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Case studies: urgent decisions in interventional radiology
Published in William H. Bush, Karl N. Krecke, Bernard F. King, Michael A. Bettmann, Radiology Life Support (Rad-LS), 2017
Perhaps the most frequent significant complication of arterial access at the groin is the formation of a pseudoaneurysm. The incidence is unknown, but their occurrence is well documented. In the past, pseudoaneurysms have been regarded as a surgical emergency, as they can rupture and cause life-threatening bleeding. Over the last few years, extensive experience has been gained in ‘repairing’ pseudoaneurysms by compression, while monitoring with the ultrasound probe. This treatment is almost always effective, with a low incidence of complications or recurrence. Furthermore, it is clear from experience with ultrasound compression that pseudoaneurysms are not true emergencies. Although urgent treatment is a reasonable approach, it is safe to wait for 12–24 h before instituting ultrasound evaluation and compression. Vascular surgical repair, either before or after ultrasound compression, is rarely if ever necessary. In general, it is important to assess any unusual hematomas to ensure that they are simply hematomas and not pseudoaneurysms. Most, but not all, occur in patients who have had relatively large sheaths placed and have had high levels of anticoagulation therapy during the procedure. They are most likely to form in patients with moderate to large hematomas.
Iatrogenic tracheobronchial and chest injury
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Marios Froudarakis, Demosthenes Makris, Demosthenes Bouros
Asymptomatic ruptures can also occur and they may present with sudden appearance of localized air-space opacification around the catheter tip, representing focal haemorrhage. However, this finding may not be obvious since it may be obscured by extensive pulmonary oedema. Another complication is the pulmonary artery pseudo-aneurysm which is a late complication of pulmonary artery rupture, and most of them are diagnosed by 2 weeks. The pseudo-aneurysm is identified as a well-defined nodule in an area of focal lung consolidation.78 The diagnosis will be confirmed by contrast-enhanced CT that reveals a characteristic halo of ground-glass opacification which represents surrounding haemorrhaging. The rate of re-bleeding is high (of the order of 30–40 per cent) and the mortality rate approaches 70 per cent. The pseudo-aneurysm can be obliterated effectively with embolotherapy.
Endovascular arteriovenous fistulas— are they the answer we haven’t been looking for?
Published in Expert Review of Medical Devices, 2021
Bynvant Sandhu, Charlie Hill, Mohammad Ayaz Hossain
The novel endovascular access (NEAT) trial was a prospective, single arm multicentre study evaluating the 6 Fr EverlinQ (now WavelinQ) device [33]. The trial reported primary and cumulative (primary and assisted) patency of 69% and 84%, respectively, at 12 months. Serious procedure-related adverse events were reported in 8% of the patients, including pseudoaneurysm formation, dissection of the brachial artery and intra-procedural thrombus. The EverlinQ (now WavelinQ) was next evaluated in the Endovascular Access System Enhancement (EASE) study [34], a single-center, single-arm, prospective study. This trial utilized a 4 Fr device to create radial or ulnar anastomoses in the proximal forearm, achieving primary and cumulative patency of 83% and 87%, respectively, at 6 months. One patient (3%) experienced a serious procedure-related adverse event; a venous guidewire perforation which was successfully managed with stent graft. This study demonstrated comparable procedural and technical successes using the 4 Fr device, compared to the 6 Fr device evaluated in the NEAT trial. The 4 Fr allowed access at the wrist, thereby reducing some of the complications observed in the NEAT trial as the 6 Fr device requires brachial artery access.