Balloon-Assisted Thrombin Injection of a Profunda Femoral Pseudoaneurysm Using Radial Access.

The profunda femoral artery is an uncommon location for a pseudoaneurysm and is technically challenging to resolve with traditional techniques, such as ultrasound-guided compression or thrombin injection, owing to its deep anatomical location. Balloon-assisted thrombin injection (BATI) is a technique that has been shown to be effective using contralateral access for technically difficult pseudoaneurysms in high-risk surgical patients. We report a case of BATI using radial access in a patient with a profunda femoral artery pseudoaneurysm.

Iatrogenic arterial injuries of spine and orthopedic operations.

OBJECTIVE: To describe the results of contemporary management of iatrogenic arterial injuries following spine and orthopedic operations. METHODS: Patients with major arterial injuries following spine and orthopedic operations in four teaching hospitals (Henry Ford Hospital, Detroit, Mich; Henry Ford Macomb Hospital, Clinton Township, Mich; St John Macomb Hospital, Warren, Mich; and St John Hospital, Detroit, Mich) over the last 10 years were studied. Data were collected on a continuous basis from vascular registries and analyzed retrospectively. RESULTS: Seventeen patients (8 spine, 9 orthopedic operations) had iatrogenic arterial injuries manifest as thrombosis or laceration with bleeding, pseudoaneurysm, or arteriovenous fistula. The majority of arterial lacerations with bleeding and pseudoaneurysms were treated with open surgical repair while the majority of thromboses and arteriovenous fistulae were treated with endovascular techniques. Fasciotomy was necessary in three of seven patients with arterial complications of knee and hip operations. There was no mortality or limb loss. Significant morbidity in the form of foot drop (1), iliac vein thrombosis (2), delayed ambulation due to hematoma and swelling of the lower extremity (2), and ischemic myonecrosis of calf muscles (1) occurred. Two patients launched legal action. CONCLUSION: Arterial injuries following orthopedic and spine operations can be successfully managed by both open and endovascular techniques. Significant morbidity and increased length of stay is common. Patient dissatisfaction with the complication and need for ensuing treatment can have significant medicolegal consequences.

A single center experience in the use of polyurethaneurea arteriovenous grafts.

BACKGROUND: Polytetrafluoroethylene (PTFE) grafts often require temporary catheters, which increase costs as well as risk of infection, bleeding, and poor blood flow. Polyurethaneurea (PUU) grafts can be cannulated within 24 hours of placement, avoiding the need for temporary catheters. METHODS: Hemodialysis patients who were not candidates for arteriovenous fistula (AVF) were eligible for the study. Those requiring urgent (<48 hours) hemodialysis access received PUU grafts; all others received PTFE grafts. One surgeon performed all implantations. RESULTS: 133 PUU grafts were implanted, 31 (24%) patients died (unrelated to graft placement). Within the first 4 days after graft placement, 108 of 133 grafts (81%) were cannulated. None required a temporary catheter. Of 102 surviving patients, 50 (49%) had graft thrombosis; 47/50 (94%) underwent successful percutaneous thrombectomy (PT). Primary patency at 6 months and at 1 year was 51% and 33%, respectively. Secondary patency at 6 months and 1 year was 78% and 61%, respectively. Mean bleeding time (after withdrawal of dialysis needle) was 4.0 (range 1-14) minutes in PUU grafts vs. 9.2 (1-30) minutes in PTFE grafts. CONCLUSIONS: Polyurethane graft placement allowed early graft cannulation without temporary catheters. Patency rates are comparable with previous reports. Decreased bleeding time with PUU grafts reduced aggregate blood exposure for patients and staff, lowering the risk of infection and anemia exacerbation and speeding time between treatments.