WJCD  Vol.2 No.3 , July 2012
Echo-guided pin-point compression can effectively repair pseudoaneurysms associated with catheter procedure
ABSTRACT
Background: Catheter intervention is occasionally complicated by a pseudoaneurysm at the puncture site. Although the feasibility of echo-guided repair of a pseudoaneurysm has been reported, this method does not always repair the pseudoaneurysm. We hypothesized that if the communication to the artery could be effectively closed by pin-point compression, the clot that forms in the residual lumen would effectively cover the communication. We studied the safety and efficacy of the echo-guided pinpoint compression procedure for repairing a pseudoaneurysm. Methods: Ten consecutive patients with a pseudoaneurysm were enrolled. We determined the site of communication by echography with a high-frequency linear probe. We performed pin-point compression on the communication point with the right index finger, and we confirmed closure of the communication by color Doppler. During compression, we monitored echo images to confirm clot formation. Results: A pseudoaneurysm was located on the femoral artery in 6 patients and on the brachial artery in 4 patients. The sizes of the pseudoaneurysms ranged from 13 to 40 mm in diameter. We successfully closed the communication with one-finger compression in all patients. During the compression, we observed clot formation in the residual lumen of the pseudoaneurysm in all patients by echography. The duration of compression ranged from 5 to 40 minutes (mean, 18 minutes). We succeeded in repairing the pseudoaneurysm in all patients using this method. The success of the procedure was also confirmed 24 hours later in all patients. Conclusions: Echo-guided pin-point compression of the communication might be an effective technique for repairing a pseudoaneurysm at the puncture site, and echography is useful for confirming the success of the procedure.

Cite this paper
Yamanaka, T. , Nakamura, Y. , Kawai, Y. , Sato, S. , Mineoi, K. , Yamada, T. , Okayama, H. , Kazatani, Y. and Ito, H. (2012) Echo-guided pin-point compression can effectively repair pseudoaneurysms associated with catheter procedure. World Journal of Cardiovascular Diseases, 2, 155-160. doi: 10.4236/wjcd.2012.23026.
References
[1]   McCan, R.L., Schwartz, L.B. and Pieper, K.S. (1991) Vascular complications of cardiac catheterization. Journal of Vascular Surgery, 174, 962-964.

[2]   Geoffrey, W. and Wegger, M.D. (2007) Contemporary management of postcatheterization pseudoaneurysms. Circulation, 115, 2666-2674. doi:10.1161/CIRCULATIONAHA.106.681973

[3]   Nigel, M., Rachel, E.T. and Nigel, S.K. (2007) Role of the extrinsic pathway of blood coagulation in hemostasis and thrombosis. Arteriosclerosis, Thrombosis, and Vascular Biology, 27, 1687-1693. doi:10.1161/ATVBAHA.107.141911

[4]   Weiss, H.J. and Lages, B. (1988) Evidece for tissue factor-dependent activation of the classic extrinsic coagulation mechanism in blood obtained from bleeding time wounds. Blood, 71, 629-635.

[5]   Latic, A., Delibegovic, M., Pudic, I., et al. (2011) Non-invasive ultrasound guided compression repair of post puncture femoral pseudoaneurysm. Medical Archives, 65, 113-114.

[6]   Eisenberg, L., Paulson, E.K., Kliewer, M.A., et al. (1999) Sonographically guided compression repair of pseudonaeurysms: Further experience from a single institution. American Journal of Roentgenology, 173, 1567-1573.

[7]   Steinkamp, H.J., Werk, M. and Felix, R. (2000) Treatment of postinterventional pseudoaneurysms by ultrasound-guided compression. Investive Radiology, 35, 186- 192. doi:10.1097/00004424-200003000-00005

[8]   La Perna, L., Olin, J.W., Goines, D., et al. (2000) Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation, 102, 2391-2395. doi:10.1161/01.CIR.102.19.2391

[9]   Krueger, K., Zaehringer, M., Strohe, D., et al. (2005) Postcatheterization pseudoaneurysm: Results of US-guided percutaneous thrombin injection in 240 patients. Radiology, 236, 1104-1110. doi:10.1148/radiol.2363040736

 
 
Top