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

Keywords: pseudoaneurysm; common femoral artery; endovascular treatment.

Abstract

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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References

Koganemaru M, Abe T, Hayabuchi N, Yokoi K. Successful endovascular treatment of iatrogenic pseudoaneurysm with a relatively long neck. BMJ Case Rep 2013. pii: bcr2012007021. doi: 10.1136/bcr-2012-007021

Huang TL, Liang HL, Huang JS et al. Ultrasound-guided compression repair of peripheral artery pseudoaneurysm: 8 years’ experience of a single institute. J Chin Med Assoc 2012;75(9):468-73. doi: 10.1016/j.jcma.2012.06.020.

Korkmaz A, Duyuler S, Kalayci S et al. An alternative noninvasive technique for the treatment of iatrogenic femoral pseudoaneurysms: stethoscope-guided compression. Acta Cardiol 2013;68(3): 279-83. doi: 10.1093/eurheartj/eht310.P5454

Sánchez-Enciso MA, Nuño-Escobar C, González-Ojeda A, Llamas Macias FJ, Ramos-López CR, Fuentes-Orozco C. Treatment of arterial pseudoaneurysms with percutaneous ultrasound-guided thrombin injection. Cir Cir 2012;80(2):134-9. PMID: 22644008.

Ergun O, Çeltikçi P, Güneş Tatar İ, Yılmaz M, Hekimoğlu B. Percutaneous thrombin injection treatment of a femoral artery pseudoaneurysm with simultaneous arterial balloon occlusion: Case report and review of the literature. Turk Kardiyol Dern Ars. 2016 Dec;44(8):684-689. doi: 10.5543/tkda.2016.03063.

Waldherr C, Kickuth R, Ludwig K, Do DD, Triller J. Superselective embolization of deep femoral artery branch pseudoaneurysm with a coaxial microcatheter system. Vasa. 2006;35(1):45-9. PubMed PMID: 16535970.

Nakai M, Sato M, Sanda H et al. Percutaneous fluoroscopically guided n-butyl cyanoacrylate (NBCA) injection for iatrogenic femoral arterial pseudoaneurysm under temporary balloon occlusion of arterial blood flow. Jpn J Radiol. 2012;30(4):365-9. doi: 10.1007/s11604-011-0049-0.

Orimoto Y, van Keulen JW, Waasdorp EJ, Moll FL, van Herwaarden JA. Treatment of a recurrent false aneurysm of the femoral artery by stent-graft placement from the brachial artery. Ann Vasc Surg. 2011;25(6):e1-e4. https://doi.org/(...)6/j.avsg.2011.01.010

Borioni R, Garofalo M, De Paulis R et al. Surgical treatment of femoral artery pseudoaneurysms after cardiac catheterization. Minerva Chir. 2008;63(4):277-82. PMID: 18607323

Gabrielli R, Rosati MS, Vitale S et al. Fatal complication after thrombin injection for post-catheterization femoral pseudoaneurysm. Thorac Cardiovasc Surg. 2011;59(6):372-5. doi: 10.1055/s-0030-1270837. Epub 2011 Apr 26.

Piffaretti G, Mariscalco G, Tozzi M, Rivolta N, Castelli P, Sala A. Predictive factors of complications after surgical repair of iatrogenic femoral pseudoaneurysms. World J Surg. 2011;35(4):911-6. doi: 10.1007/s00268-011-0964-3.

Chatterjee T, Do DD, Kaufmann U, Mahler F, Meier B. Ultrasound-guided compression repair for treatment of femoral artery pseudoaneurysm: acute and follow-up results. Cathet Cardiovasc Diagn. 1996;38(4):335-40. PMID: 8853137 doi: 10.1002/(SICI)1097-0304(199608)38:4<335::AID-CCD1>3.0.CO;2-8

Demirbas O, Guven A, Batyraliev T. Management of 28 consecutive iatrogenic femoral pseudoaneurysms with ultrasound-guided compression. Heart Vessels. 2005;20(3):91-4. PMID: 15912303 DOI: 10.1007/s00380-004-0809-1

Robken J, Shammas NW. Novel technique to treat common femoral artery pseudoaneurysm using Angio-Seal Closure Device. Int J Angiol. 2016 Dec; 25(4):266-70. Epub 2014 Jul 4. doi: 10.1055/s-0034-1382100

Xiang DC, Hillegass WB, Luo GX, He JX. Treatment of refractory iatrogenic femoral artery pseudoaneurysm with a vascular closure device. J Vasc Interv Radiol. 2009 Dec;20(12):1639-40. doi: 10.1016/j.jvir.2009.08.023. Epub 2009 Oct 24.

Published
2020-01-22
How to Cite
Cherednichenko, Y. (2020). Experience of endovascular treatment of common femoral artery pseudoaneurysm with usage Angio-Seal Closure Device. Ukrainian Interventional Neuroradiology and Surgery, 29(3), 71-79. https://doi.org/10.26683/2304-9359-2019-3(29)-71-79