Üst Ekstremitede İyatrojenik Psödoanevrizma Gelişen Hastaların Demografik Özelliklerinin ve Tedavilerinin Değerlendirilmesi: Tek Merkez Deneyimi
Abstract
Amaç: Üst ekstremite arterlerinden perkütan girişimler sonrası psödoanevrizma nadiren görülür. Bu çalışmada üst ekstremitede iatrojenik psödoanevrizması olan hastaların demografik özelliklerini ve psödoanevrizma tedavi yöntemlerini değerlendirmeyi amaçladık.
Yöntem ve Gereçler: 2012-2022 yılları arasında kliniğimizde psödoanevrizma nedeniyle takip edilen 17 hasta retrospektif olarak incelendi. Son nokta sinir hasarı, kompartman sendromu, tromboembolik olay, fistül ve cerrahi ihtiyacı olarak belirlendi. Sinir hasarı, elektromiyografi ve semptomlarla görüldüğü gibi aksonal dejenerasyon olarak belirlendi.
Bulgular: Çalışmaya alınan 17 hastanın 8'inde radial arter psödoanevrizması, 5'inde ulnar arter psödoanevrizması ve 4'ünde brakiyal arter psödoanevrizması gelişti. 15'i konservatif yöntemlerle tedavi edilirken, 2'si cerrahi olarak tedavi edildi. İkisinden biri geç dönemde teşhis edilen 9X9 mm çapındaki psödoanevrizma nedeniyle, diğeri ise ağrı ve 36x26 mm çapındaki psödoanevrizma nedeniyle ameliyat edildi. Bir hastada ulnar sinir hasarı tespit edildi. Bir hastaya fistül teşhisi konuldu. Ulnar sinir yaralanması ve brakial arterovenöz fistül konservatif yöntemlerle ameliyatsız tedavi edildi.
Sonuç: Üst ekstremite arterlerinde perkütan girişim sonrası gelişen psödoanevrizmaların çoğu konservatif yöntemler ile tedavi edilebilmektedir. Girişimsel kardiyologlar psödoanevrizmalar için farklı tedavi yöntemlerinin olduğunu bilmeli ve güncel veriler ışığında başarılı bir şekilde tedavi edebilmelidir. Erken tanı ve tedavi, geç tanı daha kötü komplikasyonlara ve cerrahi müdahale gereksinimine yol açtığı için hayati önem taşımaktadır.
Keywords
References
- Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G, et al. Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. 2016;9:1419-1434.
- Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385:2465-2476.
- Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315.
- Wixon CL, Philpott JM, Bogey WM Jr, Powell CS. Duplex-directed thrombin injection as a method to treat femoral artery pseudoaneurysms. J Am Coll Surg. 1998;187:464-466.
- Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409-1920.
- Hahalis GN, Leopoulou M, Tsigkas G, Xanthopoulou I, Patsilinakos S, Patsourakos NG, et al. Multicenter Randomized Evaluation of High Versus Standard Heparin Dose on Incident Radial Arterial Occlusion After Transradial Coronary Angiography: The SPIRIT OF ARTEMIS Study. JACC Cardiovasc Interv. 2018;11:2241-2250.
- Gokhroo R, Kishor K, Ranwa B, Bisht D, Gupta S, Padmanabhan D, et al. Ulnar Artery Interventions Non-Inferior to Radial Approach: AJmer Ulnar ARtery (AJULAR) Intervention Working Group Study Results. J Invasive Cardiol. 2016;28:1-8.
- Lam UP, Lopes Lao EP, Lam KC, Evora M, Wu NQ. Trans-brachial artery access for coronary artery procedures is feasible and safe: data from a single-center in Macau. Chin Med J (Engl). 2019;132:1478-1481.
- Ratschiller T, Müller H, Schachner T, Zierer A. Pseudoaneurysm of the Radial Artery After a Bicycle Fall. Vasc Endovascular Surg. 2018;52:395-397.
- Maertens A, Tchoungui Ritz FJ, Poumellec MA, Camuzard O, Balaguer T. Posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery: A case report. Int J Surg Case Rep. 2020;75:317-321.
- Polytarchou K, Triantafyllou K, Antypa E, Kappos K. Ulnar pseudoaneurysm after transulnar coronary angiogram treated with percutaneous ultrasound-guided thrombin injection. Int J Cardiol. 2016;222:404-406.
- Deşer SB. Management of iatrogenic brachial artery pseudoaneurysm: surgical treatment of iatrogenic brachial artery pseudoaneurysm. International Journal of the Cardiovascular Academy. 2017;3:9-10.
- Sarkadi H, Csőre J, Veres DS, Szegedi N, Molnár L, Gellér L, et al. Incidence of and predisposing factors for pseudoaneurysm formation in a high-volume cardiovascular center. PLoS One. 2021;16:e0256317.
- Kanei Y, Kwan T, Nakra NC, Liou M, Huang Y, Vales LL, et al. Transradial cardiac catheterization: a review of access site complications. Catheter Cardiovasc Interv. 2011;78:840-846.
- Hachem K, Kfoury J, Tohmé J, Chalhoub V. Rupture of an infected radial artery false aneurysm. Can J Anaesth. 2017;64:92-93.
- Siddiqui S, Weedle R, Vainorius A, Kelly R, Da Costa M. Infected radial artery pseudoaneurysm: a rare entity. Chirurgia. 2020;33:325-7.
- Kongunattan V, Ganesh N. Radial Artery Pseudoaneurysm following Cardiac Catheterization: A Nonsurgical Conservative Management Approach. Heart Views. 2018;19:67-70.
- Moussa Pacha H, Alraies MC, Soud M, Bernardo NL. Minimally invasive intervention of radial artery pseudoaneurysm using percutaneous thrombin injection. Eur Heart J. 2018;39:257.
- Washimi S, Yamada T, Takahashi A. Successful coil embolization with distal radial access for a ruptured radial artery pseudoaneurysm in a patient with SARS-CoV-2 infection. Clin Case Rep. 2022;10:e05509.
- Tsiafoutis I, Zografos T, Koutouzis M, Katsivas A. Percutaneous Endovascular Repair of a Radial Artery Pseudoaneurysm Using a Covered Stent. JACC Cardiovasc Interv. 2018;11:e91-e92.
- Mahanta D, Mahapatra R, Barik R, Singh J, Sathia S, Mohanty S. Surgical repair of postcatheterization radial artery pseudoaneurysm. Clin Case Rep. 2020;8:355-358.
- Tosti R, Özkan S, Schainfeld RM, Eberlin KR. Radial Artery Pseudoaneurysm. J Hand Surg Am. 2017;42:295.e1-295.e6.
- Villanueva-Benito I, Solla-Ruiz I, Rodriguez-Calveiro R, Maciñeiras-Montero JL, Rodriguez-Paz CM, Ortiz-Saez A. Iatrogenic subclavian artery pseudoaneurysm complicating a transradial percutaneous coronary intervention. JACC Cardiovasc Interv. 2012;5:360-361.
- Hahalis G, Tsigkas G, Kakkos S, Panagopoulos A, Tsota I, Davlouros P, et al. Vascular complications following transradial and transulnar coronary angiography in 1600 consecutive patients. Angiology. 2016;67:438-43.
- Geng W, Fu X, Gu X, Jiang Y, Fan W, Wang Y, et al. Safety and feasibility of transulnar versus transradial artery approach for coronary catheterization in non‐selective patients. Chin Med J. 2014;127:1222-1228.
Evaluation of Demographic Characteristics and Treatment of Upper Extremity Iatrogenic Pseudoaneurysm Patients: A Single Center Experience
Abstract
Objective: Pseudoaneurysm is rarely seen after percutaneous interventions from upper extremity arteries. In this study, we aimed to evaluate the demographic characteristics of patients with iatrogenic pseudoaneurysms in the upper extremities and the treatment methods for pseudoaneurysms.
Material and Methods: We retrospectively reviewed the cases seventeen patients who were followed up in our clinic for pseudoaneurysm between 2012 and 2022. The endpoint was determined as nerve damage, compartment syndrome, thromboembolic event, fistula and the need for surgery. Nerve damage was determined as axonal degeneration, as seen by electromyography and symptoms.
Results: Of the 17 patients included in the study, 8 developed radial artery pseudoaneurysms, 5 developed ulnar artery pseudoaneurysms, and 4 developed brachial artery pseudoaneurysms. While 15 were treated with conservative methods, 2 were treated surgically. One of the two underwent surgery due to a pseudoaneurysm with a diameter of 9X9 mm diagnosed in the late period, and the other underwent surgery due to pain and a pseudoaneurysm with a diameter of 36x26 mm. Ulnar nerve damage was detected in one patient. One patient was diagnosed with fistula. Ulnar nerve injury and brachial arterovenous fistula were treated with conservative methods without surgery.
Conclusion: Most of the pseudoaneurysms developing after percutaneous intervention in the upper extremity arteries can be treated with conservative methods. Interventional cardiologists should know that different treatment methods are available for pseudoaneurysms and should be able to treat them successfully in light of the current data. Early diagnosis and treatment are of vital importance since late diagnosis leads to worse complications and the need for surgical intervention.
References
- Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G, et al. Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. 2016;9:1419-1434.
- Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385:2465-2476.
- Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315.
- Wixon CL, Philpott JM, Bogey WM Jr, Powell CS. Duplex-directed thrombin injection as a method to treat femoral artery pseudoaneurysms. J Am Coll Surg. 1998;187:464-466.
- Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409-1920.
- Hahalis GN, Leopoulou M, Tsigkas G, Xanthopoulou I, Patsilinakos S, Patsourakos NG, et al. Multicenter Randomized Evaluation of High Versus Standard Heparin Dose on Incident Radial Arterial Occlusion After Transradial Coronary Angiography: The SPIRIT OF ARTEMIS Study. JACC Cardiovasc Interv. 2018;11:2241-2250.
- Gokhroo R, Kishor K, Ranwa B, Bisht D, Gupta S, Padmanabhan D, et al. Ulnar Artery Interventions Non-Inferior to Radial Approach: AJmer Ulnar ARtery (AJULAR) Intervention Working Group Study Results. J Invasive Cardiol. 2016;28:1-8.
- Lam UP, Lopes Lao EP, Lam KC, Evora M, Wu NQ. Trans-brachial artery access for coronary artery procedures is feasible and safe: data from a single-center in Macau. Chin Med J (Engl). 2019;132:1478-1481.
- Ratschiller T, Müller H, Schachner T, Zierer A. Pseudoaneurysm of the Radial Artery After a Bicycle Fall. Vasc Endovascular Surg. 2018;52:395-397.
- Maertens A, Tchoungui Ritz FJ, Poumellec MA, Camuzard O, Balaguer T. Posttraumatic pseudoaneurysm of a superficial branch of the ulnar artery: A case report. Int J Surg Case Rep. 2020;75:317-321.
- Polytarchou K, Triantafyllou K, Antypa E, Kappos K. Ulnar pseudoaneurysm after transulnar coronary angiogram treated with percutaneous ultrasound-guided thrombin injection. Int J Cardiol. 2016;222:404-406.
- Deşer SB. Management of iatrogenic brachial artery pseudoaneurysm: surgical treatment of iatrogenic brachial artery pseudoaneurysm. International Journal of the Cardiovascular Academy. 2017;3:9-10.
- Sarkadi H, Csőre J, Veres DS, Szegedi N, Molnár L, Gellér L, et al. Incidence of and predisposing factors for pseudoaneurysm formation in a high-volume cardiovascular center. PLoS One. 2021;16:e0256317.
- Kanei Y, Kwan T, Nakra NC, Liou M, Huang Y, Vales LL, et al. Transradial cardiac catheterization: a review of access site complications. Catheter Cardiovasc Interv. 2011;78:840-846.
- Hachem K, Kfoury J, Tohmé J, Chalhoub V. Rupture of an infected radial artery false aneurysm. Can J Anaesth. 2017;64:92-93.
- Siddiqui S, Weedle R, Vainorius A, Kelly R, Da Costa M. Infected radial artery pseudoaneurysm: a rare entity. Chirurgia. 2020;33:325-7.
- Kongunattan V, Ganesh N. Radial Artery Pseudoaneurysm following Cardiac Catheterization: A Nonsurgical Conservative Management Approach. Heart Views. 2018;19:67-70.
- Moussa Pacha H, Alraies MC, Soud M, Bernardo NL. Minimally invasive intervention of radial artery pseudoaneurysm using percutaneous thrombin injection. Eur Heart J. 2018;39:257.
- Washimi S, Yamada T, Takahashi A. Successful coil embolization with distal radial access for a ruptured radial artery pseudoaneurysm in a patient with SARS-CoV-2 infection. Clin Case Rep. 2022;10:e05509.
- Tsiafoutis I, Zografos T, Koutouzis M, Katsivas A. Percutaneous Endovascular Repair of a Radial Artery Pseudoaneurysm Using a Covered Stent. JACC Cardiovasc Interv. 2018;11:e91-e92.
- Mahanta D, Mahapatra R, Barik R, Singh J, Sathia S, Mohanty S. Surgical repair of postcatheterization radial artery pseudoaneurysm. Clin Case Rep. 2020;8:355-358.
- Tosti R, Özkan S, Schainfeld RM, Eberlin KR. Radial Artery Pseudoaneurysm. J Hand Surg Am. 2017;42:295.e1-295.e6.
- Villanueva-Benito I, Solla-Ruiz I, Rodriguez-Calveiro R, Maciñeiras-Montero JL, Rodriguez-Paz CM, Ortiz-Saez A. Iatrogenic subclavian artery pseudoaneurysm complicating a transradial percutaneous coronary intervention. JACC Cardiovasc Interv. 2012;5:360-361.
- Hahalis G, Tsigkas G, Kakkos S, Panagopoulos A, Tsota I, Davlouros P, et al. Vascular complications following transradial and transulnar coronary angiography in 1600 consecutive patients. Angiology. 2016;67:438-43.
- Geng W, Fu X, Gu X, Jiang Y, Fan W, Wang Y, et al. Safety and feasibility of transulnar versus transradial artery approach for coronary catheterization in non‐selective patients. Chin Med J. 2014;127:1222-1228.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 30, 2023 |
| Submission Date | February 19, 2023 |
| Published in Issue | Year 2023 Volume: 13 Issue: 4 |
The published articles in SMJ are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.