RESUMO
We present an unusual case of ruptured subclavian artery pseudoaneurysm following hydrotherapy and shoulder massage session on a background of clavicle non-union.Following a clavicle fracture 16 years ago, which was managed conservatively, a woman in her 30s presents over a decade later with a ruptured subclavian artery pseudoaneurysm.The original midshaft clavicle fracture was sustained 16 years ago. Conservative management was agreed, and she was discharged. Six years ago, she developed a small subclavian artery pseudoaneurysm which was kept under surveillance for 12 months with no active intervention required.Over the following years, she continued to have intermittent shoulder girdle discomfort and neuropathic symptoms. On this presentation, after a sports massage, she presented with rapid-onset supraclavicular and axillary swelling. This was diagnosed as a ruptured subclavian artery pseudoaneurysm and was treated with emergency radiological-guided stenting and subsequent internal fixation of the clavicle non-union.The patient then attended regular orthopaedic and vascular follow-up to ensure her clavicle fracture unites and the graft remains patent.We discuss the case presentation and management of this unusual injury.
Assuntos
Falso Aneurisma , Fraturas Ósseas , Feminino , Humanos , Ombro , Clavícula/lesões , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Fixação Interna de Fraturas , MassagemRESUMO
Pseudoaneurysms are vascular abnormalities caused by a damaging force on an arterial wall, resulting in a persistent extravasation of blood into the surrounding tissue, which can be the result of infection, inflammation, trauma or any iatrogenic procedure. The incidence of extremity artery pseudoaneurysms is rising because of increased number of endovascular procedures. As a number of complications are associated with these false aneurysms, it is important to know the treatment modalities available. Ultrasound is the most common method of diagnosing extremity pseudoaneurysm because of their superficial location. Computed tomographic angiography is the next investigation of choice as it has three-dimensional capability and can help evaluate the vascular bed. Digital subtraction angiography is rarely used for diagnosis alone, and is used only when a therapeutic procedure is planned. Treatment of these pseudoaneurysms has shifted from open surgical procedures to minimally invasive treatment in recent years. The different techniques for tackling these lesions include ultrasound-guided compression, percutaneous thrombin or glue embolisation and endovascular coil or stent graft placement. In this pictorial essay, we review the different treatment modalities so that an interventional radiologist is aware of all the treatments he can offer when confronted with these lesions.
Assuntos
Falso Aneurisma , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Angiografia Digital , Extremidades , Humanos , Masculino , Radiologia Intervencionista , Trombina , Resultado do TratamentoAssuntos
Falso Aneurisma/terapia , Cianoacrilatos/administração & dosagem , Embolização Terapêutica , Artérias Epigástricas/lesões , Óleo Etiodado/administração & dosagem , Doença Iatrogênica , Ultrassonografia de Intervenção , Lesões do Sistema Vascular/terapia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Artérias Epigástricas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologiaAssuntos
Falso Aneurisma/terapia , Aneurisma Roto/terapia , Tomografia Computadorizada de Feixe Cônico , Embolização Terapêutica , Embucrilato/administração & dosagem , Óleo Etiodado/administração & dosagem , Hemorragia/terapia , Radiografia Intervencionista/métodos , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Aneurisma Roto/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Humanos , Masculino , Punções , Resultado do TratamentoAssuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Geotricose/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Esplenopatias/microbiologia , Falso Aneurisma/terapia , Antifúngicos/uso terapêutico , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Embolização Terapêutica , Fungemia/diagnóstico por imagem , Fungemia/microbiologia , Fungemia/terapia , Geotricose/terapia , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Esplenopatias/terapia , Ultrassonografia Doppler em CoresRESUMO
A pseudoaneurysm or a false aneurysm is the consequence of a persistent blood leak caused generally by iatrogenic rupture of a vessel wall. In hemodialysis fistula, pseudoaneurysm results from repeated puncturing of the vein at the same site. Surgery and endovascular treatment stay widely used as the treatment of pseudoaneurysm compared to the ultrasound-guided manual compression (UGMC). UGMC is a non-invasive and effective procedure which could be attempted before invasive procedures. We reported two cases of successful treatment of pseudoaneurysm by ultrasound-guided compression. A total thrombosed cavity has been obtained and fistulas could be cannulated in the next session.
Assuntos
Falso Aneurisma/terapia , Derivação Arteriovenosa Cirúrgica , Massagem/métodos , Ultrassonografia de Intervenção , Idoso , Feminino , Humanos , Pressão , Indução de Remissão , Resultado do TratamentoRESUMO
Radiation-associated vascular changes most commonly present in the form of stenosis, thrombosis and occlusion. However, development of intracranial aneurysms secondary to radiation is far less common and often manifests with rupture. These aneurysms are difficult to treat and associated with high morbidity and mortality when ruptured compared with saccular aneurysms unrelated to radiation treatment. Both surgical and endovascular options are available for treatment of these aneurysms. We present a young patient with a radiation-induced intracranial pseudoaneurysm arising from the lenticulostriate branch of the left middle cerebral artery (MCA); this developed 1 year 4 months after 59.4 Gy of focused radiation to the suprasellar pilomyxoid astrocytoma. The patient successfully underwent endovascular glue embolization of the aneurysm and occlusion of the lenticulostriate artery after unsuccessful trapping of the aneurysm and occlusion of the parent artery using coils. She developed transient hemiparesis of the right side following the procedure, which was managed conservatively. We performed a complete review of the literature dealing with the radiation-induced intracranial aneurysms, their presentation, treatment and outcome.
Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Embolização Terapêutica/métodos , Glioma/radioterapia , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/terapia , Artéria Cerebral Média/efeitos da radiação , Neoplasias do Nervo Óptico/radioterapia , Adolescente , Angiografia Cerebral , Meios de Contraste , Óleo Etiodado/uso terapêutico , Feminino , Humanos , Imageamento por Ressonância Magnética , Adesivos Teciduais/uso terapêuticoAssuntos
Falso Aneurisma/complicações , Rouquidão/etiologia , Síndrome do Desconforto Respiratório/etiologia , Artéria Subclávia/diagnóstico por imagem , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Óleo Etiodado/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Ultrassonografia Doppler em CoresRESUMO
The rate of non-typhoid Salmonella infections has increased remarkably in recent years. Endovascular system infection is one of the most serious forms of extraintestinal Salmonella infection. The abdominal aorta is frequently involved, while bone and joint involvement are rarely seen. We present a rare case of successful endovascular treatment of a left iliac artery rupture and pseudoaneurysm both occurring due to the direct invasion of lumbar spondylodiscitis caused by Salmonella typhimurium.
Assuntos
Falso Aneurisma/terapia , Discite/diagnóstico , Artéria Ilíaca/microbiologia , Ruptura/terapia , Infecções por Salmonella/tratamento farmacológico , Falso Aneurisma/diagnóstico por imagem , Antibacterianos/uso terapêutico , Ciprofloxacina/uso terapêutico , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Ruptura/diagnóstico por imagem , Salmonella typhimurium/patogenicidadeRESUMO
BACKGROUND: Because of the risk of associated complications, femoral pseudoaneurysm (PSA) formation implies further treatment. Ultrasound-guided thrombin injection (UGTI) is becoming the accepted gold standard, but manual compression (MC) represents an established treatment option including PSAs not feasible for UGTI. This study aims to assess our experience in PSA treatment using MC or UGTI according to a potential algorithm based on morphological properties in a large patient cohort. METHODS AND RESULTS: Between January 2007 and January 2011, a total of 432 PSAs were diagnosed in 29091 consecutive patients (1.49%) undergoing femoral artery catheterization. When compressible, small PSAs (<20 mm), PSAs without clearly definable neck, PSAs directly adjacent to vessels, and PSAs with concomitant arteriovenous fistula were referred to MC (n=145, 34%). All other PSAs were treated by UGTI (n=287, 66%). Follow-up duplex scans were performed within 12 to 14 hours after manual compression therapy and within 4 to 6 hours after UGTI or by the next morning and were available for 428 patients (99.1%). The overall success rate of our institutional therapeutic approach was 97.2%, which was achieved by 178 MC- and 357 UGTI-procedures, respectively. Procedural complications occurred in 5 cases (1.4%) after UGTI and in 3 cases (1.7%) after MC, respectively. The treatment algorithm was not successful in 12 patients, whereas 2 PSAs (0.5%) were successfully excluded by implantation of a covered stent-graft, and 10 patients necessitated surgical intervention (2.3%), which was associated with a high complication rate (30%). CONCLUSIONS: The presented treatment algorithm facilitates effective and safe PSA elimination.
Assuntos
Algoritmos , Falso Aneurisma/terapia , Artéria Femoral , Doença Iatrogênica , Manipulações Musculoesqueléticas/métodos , Trombina/uso terapêutico , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/epidemiologia , Cateterismo Cardíaco/efeitos adversos , Estudos de Coortes , Terapia Combinada , Feminino , Artéria Femoral/diagnóstico por imagem , Seguimentos , Humanos , Incidência , Injeções Intra-Arteriais , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Manipulações Musculoesqueléticas/efeitos adversos , Estudos Retrospectivos , Trombina/administração & dosagem , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversosRESUMO
OBJECTIVE: latrogenic femoral pseudoaneurysm is a well-known vascular access site complication. Many invasive and noninvasive techniques have been proposed for the management of this relatively common complication. In this study, we aimed to evaluate efficiency and safety of stethoscope-guided compression as a novel noninvasive technique in the femoral pseudoaneurysm treatment. METHODS AND RESULTS: We prospectively included 29 consecutive patients with the diagnosis of femoral pseudoaneurysm who underwent coronary angiography. Patients with a clinical suspicion of femoral pseudoaneurysm were referred to colour Doppler ultrasound evaluation. The adult (large) side of the stethoscope was used to determine the location where the bruit was best heard. Then compression with the paediatric (small) side of the stethoscope was applied until the bruit could no longer be heard and compression was maintained for at least two sessions. Once the bruit disappeared, a 12-hour bed rest with external elastic compression was advised to the patients, in order to prevent disintegration of newly formed thrombosis. Mean pseudoaneurysm size was 1.7 +/- 0.4 cmx 3.0 +/- 0.9 cm and the mean duration of compression was 36.2 +/- 8.5 minutes.Twenty-six (89.6%) of these 29 patients were successfully treated with stethoscope-guided compression. In 18 patients (62%), the pseuodoaneurysms were successfully closed after 2 sessions of 15-minute compression. No severe complication was observed. CONCLUSION: Stethoscope-guided compression of femoral pseudoaneurysms is a safe and effective novel technique which requires less equipment and expertise than other contemporary methods.
Assuntos
Falso Aneurisma/terapia , Terapias Complementares/instrumentação , Artéria Femoral , Doença Iatrogênica , Estetoscópios , Adulto , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Cateterismo Periférico/efeitos adversos , Angiografia Coronária/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia Doppler em CoresRESUMO
OBJECTIVE: The current study retrospectively evaluated whether the percutaneous N-butyl cyanoacrylate (NBCA) seal-off technique is an effective treatment for controlling the angioplasty-related ruptures, which are irresponsive to prolonged balloon tamponade, during interventions for failed or failing hemodialysis vascular accesses. MATERIALS AND METHODS: We reviewed 1588 interventions performed during a 2-year period for dysfunction and/or failed hemodialysis vascular access sites in 1569 patients. For the angioplasty-related ruptures, which could not be controlled with repeated prolonged balloon tamponade, the rupture sites were sealed off with an injection of a glue mixture (NBCA and lipiodol), via a needle/needle sheath to the rupture site, under a sonographic guidance. Technical success rate, complications and clinical success rate were reported. The post-seal-off primary and secondary functional patency rates were calculated by a survival analysis with the Kaplan-Meier method. RESULTS: Twenty ruptures irresponsive to prolonged balloon tamponade occurred in 1588 interventions (1.3%). Two technical failures were noted; one was salvaged with a bailout stent-graft insertion and the other was lost after access embolization. Eighteen accesses (90.0%) were salvaged with the seal-off technique; of them, 16 ruptures were completely sealed off, and two lesions were controlled as acute pseudoaneurysms. Acute pseudoaneurysms were corrected with stentgraft insertion in one patient, and access ligation in the other. The most significant complication during the follow-up was delayed pseudoaneurysm, which occurred in 43.8% (7 of 16) of the completely sealed off accesses. Delayed pseudoaneurysms were treated with surgical revision (n = 2), access ligation (n = 2) and observation (n = 3). During the follow-up, despite the presence of pseudoaneurysms (acute = 1, delayed = 7), a high clinical success rate of 94.4% (17 of 18) was achieved, and they were utilized for hemodialysis at the mean of 411.0 days. The post-seal-off primary patency vs. secondary patency at 90, 180 and 360 days were 66.7 ± 11.1% vs. 94.4 ± 5.4%; 33.3 ± 11.1% vs. 83.3 ± 8.8%; and 13.3 ± 8.5% vs. 63.3 ± 12.1%, respectively. CONCLUSION: Our results suggest that the NBCA seal-off technique is effective for immediate control of a venous rupture irresponsive to prolonged balloon tamponade, during interventions for hemodialysis accesses. Both high technical and clinical success rates can be achieved. However, the treatment is not durable, and about 40% of the completely sealed off accesses are associated with developed delayed pseudoaneurysms in a 2-month of follow-up. Further repair of the vascular tear site, with surgery or stent-graft insertion, is often necessary.
Assuntos
Angioplastia com Balão/efeitos adversos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Embucrilato/administração & dosagem , Oclusão de Enxerto Vascular/terapia , Diálise Renal , Idoso , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Óleo Etiodado/administração & dosagem , Feminino , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Estudos Retrospectivos , Ruptura , Análise de Sobrevida , Resultado do Tratamento , Ultrassonografia de Intervenção , Grau de Desobstrução VascularRESUMO
OBJECTIVES: The purpose of this study was to evaluate the effectiveness of sonographically guided hand kneading and compression for the treatment of femoral artery pseudoaneurysms after percutaneous intervention. METHODS: Twenty-four patients who had post-percutaneous intervention femoral artery pseudoaneurysms treated with sonographically guided compression from 2001 to 2004 and 2008 to 2009 were compared with 25 patients who had postintervention pseudoaneurysms treated with sonographically guided hand kneading and compression from 2005 to 2009. RESULTS: All 25 patients (100%) treated with 1-stage sonographically guided hand kneading and compression had pseudoaneurysm occlusion; the median treatment time was 10 minutes. Twenty-two of the 24 patients (91.7%) treated with conventional sonographically guided compression had pseudoaneurysm occlusion. One-stage compression was successful in 10 patients; 9 and 3 patients had pseudoaneurysm occlusion after 2 and 3 compression treatments, respectively. Two other patients who underwent compression treatment 3 and 4 times did not have pseudoaneurysm occlusion and required surgery. The median treatment time for sonographically guided compression was 30 minutes. The treatment time was significantly shorter for the hand-kneading and compression technique (P < .001), and significantly fewer procedures were needed (P < .001). CONCLUSIONS: Sonographically guided hand kneading and compression is as effective as sonographically guided compression alone for pseudoaneurysm occlusion after femoral artery percutaneous intervention and requires significantly less time to perform.
Assuntos
Falso Aneurisma/terapia , Artéria Femoral/diagnóstico por imagem , Massagem , Ultrassonografia de Intervenção/métodos , Idoso , Falso Aneurisma/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Pressão , Estatísticas não Paramétricas , Resultado do TratamentoAssuntos
Falso Aneurisma/terapia , Embolização Terapêutica/métodos , Endossonografia , Vísceras/irrigação sanguínea , Idoso , Falso Aneurisma/diagnóstico por imagem , Artérias , Embucrilato/administração & dosagem , Óleo Etiodado/administração & dosagem , Feminino , Humanos , Injeções Intralesionais , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Doenças das Artérias Carótidas/terapia , Neoplasias de Cabeça e Pescoço/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Angiografia Digital , Doenças das Artérias Carótidas/classificação , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Procedimentos Clínicos , Embolização Terapêutica/efeitos adversos , Neoplasias de Cabeça e Pescoço/radioterapia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Hemorragia/terapia , Humanos , Ligadura/efeitos adversos , Ligadura/mortalidade , Masculino , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Stents , Resultado do TratamentoRESUMO
Although n-butyl-2-cyanoacrylate (NBCA) has been used as an effective liquid embolization material, its indication for pseudoaneurysms has seemingly been limited because of the technical difficulties of using NBCA, such as reflux to the parent artery and causing significant infarction. Thus, considerable skill in using NBCA or a device to control blood flow during its polymerization is required to achieve embolization without severe complications. We report our new technique for controlling blood flow using diluted epinephrine in transcatheter arterial NBCA embolization of five pseudoaneurysms in four cases secondary to hemosuccus pancreaticus.