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Common Femoral Artery Pseudoaneurysm Associated with Arteriovenous Fistula

Common Femoral Artery Pseudoaneurysm Associated with Arteriovenous Fistula BackgroundThrombin injection (TI) is a common modality for the treatment of femoral artery pseudoaneurysm (PSA) of arterial access sites. It has decreased the need for open repair in this cohort of patients who often have increased surgical risk. Deep venous thrombosis and venous thromboembolism (VTE) have been reported after TI for PSA in the presence of an arteriovenous fistula (AVF). A combined treatment modality using ultrasound-guided TI with concomitant balloon occlusion of the AVF is described.PatientA high cardiac risk patient presented with a large pulsatile right groin mass after cardiac catheterization. Ultrasound identified a PSA arising from the right common femoral artery. The anatomy was suitable for TI; however, a large AVF also was present. The patient was a poor surgical candidate because of cardiac morbidity and body habitus.MethodsThe patient was taken to the hybrid vascular operative suite. Conscious sedation was administered. Venous access was obtained via the right internal jugular vein. Venography identified the AVF in the right common femoral vein. Thrombin was injected into the right groin PSA using direct ultrasound visualization. Simultaneous fluoroscopic-guided balloon inflation was used to occlude the common femoral vein and prevent flow through the AVF. Postinjection venography and Doppler examination of the femoral vessels were performed.ResultsThe PSA was successfully occluded. There was no identifiable venous thrombus. Doppler examination also showed resolution of the AVF. There were no clinical signs or symptoms of pulmonary embolism.ConclusionTI of femoral artery PSA associated with AVF has increased risk of VTE. Concomitant venous occlusion during TI of a PSA may decrease the risk of VTE in the setting of a large AVF. This has the potential to expand the indications for TI in the high-risk surgical patient. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal for Vascular Ultrasound SAGE

Common Femoral Artery Pseudoaneurysm Associated with Arteriovenous Fistula

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References (23)

Publisher
SAGE
Copyright
© 2014 Society for Vascular Ultrasound
ISSN
1544-3167
eISSN
1544-3175
DOI
10.1177/154431671403800207
Publisher site
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Abstract

BackgroundThrombin injection (TI) is a common modality for the treatment of femoral artery pseudoaneurysm (PSA) of arterial access sites. It has decreased the need for open repair in this cohort of patients who often have increased surgical risk. Deep venous thrombosis and venous thromboembolism (VTE) have been reported after TI for PSA in the presence of an arteriovenous fistula (AVF). A combined treatment modality using ultrasound-guided TI with concomitant balloon occlusion of the AVF is described.PatientA high cardiac risk patient presented with a large pulsatile right groin mass after cardiac catheterization. Ultrasound identified a PSA arising from the right common femoral artery. The anatomy was suitable for TI; however, a large AVF also was present. The patient was a poor surgical candidate because of cardiac morbidity and body habitus.MethodsThe patient was taken to the hybrid vascular operative suite. Conscious sedation was administered. Venous access was obtained via the right internal jugular vein. Venography identified the AVF in the right common femoral vein. Thrombin was injected into the right groin PSA using direct ultrasound visualization. Simultaneous fluoroscopic-guided balloon inflation was used to occlude the common femoral vein and prevent flow through the AVF. Postinjection venography and Doppler examination of the femoral vessels were performed.ResultsThe PSA was successfully occluded. There was no identifiable venous thrombus. Doppler examination also showed resolution of the AVF. There were no clinical signs or symptoms of pulmonary embolism.ConclusionTI of femoral artery PSA associated with AVF has increased risk of VTE. Concomitant venous occlusion during TI of a PSA may decrease the risk of VTE in the setting of a large AVF. This has the potential to expand the indications for TI in the high-risk surgical patient.

Journal

Journal for Vascular Ultrasound – SAGE

Published: Jun 1, 2014

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