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      Successful Endovascular Treatment of Iatrogenic Thyrocervical Trunk Pseudoaneurysm with Concomitant Arteriovenous Fistula Using 0.010-Inch Detachable Microcoils

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          Abstract

          Pseudoaneurysms (PsA) and arteriovenous fistulae (AVF) of the thyrocervical trunk and its branches are rare complications of traumatic or iatrogenic arterial injuries. Most such injuries are iatrogenic and are associated with central venous catheterization. Historically, thyrocervical trunk PsA and AVF have been managed with open surgical repair; however, multiple treatment modalities are now available, including ultrasound-guided compression repair, ultrasound-guided thrombin injection, and endovascular repair with covered stent placement. We report a case of a 65-year-old woman with an iatrogenic thyrocervical trunk PsA with concomitant AVF that developed after attempted internal jugular vein cannulation for hemodialysis access. The PsA was successfully treated by transcatheter coil embolization using 0.010-inch detachable microcoils. Our case is the first published instance of a thyrocervical trunk PsA with concomitant AVF that was successfully treated by endovascular procedure.

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          Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents.

          To assess the effectiveness and safety of endovascular covered stents in the management of pseudoaneurysms and arteriovenous fistulas after cardiac and vascular catheterization. Twenty-six endovascular covered stents were used to repair 16 pseudoaneurysms, nine arteriovenous fistulas, and one combined lesion after femoral arterial puncture for diagnostic coronary angiography and/or angioplasty. Fistulas and aneurysms were in the superficial femoral artery in 16 cases, in the deep femoral artery in six cases, and in the common femoral artery in four cases. Implantation was performed from the opposite femoral artery in most cases. It was not possible to treat three additional cases transcutaneously for technical reasons (three of 29 cases). Percutaneous closure of the lesions with an endovascular covered stent was successful in 26 of 29 cases. Initial follow-up showed good stent patency. Two major complications were observed after stent implantation. During follow-up (about 1 year in 23 of 26 patients [88%]), stent thromboses were detected in four of 23 patients (17%) with follow-up color duplex flow imaging. Implantation of endovascular covered stents is an effective and safe method for the percutaneous closure of pseudoaneurysms and arteriovenous fistulas. Thus, endoluminal vascular repair with covered stents offers an alternative therapeutic approach to vascular surgery in selected patients.
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            Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort.

            Because of the risk of associated complications, femoral pseudoaneurysm (PSA) formation implies further treatment. Ultrasound-guided thrombin injection (UGTI) is becoming the accepted gold standard, but manual compression (MC) represents an established treatment option including PSAs not feasible for UGTI. This study aims to assess our experience in PSA treatment using MC or UGTI according to a potential algorithm based on morphological properties in a large patient cohort.
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              Diagnosis and treatment of iatrogenic femoral artery pseudoaneurysms.

              Color Doppler is the procedure of choice for the diagnosis of iatrogenic femoral artery pseudoaneurysms. Although surgery is still necessary in a limited number of patients, most can be treated with ultrasound-guided thrombin injection. Success exceeds 90% and complications are much lower than surgery. Although rare, the major complication is embolization into the femoral artery. This can be minimized by using as little thrombin as possible, and by avoiding small pseudoaneurysms with short necks.
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                Author and article information

                Journal
                Case Rep Vasc Med
                Case Rep Vasc Med
                CRIVAM
                Case Reports in Vascular Medicine
                Hindawi Publishing Corporation
                2090-6986
                2090-6994
                2014
                24 December 2014
                : 2014
                : 479656
                Affiliations
                1Department of Radiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
                2Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
                3Department of Laboratory Medicine, Diagnostic Ultrasound Division, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
                4Department of Radiology, Maruyama Memorial General Hospital, 2-10-5 Hon-cho, Iwatsuki-ku, Saitama 339-8521, Japan
                Author notes

                Academic Editor: Konstantinos A. Filis

                Article
                10.1155/2014/479656
                4290149
                6510919b-8645-4eca-9609-0b3e91d28258
                Copyright © 2014 Kohei Hamamoto et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 September 2014
                : 9 December 2014
                : 13 December 2014
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                Case Report

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