Perkutaninio šlaunies arterijos kateterizavimo vietinių komplikacijų gydymo taktika

Darbo tikslas Nustatyti po intervencinių kardiologinių procedūrų per šlaunies arteriją susidariusių vietinių komplikacijų dažnį, pažeidimo vietos tipą ir optimalų gydymo metodą. Tyrimo medžiaga ir metodai Atlikta 166 pacientų, 2007–2011 metais patyrusių vietinių komplikacijų po kateterizavimo dėl įtariamos vainikinių arterijų patologijos, ligos istorijų duomenų retrospektyvi analizė. Vietinės kraujagyslių komplikacijos diagnozuotos ir gydytos kraujagyslių chirurgų. Rezultatai Tiriamąją grupę sudarė 96 (57,8 %) moterys ir 70 (42,2 %) vyrų. Vidutinis pacientų amžius buvo 69,1 metų (±11,4 metai). 63 pacientams (38 %) nustatyta sutrikusi kojų arterinė kraujotaka. Po kateterizavimo, atlikto dėl širdies kraujagyslių sistemos patologijos, šlaunies arterijos pseudoaneurizma išsivystė 162 (97,6%), arterioveninė fistulė – 3 (1,8 %), didelė hematoma – 1 pacientui. 111 (66,9 %) pacientų gydyta konservatyviai. Chirurginio gydymo prireikė 55 (33,1 %) pacientams. Operuotos 37 moterys (67,3 %) ir 18 vyrų (32,7 %). Vidutinis operuotų pacientų amžius buvo 69,9 (±10) metai. Pseudoaneurizmos pašalinimas ir arterijos plastika venos lopu atlikta 33 (60 %) pacientams, pašalinti krešuliai ir užsiūti arterijos defektai 22 (40 %) pacientams. Išvados Vietinių kraujagyslių komplikacijų po intervencinių kardiologinių procedūrų per šlaunies arteriją įvyko 166 pacientams (0,706 %). Dažniausia komplikacija po šlaunies arterijos kateterizavimo – pseudoaneurizma. Pseudoaneurizmos sėkmingai gydytos konservatyviai 111 pacientų (66,9 %). Punkcijos vietos kraujagyslių komplikacijos buvo dažnesnės ligoniams, kuriems buvo periferinių arterijų aterosklerozinis pažeidimas (p<0,01). Reikšminiai žodžiai: jatrogeninis šlaunies arterijos pažeidimas, pseudoaneurizma Treatment of local complications that develop after catheterisation through the femoral artery punctureIngrida Ašakienė, Andrius Černauskas, Nerijus Misonis, Vaidotas Zabulis, Robertas Breivis, Sigitas Tvarionavičius, Ramūnas Kvietkauskas ObjectiveTo determine what is the rate, type, and the best treatment of local femoral access complications after interventional cardiology catheterisation procedures through percutaneous femoral artery puncture.Materials and methodsRetrospective analysis of 166 patient medical records was carried out. All the patients underwent coronarography for the suspected coronary artery disease. All of them from 2007 to 2011 developed local femoral access complications. All complications were diagnosed and treated by vascular surgeons.ResultsThe study group consisted of 96 (57.8%) women and 70 (42.2%) men. The average age of the patients was 69.1 years (±11.4 years). Limb ischemia was determined in 63 patients (38%). After catheterisation due to cardiovascular pathology, femoral artery pseudoaneurysm developed in 162 patients (97.6%), arteriovenous fistula in 3 patients (1.8%), and massive hematoma in 1 patient; 111 patients (66.9%) were treated conservatively and 55 (33.1%) surgically. The surgically treated group consisted of 37 women (67.3%) and 18 men (32.7%). The average age of surgically treated patients was 69.9 (±10) years. Pseudoaneurysm removal and venous patch plasty were performed in 33 patients (60%). The removal of blood clots and direct suture of arterial defects were performed in 22 patients (40%).Conclusions166 patients (0.706%) developed local vascular complications after cardiovascular interventions through the femoral artery. Pseudoaneurysm was the most common complication after femoral artery catheterisation. Conservative treatment was successful in 111 patients (66.9%). Local vascular complications of the puncture site were more common in patients with a peripheral arterial disease (p < 0.01).Key words: iatrogenic femoral artery damage, pseudoaneurysm

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Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

International Journal of Angiology ◽

10.1055/s-0040-1709504 ◽

2020 ◽

Vol 29 (03) ◽

pp. 143-148

Author(s):

Ranjit Kumar Nath ◽

Siva Subramaniyan ◽

Neeraj Pandit ◽

Deepankar Vatsa

Keyword(s):

High Risk ◽

Peripheral Arterial Disease ◽

Femoral Artery ◽

Lower Limb ◽

Treatment Strategies ◽

Arterial Disease ◽

Retrograde Approach ◽

Femoral Access ◽

Antegrade Approach ◽

Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

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Prophylactic Ipsilateral Superficial Femoral Artery Access in Patients With Elevated Risk for Femoral Access Complications During Transfemoral Transcatheter Aortic Valve Replacement

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2018.05.004 ◽

2018 ◽

Vol 11 (15) ◽

pp. e123-e125

Author(s):

Nicholas Ierovante ◽

Kintur Sanghvi

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Transcatheter Aortic Valve Replacement ◽

Elevated Risk ◽

Femoral Access ◽

Transcatheter Aortic Valve ◽

Access Complications

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Antegrade vs Crossover Femoral Artery Access in the Endovascular Treatment of Isolated Below-the-Knee Lesions in Patients With Critical Limb Ischemia

Journal of Endovascular Therapy ◽

10.1177/1526602817701251 ◽

2017 ◽

Vol 24 (3) ◽

pp. 331-336 ◽

Cited By ~ 3

Author(s):

Yukun Li ◽

Ali Esmail ◽

Konstantinos P. Donas ◽

Georgios Pitoulias ◽

Giovanni Torsello ◽

...

Keyword(s):

Endovascular Treatment ◽

Success Rate ◽

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Technical Success ◽

Femoral Access ◽

Technical Success Rate ◽

Below The Knee ◽

Antegrade Approach

Purpose: To evaluate the safety and effectiveness of antegrade vs crossover femoral artery access in the endovascular treatment of isolated below-the-knee (BTK) lesions in patients with critical limb ischemia (CLI). Methods: Between January 2014 and December 2015, 224 high-risk patients (mean age 75.8±9.8 years; 151 men) with CLI underwent infragenicular interventions on 292 crural vessels in 3 European vascular centers. All patients had isolated TransAtlantic Inter-Society Consensus (TASC) C (n=26) or D (n=198) BTK lesions. Primary endpoints were freedom from access-related complications and technical success comparing the antegrade vs crossover access groups. Results: Balloon angioplasty was the most used treatment modality (169 vessels, 75.4%). The technical success rate was 88.4% in the entire cohort and 88.0% in the antegrade group vs 90.4% in the crossover group (p>0.99). In all patients, the technical success rate was higher for stenotic lesions (100%) vs occlusions (85.5%, p=0.002) and in patients with TASC C BTK lesions (100%) vs TASC D (86.9%, p=0.033). The overall freedom from access-related complications was 97.8%: 99% in the antegrade group and 90.6% in the crossover group (p=0.022). Larger sheath size (5/6-F vs 4-F) was associated with a significantly higher risk for access-related complications (7.1% vs 1.1%, respectively; p=0.047). Conclusion: The present multicenter study showed high technical success and a low incidence of access-related complications in the treatment of isolated BTK lesions using either antegrade or crossover femoral access. The antegrade approach with the use of a 4-F system seems to have a significantly lower rate of access-related complications.

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Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention

DeckerMed Surgery ◽

10.2310/surg.2387 ◽

2018 ◽

Author(s):

Lalithapriya Jayakumar ◽

Mark Davies

Keyword(s):

Lower Extremity ◽

Vascular Disease ◽

Endovascular Procedures ◽

Vascular Diseases ◽

Limb Ischemia ◽

Arterial Disease ◽

Surgical Approaches ◽

Acute Ischemia ◽

Acute Limb Ischemia ◽

Access Complications

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies. Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access

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Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention

10.2310/vasc.2387 ◽

2018 ◽

Author(s):

Lalithapriya Jayakumar ◽

Mark Davies

Keyword(s):

Lower Extremity ◽

Vascular Disease ◽

Endovascular Procedures ◽

Vascular Diseases ◽

Limb Ischemia ◽

Arterial Disease ◽

Surgical Approaches ◽

Acute Ischemia ◽

Acute Limb Ischemia ◽

Access Complications

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies. Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access

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Femoral Artery Pseudoaneurysm Caused by an Osteochondroma of the Femur: A Case Report

Journal for Vascular Ultrasound ◽

10.1177/154431670302700111 ◽

2003 ◽

Vol 27 (1) ◽

pp. 51-54 ◽

Cited By ~ 2

Author(s):

Courtney Nelms ◽

Kathleen Carter ◽

Richard DeMasi ◽

George Meier ◽

Dulcie Chaler ◽

...

Keyword(s):

Case Report ◽

Femoral Artery ◽

Young Patients ◽

Vascular Complications ◽

Left Thigh ◽

Artery Pseudoaneurysm ◽

Adductor Canal ◽

Common Benign Tumor ◽

Arterial Complications ◽

Pulsatile Mass

Introduction The osteochondroma is the most common benign tumor of bone. Typically asymptomatic bony protuberances are discovered in childhood or adolescence. Although vascular complications are rare, these bony spikes can course along an artery and cause severe arterial complications. Reported here is a case involving the use of color duplex ultrasonography (CDU) to identify a superficial femoral artery (SFA) pseudoaneurysm as a result of an osteochondroma. Case Report A 12-year-old girl had been experiencing left lower extremity pain for approximately 2 months. The pain became progressively severe, and her parents noticed that she was limping. Magnetic resonance imaging (MRI) demonstrated a mass in the left thigh, suggesting the possibility of a femoral aneurysm. A bony spicule was noted on x-ray at the distal femur, projecting posteriorly. Clinical evaluation revealed an impressive pulsatile mass in the left distal medial thigh. The left thigh was noticeably larger than the right with poor pedal pulses compared with the asymptomatic limb. CDU was performed and identified an aneurysm of the SFA at the adductor canal. There was unusual oscillatory flow in the SFA proximal to the aneurysm with monophasic signals distally. The large aneurysm size displaced the normal anatomic course of the SFA and vein. Ankle-brachial indices (ABI) were 0.72 and monophasic in the affected limb and >1.0 and triphasic in the contralateral limb. Angiography confirmed the CDU and MRA findings, demonstrating a large pseudoaneurysm at the adductor canal caused by an osteochondroma of the femur. At time of surgical repair, the bony spicule was noted to have eroded into the femoral artery. Conclusion Vascular complications as a result of an osteochondroma are rare. Rapid diagnosis is necessary to prevent serious arterial compromise in these young patients. CDU can quickly and accurately confirm the presence of a pseudoaneurysm when an osteochondroma is suspected.

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Radial pseudoaneurysm following diagnostic coronary angiography

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v10i3.12776 ◽

2015 ◽

Vol 10 (3) ◽

pp. 48-50

Author(s):

Shankar Laudari ◽

Sachin Dhungel ◽

Laxman Dubey ◽

Guru Prasad ◽

R Bhattacharya ◽

...

Keyword(s):

Coronary Angiography ◽

Radial Artery ◽

Femoral Artery ◽

Rare Complication ◽

Vascular Complications ◽

Medical Sciences ◽

Artery Pseudoaneurysm ◽

Early Ambulation ◽

Coronary Catheterization ◽

Diagnostic Coronary Angiography

The radial artery access has gained popularity as a method of diagnostic coronary catheterization compared to femoral artery puncture in terms of vascular complications and early ambulation. However, very rare complication like radial artery pseudoaneurysm may occur following cardiac catheterization which may give rise to serious consequences. Here, we report a patient with radial pseudoaneurysm following diagnostic coronary angiography. Adequate and correct methodology of compression of radial artery following puncture for maintaining hemostasis is the key to prevention.DOI: http://dx.doi.org/10.3126/jcmsn.v10i3.12776 Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 48-50

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Localization of the femoral artery bifurcation: hips don't lie – in at least 97% of cases

European Heart Journal ◽

10.1093/eurheartj/ehab724.2152 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Uehlein ◽

S Smolka ◽

M Arnold ◽

M Marwan ◽

S Achenbach

Keyword(s):

Femoral Head ◽

Femoral Artery ◽

Hip Replacement ◽

Age Groups ◽

Vascular Complications ◽

Common Femoral Artery ◽

Femoral Access ◽

Funding Sources ◽

Transcatheter Aortic Valve ◽

Upper Third

Abstract Background The most common vascular access for structural cardiac interventions such as transcatheter aortic valve implantation (TAVI) is the common femoral artery (CFA). Depending on the procedure CFA puncture has to be performed not only unilaterally, but also bilaterally. Since incorrect localization of femoral access can lead to severe vascular complications, specific knowledge about the exact position of the CFA bifuraction is helpful. Such information might be systematically obtained from pre-TAVI CT scans. Methods We performed a retroperspective analysis of consecutive contrast-enhanced pre-TAVI CT angiography data sets (n=1000) to determine the CFA bifurcation localization relative to the femoral head and the correlation to contralateral CFA bifurcation location. Results The site of the CFA bifurcation was in 67.2% below the femoral head (−−), in 24.3% within the lower third of the femoral head (−), in 7.4% in the mid (0) and in 1.2% within the upper third (+) of the femoral head. Bifurcations above (++) the femoral head were not detected. CFA bifurcations below the femoral head showed the highest prevalence within men and women in all age groups (50–59, 60–69, 70–79, 80–89, 90–99 years). Bilateral agreement of CFA bifurcations was observed in only 69.3% and was independent of one-sided hip replacement (agreement 72.7%) or two-sided hip replacement (agreement 78.7%). A congruent contralateral left CFA bifurcation below the femoral head could be predicted in 80.6%, whereas CFA bifurcations within the lower and upper margins of the femoral head were congruent in only 65.7% (of these, 49.2% for the lower third, 29.7% for the mid and 36.4% for the upper third). Conclusion In conclusion, punctures within the upper third of the femoral head will provide an ideal puncture site in at least 97% of cases, independent of age, sex, or previous hip replacement. FUNDunding Acknowledgement Type of funding sources: None.

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Experience of endovascular treatment of common femoral artery pseudoaneurysm with usage Angio-Seal Closure Device

Endovascular Neuroradiology ◽

10.26683/2304-9359-2019-3(29)-71-79 ◽

2020 ◽

Vol 29 (3) ◽

pp. 71-79

Author(s):

Yu.V. Cherednichenko

Keyword(s):

Endovascular Treatment ◽

Femoral Artery ◽

Common Femoral Artery ◽

Left Vertebral Artery ◽

Closure Device ◽

Severe Stenosis ◽

Femoral Access ◽

Artery Pseudoaneurysm ◽

The Common ◽

The Right

One case of successful treatment of the common femoral artery pseudoaneurysm with usage of modified technique of pseudoaneurysm neck sealing with Angio-Seal with retrograde access percutaneously is presented.A 52-year-old man was admitted in the recovery period of ischemic stroke in the left carotid basin. A total subtraction cerebral angiography was performed, which revealed severe stenosis in the bulb of the left internal carotid artery with ulcerated contour and severe stenosis in the ostium of the left vertebral artery. Hemostasis was performed by compression. A pressure dressing was applied for a day. The puncture site was without any problems on the next day. The patient received double antiplatelet therapy 5 days before endovascular surgery. Before surgery, palpation in the right inguinal region determines a rounded painful compaction. Carotid stenting on the left side, stenting of the left vertebral artery and control angiography of arteries of the right lower limb were performed by left-side femoral access. Pseudoaneurysm in the bifurcation of the right common femoral artery with a narrow neck was verified. Attempts to cure it by manual compression under angiographic control and ultrasound control were unsuccessful.After 6 days, endovascular treatment of pseudoaneurysms of the right common femoral artery with closure of the pseudoaneurysm neck was performed. The right common femoral artery was catheterized with left radial access with diagnostic catheter on a hydrophilic wire 0.035ʺ. This wire was carefully advanced into pseudoaneurysm through a defect in the common femoral artery and subsequently served as a marker. The pseudoaneurysm was punctured with miniaccess needle, then the 0.018ʺ wire passed through the pseudoaneurysm neck into the femoral artery retrogradly, focusing on the “marker” wire. A 6F radial introducer is introduced along 0.018ʺ wire. Further, this access was used to close the pseudoaneurysm neck with the Angio-Seal Closure Device 6F according to the standard method. In a control angiograms, a pseudoaneurysm did not contrast, arteries are passable without stenosis and signs of dissection. Hemostasis at the site of puncture of the radial artery was performed with a hemostatic bracelet. The patient was discharged from the clinic to continue treatment in a rehabilitation neurological center.This technique of endovascular treatment of postcatheterization pseudoaneurysms of the common femoral artery is quite simple, causing minimal discomfort for the patient. The closure is immediate and angiographically controled. The use of radial access instead of contralateral femoral access for introducing of a “marker” wire and angiographic control reduces the risk of local complications at the access site.

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