title: Percutaneous treatment of iatrogenic pseudoaneurysms by cyanoacrylate-based wall-gluing.
abstract: OBJECTIVE
  Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA.
  
  
  METHODS
  During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up.
  
  
  RESULTS
  PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 ± 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary.
  
  
  CONCLUSIONS
  PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.
authors.affiliation: Division of General and Vascular Surgery, Ospedale Cisanello, Università di Pisa, Via Paradisa 2, 56124 Pisa, Italy. adelcorso2000@hotmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Del Corso
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vergaro
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000628:therapy*; D003487:Cyanoacrylates / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007267:Injections; D008297:Male; D009336:Necrosis; D011446:Prospective Studies; D014014:Tissue Adhesives / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives