Successful Percutaneous Transcatheter Closure of a Common Femoral Artery Pseudoaneurysm With Use of MicroVascular Plug Despite Continued Catheter-Directed Thrombolysis

2020 ◽  
Vol 54 (5) ◽  
pp. 458-462
Author(s):  
Reza Talaie ◽  
Hamed Jalaeian ◽  
Donna D’Souza ◽  
Yasmina Aboufirass ◽  
Jafar Golzarian
Keyword(s):  
Thrombolytic Therapy ◽  
Femoral Artery ◽  
Treatment Options ◽  
Common Femoral Artery ◽  
Artery Pseudoaneurysm ◽  
Catheter Directed Thrombolysis ◽  
Systemic Thrombolytic Therapy ◽  
Endovascular Methods ◽  
Iatrogenic Pseudoaneurysm

Common femoral artery pseudoaneurysm is a known complication of percutaneous vascular access. Treatment options include surgical repair of the pseudoaneurysm or endovascular methods such as ultrasound-guided compression and direct thrombin injection into the pseudoaneurysm sac. Treatment of pseudoaneurysm is more challenging when a patient is undergoing concurrent catheter-directed or systemic thrombolytic therapy. This is a case report of endovascular treatment of an iatrogenic pseudoaneurysm of common femoral artery in a patient receiving concurrent catheter-directed thrombolytic therapy. This was performed successfully by precise deployment of a MicroVascular Plug into the pseudoaneurysm neck with immediate closure of pseudoaneurysm. Midterm follow-up confirmed sustained exclusion of the pseudoaneurysm sac with continued patency of the treated femoral artery.

scholarly journals Stent-assisted coiling of large common femoral artery pseudoaneurysm following coronary artery catheterization: an uncommon and novel approach

2017 ◽  
Vol 55 (1) ◽  
pp. 57-59
Author(s):  
Mohammad Parsa Mahjoob ◽  
Isa Khaheshi ◽  
Mohammadreza Naderian
Keyword(s):  
Coronary Artery ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Access Site ◽  
Artery Pseudoaneurysm ◽  
Arterial Access ◽  
Novel Approach ◽  
Femoral Arterial Access ◽  
Cardiovascular Interventions

Abstract The femoral artery pseudoaneurysm is a disturbing groin complication associated with the femoral arterial access site used for invasive cardiovascular interventions. We present a 39 year old man who developed a huge right common femoral artery pseudoaneurysm, following diagnostic coronary artery catheterization, which was successfully managed with stent-assisted coiling, an emerging and narrative option in invasive percutaneous approaches to femoral artery pseudoaneurysm.

scholarly journals Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Chandan Noel Vincent ◽  
S Elango ◽  
Dinakar Rai ◽  
Sujith Kumar ◽  
Ajay Sivakumar
Keyword(s):  
Respiratory Failure ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Third Trimester ◽  
Distal Limb ◽  
Catheter Directed Thrombolysis ◽  
Ct Angiogram ◽  
Severe Infections ◽  
The Right

Introduction:Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopathy. Case Report:A 37-year-old lady, day-2 postpartum, was brought with severe COVID infection & and respiratory failure. She developed progressive gangrene of the foot. A computed tomography (CT) angiogram confirmed the presence of thrombosis of the left external iliac & and common femoral artery. She was managed with catheter- directed thrombolysis and fasciotomy. The dry gangrene of the foot was managed with a Boyd’s amputation. At 1-year follow-up, she is ambulant with a healthy stump. Case Two: A 34-year-old lady, 36 weeks of gestation, presented with fulminant COVID infection with respiratory failure and pulmonary embolus. The lady developed gangrene of the B/L toes. A CT angiogram revealed thrombosis below the popliteal trifurcation in both limbs along with segmental pulmonary thrombo-embolism involving the right lung and multiple splenic infarcts. She succumbed to the overwhelming infection and sepsis. Discussion:The pathogenesis of coagulopathy in pregnant COVID patients is attributed to the hypercoagulable effect, which leads to thrombo-embolisms and limb ischemia following a cytokine storm syndrome in severe infections. To date, this is the first experience detailing distal limb gangrene in fulminant COVID infection in peri-partum women. Although, cases have been reported on distal limb gangrene in severe COVID infection among non-pregnant individuals. Conclusion:A multidisciplinary team must manage COVID infections in the third trimester. A prompt recognition of any forms of lethal coagulopathy and vigilant treatment will prevent loss of life. Keywords:Coronavirus diseaseCOVID, foot gangrene, pregnancy, coagulopathy.

scholarly journals Pulsatile Mass: Ruptured Common Femoral Artery Pseudoaneurysm with Active Extravasation

Cureus ◽  
2019 ◽  
Author(s):  
John O Patrick ◽  
Michael J Yoo ◽  
Neil P Larson ◽  
Rachel E Bridwell
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Artery Pseudoaneurysm ◽  
Pulsatile Mass ◽  
Active Extravasation

scholarly journals Systematic Review and Proportional Meta-Analysis of Endarterectomy and Endovascular Therapy with Routine or Selective Stenting for Common Femoral Artery Atherosclerotic Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Khalid Hamid Changal ◽  
Mubbasher Ameer Syed ◽  
Tawseef Dar ◽  
Muhammad Asif Mangi ◽  
Mujeeb Abdul Sheikh
Keyword(s):  
Endovascular Treatment ◽  
Femoral Artery ◽  
Meta Analysis ◽  
Common Femoral Artery ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Inclusion Criteria ◽  
One Year ◽  
New Evidence

Introduction. Common femoral endarterectomy (CFE) has been the therapy of choice for common femoral artery atherosclerotic disease (CFA-ASD). In the past, there was inhibition to treat CFA-ASD endovascularly with stents due to fear of stent fracture and compromise of future vascular access site. However, recent advances and new evidence suggest that CFA may no longer be a ‘stent-forbidden zone’. In the light of new evidence, we conducted a meta-analysis to determine the use of endovascular treatment for CFA-ASD and compare it with common femoral endarterectomy in the present era.Methods. Using certain MeSH terms we searched multiple databases for studies done on endovascular and surgical treatment of CFA-ASD in the last two decades. Inclusion criteria were randomized control trials, observational, prospective, or retrospective studies evaluating an endovascular treatment or CFE for CFA-ASD. For comparison, studies were grouped based on the treatment strategy used for CFA-ASD: endovascular treatment with selective stenting (EVT-SS), endovascular treatment with routine stenting (EVT-RS), or common femoral endarterectomy (CFE). Primary patency (PP), target lesion revascularization (TLR), and complications were the outcomes studied. We did proportional meta-analysis using a random-effect model due to heterogeneity among the included studies. If confidence intervals of two results do not overlap, then statistical significance is determined.Results. Twenty-eight studies met inclusion criteria (7 for EVT-RS, 8 for EVT-SS, and 13 for CFE). Total limbs involved were 2914 (306 in EVT-RS, 678 in EVT-SS, and 1930 in CFE). The pooled PP at 1 year was 84% (95% CI 75-92%) for EVT-RS, 78% (95% CI 69-85%) for EVT-SS, and 93% (95% CI 90-96%) for CFE. PP at maximum follow-up in EVT-RS was 83.7% (95% CI 74-91%) and in CFE group was 88.3% (95% CI 81-94%). The pooled target lesion revascularization (TLR) rate at one year was 8% (95% CI 4-13%) for EVT-RS, 19% (95% CI 14-23%) for EVT-SS, and 4.5% (95% CI 1-9%) for CFE. The pooled rate of local complications for EVT-RS was 5% (95% CI 2-10%), for EVT-SS was 7% (95% CI 3 to 12%), and CFE was 22% (95% CI 14-32%). Mortality at maximum follow-up in CFE group was 23.1% (95% CI 14-33%) and EVT-RS was 5.3% (95% CI 1-11%).Conclusion. EVT-RS has comparable one-year PP and TLR as CFE. CFE showed an advantage over EVT-SS for one-year PP. The complication rate is lower in EVT RS and EVT SS compared to CFE. At maximum follow-up, CFE and EVT-RS have similar PP but CFE has a higher mortality. These findings support EVT-RS as a management alternative for CFA-ASD.

scholarly journals Ruptured Mycotic Common Femoral Artery Pseudoaneurysm: Fatal Pulmonary Embolism after Emergency Stent-Grafting in a Drug Abuser

2014 ◽  
Vol 41 (6) ◽  
pp. 634-637 ◽  
Author(s):  
Christos D. Karkos ◽  
Thomas E. Kalogirou ◽  
Ioakeim T. Giagtzidis ◽  
Konstantinos O. Papazoglou
Keyword(s):  
Pulmonary Embolism ◽  
Femoral Artery ◽  
Vena Cava ◽  
Common Femoral Artery ◽  
Intravenous Drug ◽  
Drug Abuser ◽  
Fatal Pulmonary Embolism ◽  
Intravenous Drug Abuser ◽  
Artery Pseudoaneurysm ◽  
Stent Grafting

The rupture of a mycotic femoral artery pseudoaneurysm in an intravenous drug abuser is a limb- and life-threatening condition that necessitates emergency intervention. Emergency stent-grafting appears to be a viable, minimally invasive alternative, or a bridge, to subsequent open surgery. Caution is required in cases of suspected concomitant deep vein thrombosis in order to minimize the possibility of massive pulmonary embolism during stent-grafting, perhaps by omitting stent-graft postdilation or by inserting an inferior vena cava filter first. We describe the emergency endovascular management, in a 60-year-old male intravenous drug abuser, of a ruptured mycotic femoral artery pseudoaneurysm, which was complicated by a fatal pulmonary embolism.

Endovascular obliteration of an intracranial pseudoaneurysm: the utility of Onyx

2009 ◽  
Vol 4 (5) ◽  
pp. 445-448 ◽  
Author(s):  
Ricky Medel ◽  
R. Webster Crowley ◽  
D. Kojo Hamilton ◽  
Aaron S. Dumont
Keyword(s):  
Pediatric Patient ◽  
Coil Embolization ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Potential Treatment ◽  
Parent Artery Occlusion ◽  
Endovascular Methods ◽  
Iatrogenic Pseudoaneurysm

Pseudoaneurysms are rare lesions with a multitude of causes, including infectious, traumatic, and iatrogenic origins. In addition, there are a number of potential treatment options, all of which require consideration to determine the most appropriate management. Historically, surgical intervention has been the method of choice, but because the histopathological features of these lesions make them largely unsuitable for clipping, trapping or excision is often required. More recently endovascular methods have been used, including coil embolization, stent reconstruction, or parent artery occlusion. Although these methods are often successful, situations arise in which they are not technically feasible. The authors describe such a case in a pediatric patient with an iatrogenic pseudoaneurysm. Onyx was used to embolize the lesion and the results were excellent.

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