Predictors of successful iatrogenic pseudoaneurysm compression dressing repair.

BACKGROUND: Complications to femoral artery puncture may result in formation of a pseudoaneurysm (PSA). We investigated whether PSA obliteration may be achieved by compression dressing repair (CDR) and sought to determine the predictors of successful CDR. METHODS: Sixty two patients (30 male, mean age 61.0 +/- 12.8) with femoral PSAs due to cardiac catheterization were included in the study. In all patients, duplex ultrasound followed by CDR was performed to evaluate PSA morphology and flow velocities in the PSA neck. RESULTS: Forty six (74.2%) patients did not respond to CDR. Predictors of successful CDR were forward [0.18 (0.07-0.47), p = 0.0004] and reverse [0.08 (0.02-0.33), p = 0.0006] flow velocities in the PSA neck. The forward velocity was identified as an independent predictor of CDR outcome (p = 0.02). CONCLUSIONS: Compression dressing repair may serve as an alternative method of femoral pseudoaneurysm management in patients with low forward and reverse velocities of the flow in pseudoaneurysm neck. The forward velocity is an independent predictor of compression dressing repair result.

[Pulmonary arterial hypertension complicating portal hypertension and liver biliary cirrhosis--a case report]. / Tetnicze nadcisnienie plucne w przebiegu nadcisnienia wrotnego i marskosci zólciowej watroby--opis przypadku.

Pulmonary arterial hypertension is a serious and severe complication of liver cirrhosis and portal hypertension. We present a case of a 47 year old female who developed pulmonary hypertension and right ventricular heart failure symptoms 6 years from the diagnosis of liver biliary cirrhosis and portal hypertension.

[Femoral artery pseudoaneurysms: treatment with ultrasound guided thrombin injection in 28 patients]. / Tetniaki rzekome tetnic udowych: wyniki leczenia 28 chorych za pomoca iniekcji trombiny pod kontrola ultrasonograficzna.

INTRODUCTION: Femoral artery pseudoaneurysms (PSA) develop in 0.2-8% patients undergoing procedures that require femoral artery cannulation. Ultrasound guided thrombin injection has been described as successful and safe alternative to ultrasound guided compression and surgical treatment. AIM OF THE STUDY: Assessment of efficacy and safety of PSA treatment with USGTI. METHODS: 28 patients (pts) (18 female, mean age 64.6 +/- 11.4) with femoral pseudoaneurysms developed due to coronary angiogram or percutaneous coronary angioplasty were treated with ultrasound guided thrombin injection. 24 PSAs arose from right common femoral artery, 3 from right superficial femoral artery, and 1 from left common femoral artery. 24 patients were receiving antiplatelet and 4 anticoagulation therapy at the time of the procedure. With ultrasound guidance, a 21Gx11/2 needle was placed into pseudoaneurysm lumen followed by thrombin injection (1074 +/- 473 U). No complications of the procedure were observed. In 24-hour observation USGTI was successful in 28 (100%) patients. However, in 7-day follow-up resolution of 1 PSA was found, which reduced efficacy rate to 96.3%. CONCLUSIONS: Ultrasound guided thrombin injection is a successful, safe and well tolerated method of pseudoaneurysms treatment. Neither antiplatelet nor anticoagulation therapy affects success rate of the method.