Correction of procedural arterial pseudoaneurysms: established and novel procedures

Abstract

Pseudoaneurysms are common complications of interventional cardiovascular procedures and represent a significant burden for patients and for health-care systems. Ultrasound-guided thrombin injection is nowadays considered as the treatment of choice for iatrogenic pseudoaneurysms without indication to surgery, but accepted guidelines are currently lacking. In recent years, several novel therapeutic approaches have been suggested, often as limited, single-center experiences. In the present review, the authors focus on promising techniques that may represent an alternative to ultrasound-guided thrombin injection, further reducing the need for surgical treatment.

Keywords::

• access site
• catheterization
• complication
• cyanoacrylate
• pseudoaneurysm

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Pseudoaneurysm (PSA) is among the most common complications in patients submitted to percutaneous cardiovascular interventions, and their incidence is likely to increase due to the growing number of procedures, to patients’ comorbidities and to concurrent antiplatelet/anticoagulant therapy.

• Ultrasound-guided thrombin injection is a minimally invasive, safe and effective technique for treatment of iatrogenic PSA and nowadays represents the treatment of choice for small, noncomplicated PSA, while complicated PSA is usually referred to surgery. Nonetheless, widely acknowledged recommendations are currently lacking.

• Several novel approaches have been reported in recent years but, although promising, they have not been properly tested in randomized trials.

• Among recently proposed techniques, percutaneous cyanoacrylate injection after ultrasound-guided chamber pre-emptying represents a safe, cost-effective alternative to thrombin injection, which may reduce the need for surgical treatment.

Notes