Non-surgical management of iatrogenic arterial pseudoaneurysms-ultrasound-guided manual compression, an Indian experience.
OBJECTIVE
To evaluate the efficacy of ultrasound-guided manual compression of arterial pseudoaneurysms formed as a result of various procedures.


METHODS
Ultrasound-guided manual compression was performed in 444 patients with ultrasound-diagnosed pseudoaneurysm. These patients were evaluated for number of locules in pseudoaneurysm, size of pseudoaneurysm, total time of compression, number of sittings, success/failure of the procedure, and possible complications.


RESULTS
Out of 444 patients, 231 (52%) were on post-coronary angiography (3 via brachial route and rest via femoral route), 212 (47.7%) had post-coronary angioplasty and 1 (0.22%) was post-nailing of fracture of right tibia (pseudoaneurysm of right anterior tibial artery). Out of 444 patients, 132 (29.7%) had hypertension, 45 (10.1%) had diabetes mellitus, 117 (26.3%) had both hypertension and diabetes, and 90 (20.2%) were obese. 384 (86.5%) had unilocular, 51 (11.5%) had bilocular, 6 (1.3%) had trilocular and 3 (0.67%) had tetralocular pseudoaneurysm. Size of pseudoaneurysm varied between 0.8 cm and 8.1 cm (mean 3.3 cm). 342 (77%), 48 (10.8%), 54 (12.1%) required 1, 2 and 3 sittings, respectively for complete closure. The compression time was between 15 and 120 minutes (mean 40 minutes). Successful compression was achieved in 423 (95.3%). There were 21 (4.7%) failures, 12 out of which required surgical repair, 6 had spontaneous closure between 12 and 24 weeks and 3 were lost to follow up at 1 year. Out of 212 post-coronary intervention patients, 9 were on low molecular weight heparin (LMWH). In 7 of these 9 patients, LMWH was stopped 48 hours before compression and in remaining 2, compression was done during the course of LMWH therapy. The compression was successful in all 9 patients. Only 2 patients had a transient vasovagal attack.


CONCLUSIONS
USG manual compression is safe, inexpensive, reliable and effective outpatient procedure for non-surgical management of arterial pseudoaneurysm.
Kumar
Vivek
V
Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, India. visujata@hotmail.com
Paul
Biswajit
B
Sharma
Vinay
V
Sachdeva
Ankush
A
Shrivastava
Sameer
S
D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy*; D001916:Brachial Artery / Q000293:injuries*; D017023:Coronary Angiography / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease; D007194:India; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018084:Ultrasonography, Interventional
D006495:Heparin, Low-Molecular-Weight