/terapia , Masculino , Trombectomia , Trombina/administração & dosagem , Terapia Trombolítica , Trombose/complicações , Trombose/terapia , Resultado do TratamentoRESUMO
A case of spontaneous pseudoaneurysm of a lumbar artery that was treated with computed tomography- guided thrombin injection is reported in this study. To the authors' knowledge, pseudoaneurysm of lumbar artery without any predisposing factors has been reported only twice in the literature previously. The aims of this case report are to discuss the differential diagnosis and management of this difficult problem.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Coagulantes/administração & dosagem , Vértebras Lombares/irrigação sanguínea , Radiografia Intervencionista , Trombina/administração & dosagem , Tomografia Computadorizada por Raios X , Artérias/efeitos dos fármacos , Artérias/patologia , Diagnóstico Diferencial , Feminino , Humanos , Injeções Intra-Arteriais , Pessoa de Meia-Idade , Tomografia Computadorizada Espiral , Resultado do TratamentoRESUMO
The present study aimed to investigate the technical feasibility and initial clinical outcomes of a covered stent for the endovascular treatment of superficial femoral artery (SFA) pseudoaneurysm in drug abusers. A total of 29 drug abuse patients with SFA pseudoaneurysm, as confirmed by color Doppler sonography, were enrolled to the present study between January 2012 and May 2014. All patients were treated percutaneously by implantation of a covered stent. Physical examination and lower extremity computed tomography angiography were performed at 1 and 9 months postoperation. Furthermore, the anklebrachial index (ABI) of all patients was measured. The results indicated that placement of the covered stent was technically successful in all 29 patients. All of the ruptured pseudoaneurysms were successfully sealed with no cases of intraprocedural mortality. In addition, all patients' conditions improved rapidly; active hemorrhage subsidence and vascular bruit disappearance were immediately detected following implantation of the covered stent. During the followup period, pain was markedly alleviated and pulsatile mass was decreased as time increased. No complaints or complications were documented. A total of 9 months postoperation, pain and pulsatile mass were not detected. The patency rate of the stent was 100%, and no migration, occlusion or infection was detected. In addition, the ABI was significantly improved, from 0.52±0.09 to 0.97±0.37 (P<0.01). In conclusion, the placement of a covered stent may be considered a promising approach to provide an effective, safe and minimally invasive option for the treatment of SFA pseudoaneurysm in drug abusers.
Assuntos
Falso Aneurisma/diagnóstico , Artéria Femoral/diagnóstico por imagem , Stents , Transtornos Relacionados ao Uso de Substâncias/patologia , Adulto , Falso Aneurisma/complicações , Falso Aneurisma/tratamento farmacológico , Índice Tornozelo-Braço , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/complicações , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
The incidence of combined neurovascular injuries among patients with high-energy shoulder trauma ranges from 27% to 44%. However, the presentation of an axillary artery pseudoaneurysm (PSA) due to shoulder dislocation without an associated osseous fracture is a very rare condition. Moreover, treatment of combined neurologic and vascular injuries of the shoulder remains controversial. Additionally, minimally invasive treatments such as thrombin injection have been mainly evaluated in patients with iatrogenic femoral artery PSAs. Therefore, we aim to report a rare case of axillary artery PSA associated with brachial plexus injury after shoulder dislocation treated with percutaneous thrombin injection.
Assuntos
Falso Aneurisma/tratamento farmacológico , Artéria Axilar/lesões , Luxação do Ombro/complicações , Trombina/administração & dosagem , Lesões do Sistema Vascular/tratamento farmacológico , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Artéria Axilar/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Injeções Intralesionais , Luxação do Ombro/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia de Intervenção , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologiaAssuntos
Falso Aneurisma/tratamento farmacológico , Fator VIII/uso terapêutico , Hemofilia A/tratamento farmacológico , Hemostáticos/uso terapêutico , Trombina/uso terapêutico , Adolescente , Falso Aneurisma/complicações , Artéria Braquial , Criança , Artéria Femoral , Hemofilia A/complicações , Humanos , Masculino , Resultado do TratamentoRESUMO
The case of a 25-year-old man admitted with an ulnar artery aneurysm of the wrist is presented. The size of the aneurysm (1.5 x 2.7 cm) and progressive pain gave the impression of a threatened rupture. Radiologic examinations confirmed the existence of a non-thrombosed ulnar artery aneurysm with occlusion of the 4th and 5th digital arteries. During an urgent surgical exploration a pseudo-aneurysm was found and resected and the artery was repaired. Thrombolysis of the digital arteries was performed with a good result. The combination of a large-sized pseudo-aneurysm, lack of a history of penetrating trauma and presentation of threatened rupture are unique and not reported previously in the literature.
Assuntos
Falso Aneurisma , Artéria Ulnar , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/cirurgia , Aneurisma Roto/prevenção & controle , Angiografia , Humanos , Masculino , Terapia Trombolítica , PunhoAssuntos
Falso Aneurisma/tratamento farmacológico , Hemartrose/terapia , Hemofilia A , Hemostáticos/uso terapêutico , Prótese do Joelho/efeitos adversos , Membrana Sinovial , Trombina/uso terapêutico , Adulto , Falso Aneurisma/diagnóstico por imagem , Inibidores dos Fatores de Coagulação Sanguínea , Fator VIII/antagonistas & inibidores , Fator VIIa/administração & dosagem , Fator VIIa/uso terapêutico , Hematoma/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Resultado do Tratamento , UltrassonografiaRESUMO
PURPOSE: To evaluate ultrasound-guided percutaneous thrombin injection to treat iatrogenic femoral pseudoaneurysms following catheter interventions. MATERIALS AND METHODS: In a period of 2 years and 11 months, 55 iatrogenic femoral pseudoaneurysms were treated in 54 patients (male : female = 29 : 25) by percutaneous thrombin injection under continuous color Doppler control. Mean maximum diameter of the perfused lumen was 2.5 cm (SD +/- 1 cm). The injected thrombin doses varied between 10 and 2,000 U (median 200 U). RESULTS: Following thrombin injection, the pseudoaneurysm occlusion rate was 100 % (n = 55/55). Complete and persistent occlusion was achieved in 54 of 55 (98 %) pseudoaneurysms. A repeated procedure was necessary in 6 pseudoaneurysms. In one case (2 %), discrete signs of reperfusion were observed after primary occlusion within 24 hours of the initial procedure (lumen diameter 3 x 5 mm), followed by spontaneous thrombosis without further treatment. No complications, in particular no clinically manifest thromboembolic events, were observed. CONCLUSION: Ultrasound-guided percutaneous thrombin injection is an effective and safe method for the treatment of iatrogenic post catheterization femoral pseudoaneurysms.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Artéria Femoral/efeitos dos fármacos , Artéria Femoral/diagnóstico por imagem , Doença Iatrogênica/prevenção & controle , Injeções/métodos , Trombina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemostáticos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , UltrassonografiaAssuntos
Falso Aneurisma/diagnóstico , Tuberculose Cardiovascular/diagnóstico , Tuberculose/diagnóstico , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Antibióticos Antituberculose/uso terapêutico , Aorta/diagnóstico por imagem , Aorta/patologia , Aorta/cirurgia , Bélgica , Implante de Prótese Vascular , Terapia Combinada , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose/cirurgia , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/tratamento farmacológico , Tuberculose Cardiovascular/cirurgiaRESUMO
An arterial pseudoaneurysm is an uncommon complication of cardiovascular procedures associated with considerable morbidity and increased hospital costs. Percutaneous thrombin injection is one approach to therapy. We describe our initial experience with this technique in 3 patients, with special attention to the utility of sonographic guidance. In all cases complete closure was achieved, although one patient required additional brief extrinsic compression with the ultrasound probe.
Assuntos
Falso Aneurisma/tratamento farmacológico , Artéria Femoral , Hemostáticos/administração & dosagem , Trombina/administração & dosagem , Idoso , Falso Aneurisma/diagnóstico por imagem , Angiografia , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Injeções Intra-Arteriais , Masculino , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Ultrassonografia Doppler em CoresRESUMO
UNLABELLED: An 84-year-old male patient presented with a swelling on his forehead which had developed gradually over a period of three weeks after a fall. Ultrasound examination revealed a complex fluid collection with a yin-yang flow pattern (revealed by colour Doppler imaging), which was suggestive of a pseudoaneurysm of the frontal branch of the superficial temporal artery. This was successfully treated with an injection of thrombin. DIAGNOSIS: traumatic pseudoaneurysm of the superficial temporal artery.