[Doppler color US in the diagnosis and treatment of iatrogenic pseudoaneurysms].
Pulsatile masses occur increasingly as a complication of transfemoral or transaxillary percutaneous catheterization, as the number of catheterization procedures and their complexity has increased. These iatrogenic injuries may be represented by a pseudoaneurysm or by a periarterial hematoma with transmitted arterial pulsation: the 2 vascular injuries require prompt differentiation because pseudoaneurysms need treatment by means of US-guided compression or surgical repair. Nineteen patients (10 men and 9 women, aged 40-85 years, mean: 62 years) with a groin (no. = 17) or axillary (no. = 2) pulsatile mass following angiographic catheterization were prospectively examined with color Doppler sonography (US). A pseudoaneurysm was detected in 13 patients (12 femoral and one axillary injury), whereas the other 6 pulsatile masses were consistent with periarterial hematomas. US-guided compression was attempted in 13 pseudoaneurysms and the pulsatile mass was repaired in 11/13 cases (84.6%), including 10/12 femoral and 1/1 axillary lesions. All the vascular injuries successfully treated with US-guided therapy were repaired 1-4 days after the angiographic complication. On the other hand, two pseudoaneurysms unsuccessfully treated with US-guided compression were studied after 8 and 24 days, respectively, after the angiographic complication and subsequently submitted to surgical repair. The pseudoaneurysms size did not seem to affect the favorable outcome of the US-guided treatment. With the exception of the 2 surgical cases, the other 17 patients underwent clinical examination and color Doppler US one and 7 days after the US-guided compression of the pulsatile mass. Moreover, a 6-25 weeks clinical follow-up showed no late complications or recurrences in all the cases. In conclusion, color Doppler US is now the technique of choice to assess potential complications related to femoral or brachial artery catheterization.
Pinto
F
F
Cattedra di Radiologia, Università degli Studi di Pisa.
Lencioni
R
R
Stringari
R
R
Armillotta
N
N
Sbrana
R
R
Russo
R
R
Scaglione
M
M
Bartolozzi
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D001366:Axillary Artery / Q000000981:diagnostic imaging*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D004621:Embolization, Therapeutic; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional