Incidence, clinical course, and risk factors in the development of femoral pseudoaneurysm after atrial fibrillation ablation.

Background: Previous studies have revealed the risk factors for femoral pseudoaneurysms (FPA). Most data on FPA are based on coronary and peripheral interventions, with limited studies focusing on atrial fibrillation (AF) ablation. However, patient backgrounds, anticoagulation regimens, and vascular access methods differ. In addition, a standard for managing FPA after AF ablation remains elusive due to the difficult nature of achieving thrombosis in pseudoaneurysms. Methods: This single-center, retrospective, observational study included 2805 consecutive patients who underwent AF ablation between January 2016 and December 2021. All patients underwent femoral artery and vein punctures. Puncture sites were checked 1 day post-procedure. Results: A total of 23 FPA patients were identified during the study period. Multivariate logistic regression analysis showed that hypertension (odds ratio 4.66, 95% confidence interval: 1.38-15.71; p = .0032) and warfarin use (odds ratio 3.83, 95% confidence interval: 1.40-10.45; p = .021) were significantly associated with the occurrence of FPA. The compression success rate was low (22%). There were nine and six patients in the endovascular treatment (EVT) and ultrasound-guided thrombin injection (UGTI) groups, respectively. The success rates were 100% and 84% in the EVT and UGTI groups, respectively. The length of hospital stay after FPA treatment was 2.1 days in the EVT group and 1.3 days in the thrombin group. Conclusion: We must be careful about post-procedural FPA, especially for hypertension and warfarin-using patients. Treatment of pseudoaneurysms with anticoagulants is unlikely to achieve hemostasis, and an early switch to invasive treatments, such as EVT, should be considered.

Delayed Giant Pseudoaneurysm With Left-to-Right Shunt Following Postinfarct Ventricular Septal Perforation Repair.

Left ventricular pseudoaneurysm with a left-to-right shunt is extremely rare, requiring surgery if symptomatic; however, surgery has a high risk. Here, the case of a 77-year-old man with heart failure symptoms is reported, in which he develops a giant left ventricular pseudoaneurysm 16 months after ventricular septal perforation repair as a result of acute myocardial infarction, with mild shunt blood flow from the pseudoaneurysm to the right ventricle. Intraoperative findings showed a free wall rupture along the area where the patch was secured during the initial surgery. The patient was discharged on postoperative day 13, and postoperative examination revealed no abnormalities.

Giant Sinoatrial Nodal Artery Aneurysm with Fistula into the Right Atrium Treated by Partial Resection and Plication: A Case Report.

Coronary artery aneurysms (CAAs) occur when an artery dilates 1.5 times the reference vessel. They occur most commonly because of atherosclerosis. CAAs are a rare phenomenon, and it is even rarer to find a giant CAA, which is roughly defined as a size 400% above the reference vessel. Giant CAAs are commonly found in the right coronary artery. The sinoatrial nodal artery (SNA) is among the least common sites for CAA involvement. Sometimes, communication exists between the aneurysm and a chamber of the heart or a great vessel. The consequences of the fistula depend on its size. Because of the rarity of the condition, guidelines are not well developed. However, small CAAs can be managed conservatively, whereas giant CAAs require resection, ligation, and bypass grafting. CAAs have a predilection for males and the elderly. We describe a 40-year-old South Asian woman presenting with mild dyspnea on exertion of 1 year's duration. Echocardiography showed a 60×60 mm cystic sac, subsequently confirmed by computerized tomography, which showed 3 large aneurysms (70×61 mm) and 3 small aneurysms in the SNA. Coronary angiography illustrated that the SNA branched off the left main coronary artery, and the aneurysm communicated with the right coronary artery. The aneurysm was partially resected and plicated.

Idiopathic pseudoaneurysm of the popliteal artery with endovascular treatment: A case report.

Popliteal pseudoaneurysms are a rare vascular pathology, usually caused by trauma or iatrogenic interventions. Idiopathic cases are exceptionally uncommon. This case report aims to describe the diagnosis and successful endovascular treatment of an idiopathic pseudoaneurysm of the popliteal artery in a 90-year-old bedridden female patient presented with acute pain and swelling in the left knee at the emergency department. The patient underwent successful endovascular treatment with a covered stent and thrombin injection, leading to complete exclusion of the pseudoaneurysm. Popliteal pseudoaneurysms are a rare pathology, and idiopathic cases are even more uncommon. Endovascular therapy for popliteal pseudoaneurysms is associated with lower morbidity and mortality rates compared to open surgical repair. This case report highlights the importance of interdisciplinary collaboration between vascular surgeons and interventional radiologists in the management of rare vascular pathologies.

Two Endovascular Stent Graft Repairs Needed for an Extrathoracic Aortic Graft: Distant Complications After an Original Open Repair for a Gunshot Wound to the Chest.

Although the management of traumatic injuries to the thoracic aorta has shifted toward endovascular management, the historical standard of care is open reconstruction. Choosing to reoperate when faced with a complication from a prior open repair can be challenging; endovascular management can be a reasonable option in this situation. This report describes a 54-year-old man with a remote history of open surgery for a traumatic injury to the descending thoracic aorta who underwent endovascular aortic stent graft placement for coverage of extrathoracic graft extension with pseudoaneurysm formation and distal embolization. He returned a year later with a type IIIb endoleak with rupture into the posterolateral chest wall. A sec ond endovascular approach was used to successfully reline the graft and exclude the rupture.

Coughing on the coil; a case report and literature review of eight cases of endovascularly treated ICA pseudoaneurysms with coil migration into the oropharnyx.

We report a case of coil migration into the oropharynx five years after treatment of a left internal carotid pseudoaneurysm following abandoned transsphenoidal resection of a pituitary macroadenoma. Eight other cases were found on literature review, with coil migration occurring between 2 and 120 months often after a history of transsphenoidal surgery. The majority of these were treated with trimming in a day case setting. This report highlights the need for careful extended follow up when a pseudoaneurysm forms with a concurrent skull base deficit.

Upper Gastrointestinal Bleeding Due to a Left Gastric Artery Pseudoaneurysm: A Case Series.

BACKGROUND: Left gastric artery (LGA) pseudoaneurysm presenting with upper gastrointestinal (UGI) bleeding is rare but fatal, unless treated. AIMS: We aimed to describe the clinical and endoscopic features of patients with UGI bleeding due to LGA pseudoaneurysms. METHODS: We performed a computerized search of our hospital's de-identified clinical data warehouse to identify patients with UGI bleeding due to an LGA pseudoaneurysm between 2000 and 2020. Patients' electronic medical records and data on esophagogastroduodenoscopy and digital subtraction angiography were reviewed retrospectively. RESULTS: Of 26 patients with an LGA pseudoaneurysm, six patients had UGI bleeding related to an LGA pseudoaneurysm. No patients had previous vascular diseases or pancreatitis. One patient had liver cirrhosis and a history of radiofrequency ablation for hepatocellular carcinoma, one had colon cancer, two had undergone abdominal surgeries, one had received chemoradiotherapy for renal cell carcinoma, and one had no intraabdominal diseases. Symptoms were hematemesis in two, hematochezia in the other two, and melena in the remaining two patients. Esophagogastroduodenoscopy showed a pulsating bulge in the ulcer in two and a large Dieulafoy's lesion-like structure in four patients. All patients achieved hemostasis by angioembolization. CONCLUSION: LGA pseudoaneurysm should be suspected in UGI bleeding if a large Dieulafoy's lesion-like structure or a pulsating bulge in the ulcer is found at the lesser curvature of the gastric body on endoscopy and if the patient has any intra-abdominal inflammatory disease.

Síndrome compartimental após ruptura espontânea de pseudoaneurisma da artéria radial esquerda / Compartment syndrome after spontaneous rupture of a left radial artery pseudoaneurysm

A abordagem transradial é indicada para reduzir risco de morte, complicações vasculares ou sangramento. Em pacientes com doença cardíaca isquêmica estável, a abordagem radial é recomendada para diminuir sangramento no local de acesso e complicações vasculares. As complicações são raras, podendo ocorrer hematoma, perfuração e, muito raramente, pseudoaneurisma da artéria radial. Neste relato de caso, é descrito um caso raro de pseudoaneurisma da artéria radial esquerda associada à síndrome compartimental no antebraço esquerdo após realização de cateterismo eletivo. O diagnóstico foi confirmado por ultrassonografia com Doppler, que evidenciou pseudoaneurisma da artéria radial esquerda, medindo 2,1x1,5cm, com colo de 0,3cm. O tratamento cirúrgico do pseudoaneurisma e da síndrome compartimental restaurou a função completa do membro.

The transradial approach is indicated to reduce the risk of death, vascular complications, or bleeding. In patients with stable ischemic heart disease, the radial approach is recommended to reduce vascular complications and bleeding on access site. The complications are rare, and hematoma, perforation, and pseudoaneurysm (very rarely) of the radial artery may occur. This case report describes a rare case of left radial artery pseudoaneurysm associated with compartment syndrome in the left forearm after elective catheterization. The diagnosis was confirmed by Doppler ultrasonography, which showed a left radial artery pseudoaneurysm, measuring 2.1x1.5cm, with a 0.3-cm long/wide neck. Surgical treatment of pseudoaneurysm and compartment syndrome restored full limb function.

Ruptured pulmonary artery pseudoaneurysm treated with stent graft: case report and literature review.

BACKGROUND: Hemoptysis is a severe condition, associated with a high mortality rate from asphyxiation. Less than 5% of cases come from the pulmonary arterial circulation and large pseudoaneurysm are rarely treatable by stent graft. CASE PRESENTATION: We present the case of a 74-year-old man who suffered from a new onset of hemoptysis despite a prior bronchial artery embolization. He underwent a rescue endovascular stent graft placement for a massive hemoptysis caused by a ruptured proximal pulmonary artery pseudoaneurysm. A short review of similar situations is provided. CONCLUSION: Salvage endovascular stent graft placement for a massive hemoptysis caused by a ruptured proximal pulmonary artery pseudoaneurysm is a viable salvage technique for life-threatening hemoptysis.

Jejunal Migration of the Stent-Graft Used for Common Hepatic Artery Pseudoaneurysm.

Hemorrhage after pancreaticobiliary surgery is an infrequent but fatal complication. It is primarily caused by rupture of the pseudoaneurysm, and treatment options include endovascular coil embolization or endovascular stent-graft placement. Herein, we report a case of migration of an arterial stent-graft that was placed in the common hepatic artery to treat pseudoaneurysm after pylorus-preserving pancreaticoduodenectomy. The stent-graft migrated to the jejunum and was eventually excreted from the body.

Rotura de Pseudoaneurisma tras Pancreatitis Aguda Necrotizante que debuta como Hemorragia Digestiva Alta por Fistulización del Duodeno

Presentamos el caso de un varón de 64 años quien, tras un primer episodio de pancreatitis aguda necrotizante, reingresa a los 20 días por cuadro de dolor epigástrico intenso y posteriormente episodio de hemorragia digestiva alta en forma de hematemesis y melenas con inestabilización hemodinámica. Se realiza en ese momento gastroscopia urgente objetivándose probable fistula gastrointestinal en bulbo duodenal con coágulo adherido sin sangrado activo en ese momento por lo que se realiza angio-TC urgente que revela colección peripancreática necrótica con presencia de sangrado activo en su interior, procedente de la arteria pancreatoduodenal. La arteriografía urgente identificó imagen compatible con pseudoaneurisma arterial dependiente de la rama de arteria pancreatoduodenal, que fue embolizada con éxito. Desgraciadamente el paciente falleció en las horas posteriores, como consecuencia de un shock séptico secundario a colección pancreática infectada.

We present the case of a 64-year-old man who, after a first episode of acute pancreatitis, was readmitted 20 days later due to severe epigastric pain and later an episode of upper gastrointestinal bleeding in the form of hematemesis and melena with hemodynamic instability. An urgent gastroscopy was performed at that time, revealing a probable gastrointestinal fistula in the duodenal bulb with an adherent clot without active bleeding at that time, so an urgent CT angiography was performed that revealed a necrotic peripancreatic collection with the presence of active bleeding inside from the pancreatoduodenal artery. Urgent arteriography identified an image compatible with arterial pseudoaneurysm dependent on the pancreaticoduodenal artery branch, which was successfully embolized. Unfortunately, the patient died a few hours later as a result of septic shock secondary to an infected pancreatic collection.

Circumflex Scapular Artery Pseudoaneurysm as an Unusual Source of Emboli in Recurrent Posterior Circulation Stroke.

OBJECTIVE: To present a rare cause of recurrent posterior embolic strokes originating from a partially thrombosed pseudoaneurysm of a shoulder artery after arthroscopy. MATERIALS AND METHODS: The clinical history, complementary studies and follow-up were reviewed. RESULTS: The patient was successfully embolized and presented no new ischemic episodes at the 3-month follow-up visit. CONCLUSIONS: Shoulder artery pseudoaneurysm should be considered as an unusual source of posterior embolic strokes.

Gastroduodenal Artery Pseudoaneurysm Causing Obstructive Jaundice.

Background: Visceral artery aneurysms and pseudoaneurysms are uncommon phenomena with a high mortality rate in cases of rupture. These rare vascular pathologies are usually asymptomatic and are therefore generally discovered incidentally on computed tomography or magnetic resonance imaging examination. Current therapeutic options have trended toward a minimally invasive approach because of evolving endovascular treatment options, with open operations typically reserved for cases of intraabdominal hemorrhage. Case Report: We describe a case of gastroduodenal artery pseudoaneurysm manifesting as obstructive jaundice and pancreatitis because of extrahepatic compression of the common bile duct and pancreatic duct by mass effect. Open repair was ultimately required secondary to arterial anatomy that was not amenable to any endovascular treatment approach. Conclusion: While endovascular options are the preferred treatment modality for visceral artery aneurysms and pseudo-aneurysms, some cases require definitive open repair for a variety of reasons, including unsuitable anatomy.

Surgical treatment of pseudoaneurysm of the ascending aorta in a patient with sepsis

Abstract Pseudoaneurysm of the ascending aorta (PAA) is a hazardous and potentially fatal cardiovascular disease. This condition is caused by the rupture of at least one layer of the vessel and contained by the remaining vascular layers or the surrounding mediastinal structures. We presented the surgical treatment of a patient with sepsis and large PAA and brachiocephalic trunk, which was compressing the brachiocephalic trunk leading to syncope.

Clinical factors that influence the occurrence of symptomatic pseudoaneurysms and arteriovenous fistulas after partial nephrectomy: multi-institutional study of renal function outcomes after one year of selective arterial embolization

ABSTRACT Purpose: Renal artery pseudoaneurysms (RAPs) and arteriovenous fistulas (AVFs) are rare but potentially life-threatening complications after partial nephrectomy (PN). Selective arterial embolization (SAE) is an effective method for controlling RAPs/AVFs. We assessed the clinical factors affecting the occurrence of RAPs/AVFs after PN and the effects of SAE on postsurgical renal function. Materials and Methods: Four hundred ninety-three patients who underwent PN were retrospectively reviewed. They were placed in either the SAE or the non-SAE group. The effects of clinical factors, including R.E.N.A.L. scores, on the occurrence of RAPs/AVFs were analyzed. The influence of SAE on the estimated glomerular filtration rate (eGFR) during the first postoperative year was evaluated. Results: Thirty-three (6.7%) patients experienced RAPs/AVFs within 8 days of the median interval between PN and SAE. The SAE group had significantly higher R.E.N.A.L. scores, higher N component scores, and higher L component scores (all, p <0.05). In the multivariate analysis, higher N component scores were associated with the occurrence of RAPs/AVFs (Odds ratio: 1.96, p=0.039). In the SAE group, the mean 3-day postembolization eGFR was significantly lower than the mean 3-day postoperative eGFR (p <0.01). This difference in the eGFRs was still present 1 year later. Conclusions: Renal tumors located near the renal sinus and collecting system were associated with a higher risk for RAPs/AVFs after PN. Although SAE was an effective method for controlling symptomatic RAPs/AVFs after PN, a procedure-related impairment of renal function after SAE could occur and still be present at the end of the first postoperative year.

Ultrasound-Guided Percutaneous Thrombin Injection of Femoral Artery Pseudoaneurysms Caused by Vascular Access.

Purpose: To analyze the success and complication rates and factors associated with technical failure of the ultrasound (US)-guided percutaneous thrombin injection of femoral artery pseudoaneurysms caused by vascular access. Materials and Methods: Records of 30 patients with post-catheterization femoral artery pseudoaneurysms who had been treated with US-guided percutaneous thrombin injections in the department of radiology between March 2009 and June 2019 were retrospectively analyzed. The lesion was diagnosed based on US or contrast-enhanced CT. The characteristics of the patients and their lesions were analyzed. Results: The mean patient age was 67.8 years. The mean diameter of the pseudoaneurysmal sac was 20.88 mm (5-40 mm). Twenty patients (66.6%) obtained complete thrombosis after the primary injection, while 10 patients (33.3%) obtained partial thrombosis. The number of patients with a low platelet count (< 130 k/µL) was significantly higher in the partial thrombosis group than in the complete thrombosis group (p = 0.02). No substantial procedure-related complications were found in any patient. Conclusion: The US-guided percutaneous thrombin injection is considered an initial treatment option for pseudoaneurysms caused by vascular access because of its safety and efficacy.