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ALISEO Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fibrin Glue Injection Genova 2012

Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fibrin Glue Injection Trattamento dello pseudoaneurisma iatrogeno mediante iniezione coguidata di colla di fibrina- XXXIII° Congresso Nazionale della Società Italiana di Cardiologia Invasiva Porto Antico di Genova, Centro Congressi-3 ottobre 2012 Treatment of iatrogenic artery pseudoaneurysm by ultrasound guided fibrin glue injection: a single center experience Francesca Faresin; Francesca Franz; Marco Zennaro; Enrico Favaretto; Luigi Pedon; Salvatore Ronsivalle; Division of Vascular Surgery,Division of Cardiology, Cittadella Hospital, Padua, Italy- (Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana) (Angiology- Vascular Surgery -ULSS 15 Alta Padovana)

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XXXIII°°°°Congresso Nazionale della Società Italiana di Cardiologia Invasiva
Porto Antico di Genova, Centro Cogressi
3 ottobre 2012
Treatment of iatrogenic artery pseudoaneurysm
by ultrasound guided fibrin glue injection: a single
center experience
Francesca Faresina; Francesca Franza; Marco Zennarob;
Enrico Favarettob; Luigi Pedonb; Salvatore Ronsivallea
aDivision of Vascular Surgery, bDivision of Cardiology,
Cittadella Hospital, Padua, Italy
Disclosure statement
The authors have nothing to disclose with
regard to the conduction of this study.
Background
A pseudoaneurysm (PSA) is a contained rupture; disruption in all 3 layers of
the arterial wall.
Postcatheterization PSA is one of the most common vascular
complication of cardiac and peripheral angiographic procedures.
Incidence of PSA: - after diagnostic catheterization: 0.05 – 2 %;
- after coronary and peripheral intervention: 2.0 – 6.0 %.
Causes: 1) after catheterization
2) at the site of native artery and synthetic graft anastomosis
(i.e. aortofemoral bypass graft)
3) trauma
4) infection (eg. Mycotic PSA)
Webber G et al. Circulation 2007
Background
Factors associated with PSA formation are: obesity; hypertension; peripheral
arterial disease; CKD requiring hemodialysis; age (>65 years); simultaneous
artery and vein catheterization; large sheath size (>8F); complex
interventions; low or high puncture sites; poor postprocedural compression;
antiplatelet and anticoagulation therapy;
Treatment:
- Surgical management (vascular anastomosis; spontaneously occuring
PSA; compression on underlying structures wich causes claudication,
neuropathy o critical ischemia)
- Ultrasound-guided compression (USGC);
- Ultrasound-guided thrombin injection (USGTI);
- Other techniques (FemStop devices; coil insertion; fibrin adhesives;
balloon occlusion)
Webber G et al. Circulation 2007
Objective
We sought to evaluate the safety and efficacy of the treatment of
iatrogenic pseudoaneurysms by ultrasound guided fibrin glue
injection (USFGI) in the PSA chamber.
Methods
Between November 2009 to June 2011, 2450 coronary or peripheral procedures were
performed in our Division of Cardiology
All patients with symptomatic (pain or swelling in the groin) post-catheterization PSA
were included in the study
Color-Doppler US examination (5- to 7-MHz linear transducer) at t=0, 1 day, 30 days
2450 patients underwenting coronary or peripheral procedures
US-guided compression
38 (58.5%) procedural unsucces27 (41.5%) procedural success
65 (2.65%) iatrogenic PSAs
3 (4.6%) surgical management
(PSA neck width >0.8 mm and/or
PSA neck length <10 mm)
36 (55.4%) USFGI

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ALISEO Treatment Of Iatrogenic Artery Pseudoaneurysm By Ultrasound Guided Fibrin Glue Injection Genova 2012

  • 1. XXXIII°°°°Congresso Nazionale della Società Italiana di Cardiologia Invasiva Porto Antico di Genova, Centro Cogressi 3 ottobre 2012 Treatment of iatrogenic artery pseudoaneurysm by ultrasound guided fibrin glue injection: a single center experience Francesca Faresina; Francesca Franza; Marco Zennarob; Enrico Favarettob; Luigi Pedonb; Salvatore Ronsivallea aDivision of Vascular Surgery, bDivision of Cardiology, Cittadella Hospital, Padua, Italy
  • 2. Disclosure statement The authors have nothing to disclose with regard to the conduction of this study.
  • 3. Background A pseudoaneurysm (PSA) is a contained rupture; disruption in all 3 layers of the arterial wall. Postcatheterization PSA is one of the most common vascular complication of cardiac and peripheral angiographic procedures. Incidence of PSA: - after diagnostic catheterization: 0.05 – 2 %; - after coronary and peripheral intervention: 2.0 – 6.0 %. Causes: 1) after catheterization 2) at the site of native artery and synthetic graft anastomosis (i.e. aortofemoral bypass graft) 3) trauma 4) infection (eg. Mycotic PSA) Webber G et al. Circulation 2007
  • 4. Background Factors associated with PSA formation are: obesity; hypertension; peripheral arterial disease; CKD requiring hemodialysis; age (>65 years); simultaneous artery and vein catheterization; large sheath size (>8F); complex interventions; low or high puncture sites; poor postprocedural compression; antiplatelet and anticoagulation therapy; Treatment: - Surgical management (vascular anastomosis; spontaneously occuring PSA; compression on underlying structures wich causes claudication, neuropathy o critical ischemia) - Ultrasound-guided compression (USGC); - Ultrasound-guided thrombin injection (USGTI); - Other techniques (FemStop devices; coil insertion; fibrin adhesives; balloon occlusion) Webber G et al. Circulation 2007
  • 5. Objective We sought to evaluate the safety and efficacy of the treatment of iatrogenic pseudoaneurysms by ultrasound guided fibrin glue injection (USFGI) in the PSA chamber.
  • 6. Methods Between November 2009 to June 2011, 2450 coronary or peripheral procedures were performed in our Division of Cardiology All patients with symptomatic (pain or swelling in the groin) post-catheterization PSA were included in the study Color-Doppler US examination (5- to 7-MHz linear transducer) at t=0, 1 day, 30 days 2450 patients underwenting coronary or peripheral procedures US-guided compression 38 (58.5%) procedural unsucces27 (41.5%) procedural success 65 (2.65%) iatrogenic PSAs 3 (4.6%) surgical management (PSA neck width >0.8 mm and/or PSA neck length <10 mm) 36 (55.4%) USFGI
  • 7. Methods Color-Doppler US examination (5- to 7-MHz linear transducer) at t=0, 1 day, 30 days
  • 8. Results Baseline clinical characteristics Variable USFGI (n=36) Gender Male, n (%) 19 (52.7%) Female, n (%) 17 (47.2%) Mean age, years 63±±±±7.4 Hypertension, n (%) 34 (94.4%) Hemodalysis, n (%) 0 (xx.x) Anticoagulation therapy, n (%) 11 (30.5%) Antiplatelet therapy, n (%) 35 (92.2%) Time to compression, days 3±±±±2 Side on which procedure was performed Right, n (%) 21 (58.3%) Left, n (%) 15 (41.7%)
  • 9. Results Baseline clinical characteristics - 2 Variable USFGI (n=36) Catheterization type Diagnostic, n (%) 6 (16.7%) Angioplasty, n (%) 30 (83.3%) Stent placement, n (%) 27 (75%) Pseudoaneurysm site Femoral 35 (97.2%) Omeral 1 (2.8%) Pseudoaneurysm Chamber mean diameter, mm 30.3±±±±11.2 Neck mean length, mm 15.2±±±±1.6 Neck mean width, mm 0.4±±±±0.2 Number of lobes 1 24 (66.7) >1 12 (33.3)
  • 10. Results Outcomes % - 1 patient, with omeral PSA, had acute thrombosis of omeral artery Fogarty’s thromboembolectomy - 2 pts experienced PSA sac refilling at 15 and 30 days surgical Tx
  • 11. Conclusions Our results suggest that the treatment of iatrogenic PSA by USGFI seems safe and effective, after an accurate pre-operative echo color Doppler ultrasound evaluation PSAs with short and wide necks seem to be at higher risk of downstream embolization Further, larger studies are needed to refine indications, limitations and complication of this technique