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The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Treatment of giant iatrogenic pseudoaneurysm of the femoral artery

대퇴동맥에 발생한 의인성 거대 가성동맥류에 대한 치료

  • Kang, Wu-Seong (Department of Trauma Surgery, Wonkwnag University Hospital) ;
  • Park, Chan-Yong (Department of Trauma Surgery, Wonkwnag University Hospital)
  • 강우성 (원광대학교병원 외상외과) ;
  • 박찬용 (원광대학교병원 외상외과)
  • Received : 2018.11.28
  • Accepted : 2019.03.08
  • Published : 2019.03.31
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Abstract

The role of angioembolization has increased because of increases in nonoperative treatment for traumatic splenic injury. We report here a case of successful treatment of iatrogenic pseudoaneurysm of the femoral artery by thrombin injection with coil embolization. A 55-year-old female was admitted to our hospital because of blunt trauma. Computed tomography (CT) revealed a grade V splenic injury with contrast extravasation; therefore, angioembolization was performed. Three days after admission, follow-up CT scan revealed rebleeding from the spleen, and repeat angioembolization was performed. Seven days after admission, an approximately $7.0cm{\times}4.0cm-sized$ pseudoaneurysm was found on follow-up CT scan and there was no bleeding from the spleen. Although thrombin was injected into the aneurysmal sac, there was still inflow of blood, as observed on color-doppler ultrasound. Therefore, coil embolization to the neck of the aneurysm was performed. On angiography, there was no contrast filling into the sac. The size of the pseudoaneurysmal sac had decreased on follow-up CT scan, and the patient was discharged to home without complications. We successfully treated a giant pseudoaneurysm of the femoral artery using thrombin and coil embolization.

외상성 비장손상에 대한 비수술적 치료가 증가하면서 혈관조영술과 색전술의 역할이 증가하고 있다. 본 연구에서는 혈관조영술 후 발생한 대퇴동맥의 가성 동맥류를 트롬빈(thrombin) 주입과 코일(coil)을 이용한 색전술로써 효과적으로 치료한 증례를 보고하고자 한다. 55세 여자가 둔상성 외상으로 내원하였다. 전산화단층촬영에서 grade V 비장손상 소견을 보였으며, 조영제의 유출이 관찰되어 혈관조영술 및 색전술을 시행하였다. 내원 3일째 시행한 시행한 전산화단층촬영에서 비장의 재출혈 소견 보여 2차 색전술을 시행하였다. 내원 7일째 시행한 전산화단층 촬영에서 비장의 출혈 소견은 관찰되지 않았으나 우측 대퇴동맥 주위로 직경 $7.0cm{\times}4.0cm$ 크기의 가성동맥류가 발견되었다. 이 가성동맥류의 치료를 위해 초음파 유도하 트롬빈 주입을 시행하였으나 주입 후에도 혈류가 계속 유입되는 것이 컬러도플러초음파에서 관찰되었다. 이에 가성동맥류의 입구에 코일을 이용하여 색전술을 시행하였으며, 시술 후 혈관조영술에서 동맥류가 조영되지 않는 것을 확인하였다. 또한 추적 전산화단층촬영에서 동맥류가 조영되지 않고 크기도 감소하여 효과적으로 치료되었음을 확인하였다. 이후 환자는 특별한 합병증 없이 퇴원하였다. 저자들은 크기가 큰 대퇴동맥의 의인성 가성동맥류를 트롬빈과 코일을 이용하여 색전술을 시행함으로써 수술을 피하고 효과적으로 치료할 수 있었다.

Keywords

SHGSCZ_2019_v20n3_423_f0001.png 이미지

Fig. 2. Abdominal CT scan on postoperative day 7, red arrow indicates huge iatrogenic pseudoaneurysm of femoral artery.

SHGSCZ_2019_v20n3_423_f0002.png 이미지

Fig. 1. (A) Abdominal CT scan on arrival at emergency room, red arrow indicates extravasation from the spleen. (B) Coil embolization of splenic artery's branches via angiography.

SHGSCZ_2019_v20n3_423_f0003.png 이미지

Fig. 3. (A) Ultrasound-guided thrombin injection into the pseudoaneurysmal sac. (B) Coil emboliztion of the pseudoaneurysmal neck.

References

  1. Gaarder C, Gaski IA, Naess PA, "Spleen and liver injuries: when to operate?", Curr Opin Crit Care, Vol. 23, No. 6, pp. 520-526. DOI: https://doi.org/10.1097/mcc.0000000000000458
  2. Tran TL, Brasel KJ, Karmy-Jones R, Rowell S, Schreiber MA, Shatz DV, Albrecht RM, Cohen MJ, DeMoya MA, Biffl WL, Moore EE, Namias N, "Western Trauma Association Critical Decisions in Trauma: Management of pelvic fracture with hemodynamic instability-2016 updates", J Trauma Acute Care Surg, Vol. 81, No. 6, pp. 1171-1174, 2016. DOI: https://doi.org/10.1097/ta.0000000000001230
  3. Kushimoto S, Arai M, Aiboshi J, Harada N, Tosaka N, Koido Y, Yoshida R, Yamamoto Y, Kumazaki T, "The role of interventional radiology in patients requiring damage control laparotomy", J Trauma, Vol. 54, No. 1, pp. 171-176, 2003. https://doi.org/10.1097/00005373-200301000-00022
  4. Otsuka H, Sato T, Sakurai K, Aoki H, Yamagiwa T, Iizuka S, Inokuchi S, "Use of interventional radiology as initial hemorrhage control to improve outcomes for potentially lethal multiple blunt injuries", Injury, Vol. 49, No. 2, pp. 226-229, 2018. DOI: https://doi.org/10.1016/j.injury.2017.11.038
  5. Polanco PM, Brown JB, Puyana JC, Billiar TR, Peitzman AB, Sperry JL, "The swinging pendulum: a national perspective of nonoperative management in severe blunt liver injury", J Trauma Acute Care Surg, Vol. 75, No. 4, pp. 590-595, 2013. DOI: https://doi.org/10.1097/TA.0b013e3182a53a3e
  6. Messina LM, Brothers TE, Wakefield TW, Zelenock GB, Lindenauer SM, Greenfield LJ, Jacobs LA, Fellows EP, Grube SV, Stanley JC, "Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: interventional versus diagnostic procedures", J Vasc Surg, Vol. 13, No. 5, pp. 593-600, 1991. https://doi.org/10.1016/0741-5214(91)90341-Q
  7. Kurzawski J, Sadowski M, Janion-Sadowska A, "Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm", J Clin Ultrasound, Vol. 44, No. 3, pp. 188-195, 2016. DOI: https://doi.org/10.1002/jcu.22274
  8. Ahmad F, Turner SA, Torrie P, Gibson M, "Iatrogenic femoral artery pseudoaneurysms--a review of current methods of diagnosis and treatment", Clin Radiol, Vol. 63, No. 12, pp. 1310-1316, 2008. DOI: https://doi.org/10.1016/j.crad.2008.07.001
  9. Middleton WD, Dasyam A, Teefey SA, "Diagnosis and treatment of iatrogenic femoral artery pseudoaneurysms", Ultrasound Q, Vol. 21, No. 1, pp. 3-17, 2005.
  10. Toursarkissian B, Allen BT, Petrinec D, Thompson RW, Rubin BG, Reilly JM, Anderson CB, Flye MW, Sicard GA, "Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae", J Vasc Surg, Vol. 25, No. 5, pp. 803-808; discussion 808-809, 1997. https://doi.org/10.1016/S0741-5214(97)70209-X
  11. Coley BD, Roberts AC, Fellmeth BD, Valji K, Bookstein JJ, Hye RJ, "Postangiographic femoral artery pseudoaneurysms: further experience with US-guided compression repair", Radiology, Vol. 194, No. 2, pp. 307-311, 1995. DOI: https://doi.org/10.1148/radiology.194.2.7824703
  12. Fellmeth BD, Roberts AC, Bookstein JJ, Freischlag JA, Forsythe JR, Buckner NK, Hye RJ, "Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression", Radiology, Vol. 178, No. 3, pp. 671-675, 1991. DOI: https://doi.org/10.1148/radiology.178.3.1994400
  13. Eisenberg L, Paulson EK, Kliewer MA, Hudson MP, DeLong DM, Carroll BA, "Sonographically guided compression repair of pseudoaneurysms: further experience from a single institution", AJR Am J Roentgenol, Vol. 173, No. 6, pp. 1567-1573, 1999. DOI: https://doi.org/10.2214/ajr.173.6.10584803
  14. Mohler ER, 3rd, Mitchell ME, Carpenter JP, Strandness DE, Jr., Jaff MR, Beckman JA, Gerhard-Herman M, "Therapeutic thrombin injection of pseudoaneurysms: a multicenter experience", Vasc Med, Vol. 6, No. 4, pp. 241-244, 2001. https://doi.org/10.1177/1358836X0100600407
  15. Owen RJ, Haslam PJ, Elliott ST, Rose JD, Loose HW, "Percutaneous ablation of peripheral pseudoaneurysms using thrombin: a simple and effective solution", Cardiovasc Intervent Radiol, Vol. 23, No. 6, pp. 441-446, 2000. https://doi.org/10.1007/s002700010101
  16. Matson MB, Morgan RA, Belli AM, "Percutaneous treatment of pseudoaneurysms using fibrin adhesive", Br J Radiol, Vol. 74, No. 884, pp. 690-694, 2001. DOI: https://doi.org/10.1259/bjr.74.884.740690
  17. Paulson EK, Nelson RC, Mayes CE, Sheafor DH, Sketch MH, Jr., Kliewer MA, "Sonographically guided thrombin injection of iatrogenic femoral pseudoaneurysms: further experience of a single institution", AJR Am J Roentgenol, Vol. 177, No. 2, pp. 309-316, 2001. DOI: https://doi.org/10.2214/ajr.177.2.1770309
  18. Morgan R, Belli AM, "Current treatment methods for postcatheterization pseudoaneurysms", J Vasc Interv Radiol, Vol. 14, No. 6, pp. 697-710, 2003. https://doi.org/10.1097/01.RVI.0000071089.76348.6A
  19. Tisi PV, Callam MJ, "Treatment for femoral pseudoaneurysms", Cochrane Database Syst Rev, Vol. No. 11, pp. Cd004981, 2013. DOI: https://doi.org/10.1002/14651858.CD004981.pub4
  20. Lonn L, Olmarker A, Geterud K, Risberg B, "Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms", J Endovasc Ther, Vol. 11, No. 5, pp. 570-576, 2004. DOI: https://doi.org/10.1583/03-1181.1
  21. O'Sullivan GJ, Ray SA, Lewis JS, Lopez AJ, Powell BW, Moss AH, Dormandy JA, Belli AM, Buckenham TM, "A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms", Ann R Coll Surg Engl, Vol. 81, No. 4, pp. 226-234, 1999.
  22. Rowell SE, Biffl WL, Brasel K, Moore EE, Albrecht RA, DeMoya M, Namias N, Schreiber MA, Cohen MJ, Shatz DV, Karmy-Jones R, Moore FA, "Western Trauma Association Critical Decisions in Trauma: Management of adult blunt splenic trauma-2016 updates", J Trauma Acute Care Surg, Vol. 82, No. 4, pp. 787-793, 2017. DOI: https://doi.org/10.1097/ta.0000000000001323
  23. Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE, Reva V, Bing C, Bala M, Fugazzola P, Bahouth H, Marzi I, Velmahos G, Ivatury R, Soreide K, Horer T, Ten Broek R, Pereira BM, Fraga GP, Inaba K, Kashuk J, Parry N, Masiakos PT, Mylonas KS, Kirkpatrick A, Abu-Zidan F, Gomes CA, Benatti SV, Naidoo N, Salvetti F, Maccatrozzo S, Agnoletti V, Gamberini E, Solaini L, Costanzo A, Celotti A, Tomasoni M, Khokha V, Arvieux C, Napolitano L, Handolin L, Pisano M, Magnone S, Spain DA, de Moya M, Davis KA, De Angelis N, Leppaniemi A, Ferrada P, Latifi R, Navarro DC, Otomo Y, Coimbra R, Maier RV, Moore F, Rizoli S, Sakakushev B, Galante JM, Chiara O, Cimbanassi S, Mefire AC, Weber D, Ceresoli M, Peitzman AB, Wehlie L, Sartelli M, Di Saverio S, Ansaloni L, "Splenic trauma: WSES classification and guidelines for adult and pediatric patients", World J Emerg Surg, Vol. 12, No. pp. 40, 2017. DOI: https://doi.org/10.1186/s13017-017-0151-4
  24. Zarzaur BL, Dunn JA, Leininger B, Lauerman M, Shanmuganathan K, Kaups K, Zamary K, Hartwell JL, Bhakta A, Myers J, Gordy S, Todd SR, Claridge JA, Teicher E, Sperry J, Privette A, Allawi A, Burlew CC, Maung AA, Davis KA, Cogbill T, Bonne S, Livingston DH, Coimbra R, Kozar RA, "Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial", J Trauma Acute Care Surg, Vol. 83, No. 6, pp. 999-1005, 2017. DOI: https://doi.org/10.1097/ta.0000000000001597