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)

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

12. enrico.favaretto@gmail.comThank you for your attention