Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing
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CLINICAL INVESTIGATION
ARTERIAL INTERVENTIONS
Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing Andrea Del Corso • Giuseppe Vergaro
Received: 17 July 2012 / Accepted: 26 September 2012 / Published online: 18 November 2012 Ó Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012
Abstract Purpose Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA. Material and Methods During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up. Results PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 ± 22 %. Neuropathy and vein
A. Del Corso (&) Division of General and Vascular Surgery, Ospedale Cisanello, Universita` di Pisa, Via Paradisa 2, 56124 Pisa, Italy e-mail: [email protected] G. Vergaro Division of Cardiovascular Medicine, Fondazione G. Monasterio CNR–Regione Toscana, Via Moruzzi 1, 56125 Pisa, Italy
compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary. Conclusion PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings. Keywords Pseudoaneurysm Percutaneous closure Catheterization Complications Access site
Introduction Iatrogenic pseudoaneurysms (PSAs) have been reported to complicate 0.1–1 % of diagnostic angiography and up to 2.6 % of interventional procedures [1–3]. Percutaneous thrombin injection is currently the first-line treatment for arterial catheterization-site PSA. However, patients presenting with mass effect (nerve, vein compression, and soft-tissue necrosis) are currently referred for surgical treatment because thromb
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