Incidence, diagnosis and treatment of femoral pseudoaneurysm

Background: The aim of the study was to assess the risk of iatrogenic damage to the femoral artery after cardiac catheterisation and to analyse the efficacy of therapeutic procedures applied in the treatment of femoral pseudoaneurysm. Methods: 4916 cases of coronary angiography and 3263 cases of PTCA performed using femoral artery access were analysed. Ultrasound examination confirmed the presence of pseudoaneurysm in 60 patients. In all cases mechanical compression was applied at the site of arterial puncture, resulting in successful obliteration of the pseudoaneurysm in 19 cases. The remaining 25 patients were referred by a vascular surgeon to either surgical procedure or thrombin injection directly into the cavity of the pseudoaneurysm. Results: Femoral artery pseudoaneurysm complicated 0.6% of coronary angiographies and 0.9% of angioplasty procedures. No correlation was observed between the frequency of this complication and sex, age or the intensity of the antiplatelet and antithrombotic treatment. The high degree of efficacy of the non-invasive approach resulted in little need for surgical intervention, which was applicable only in the case of one patient. Conclusions: The compression of a pseudoaneurysm with an elastic band combined with ultrasound-guided compression is efficient in 60% of cases. Thrombin injection into the lumen of the pseudoaneurysm is a safe procedure and appears to be the most effective method of treatment

Tętniak rzekomy tętnicy udowej - występowanie i doświadczenia własne w leczeniu

Wstęp: Celem niniejszej pracy jest ocena występowania jatrogennego uszkodzenia tętnicy udowej po zabiegach koronarografii i przezskórnej angioplastyki tętnic wieńcowych. Dokonano analizy skuteczności stosowanych zabiegów terapeutycznych w leczeniu tętniaka rzekomego. Metody: Przeanalizowano 4916 badań koronarografii i 3263 zabiegów przezskórnej angioplastyki wieńcowej wykonanych z nakłucia tętnicy udowej. W badaniu USG u 60 osób ujawniono obecność tętniaka rzekomego. U wszystkich zastosowano mechaniczny ucisk tej okolicy elastyczną opaską uciskową. U 19 pacjentów uzyskano wykrzepienie tętniaka rzekomego. U pozostałych osób wykonano ucisk tętniaka głowicą ultrasonograficzną pod kontrolą wzroku (skuteczny u 16 pacjentów). Pozostałych 25 chorych po konsultacji z chirurgiem naczyniowym zakwalifikowano do zabiegu zamknięcia tętniaka poprzez zaopatrzenie chirurgiczne lub podanie do jamy tętniaka roztworu trombiny. Wyniki: Jatrogenny tętniak rzekomy tętnicy udowej występuje z częstością 0,6% po koronarografii i 0,9% po przezskórnej angioplastyce wieńcowej. Nie wykazano zwiększonej częstości występowania tętniaków rzekomych w zależności od płci, wieku oraz intensywności leczenia przeciwpłytkowego i przeciwkrzepliwego. Skuteczność nieoperacyjnych metod terapii sprawiła, że tylko w 1 przypadku tętniaka rzekomego tętnicy udowej konieczne było zaopatrzenie chirurgiczne. Wnioski: Ucisk tętniaka rzekomego opaską uciskową uzupełniony o kompresję pod kontrolą wzroku jest skuteczny w około 60% przypadków. Zabieg podawania do światła tętniaka trombiny jest bezpiecznym i najskuteczniejszym sposobem leczenia jatrogennego tętniaka rzekomego tętnicy udowej

Massive pulmonary embolism mimicking ST-elevation acute coronary syndrome successfully treated with hybrid therapy in a trauma patient receiving nadroparin : diagnostic and therapeutic dilemmas

A case of a 48-year-old woman with a comminuted fracture of the left tibia and receiving prophylactic doses of nadroparin, with massive pulmonary embolism mimicking ST-elevation acute coronary syndrome and complicated by cardiogenic shock and cardiac arrest, is presented. Pulmonary angiography showed total right pulmonary artery occlusion. Intraarterial thrombolysis with reduced dose of alteplase (50 mg), platelet GP IIb/IIIa blockade with eptifibatide, endovascular embolus fragmentation with a pigtail rotation catheter, and rescue pulmonary balloon angioplasty were performed, after which complete recovery was achieved. On day 4 of hospitalisation the patient was transferred to the orthopaedic ward where she underwent uneventful tibial surgery

Mobilization of CD34+CXCR4+ Stem/Progenitor Cells and the Parameters of Left Ventricular Function and Remodeling in 1-Year Follow-up of Patients with Acute Myocardial Infarction

Mobilization of stem cells in acute MI might signify the reparatory response. Aim of the Study. Prospective evaluation of correlation between CD34+CXCR4+ cell mobilization and improvement of LVEF and remodeling in patients with acute MI in 1-year followup. Methods. 50 patients with MI, 28 with stable angina (SAP), and 20 individuals with no CAD (CTRL). CD34+CXCR4+ cells, SDF-1, G-CSF, troponin I (TnI) and NT-proBNP were measured on admission and 1 year after MI. Echocardiography and ergospirometry were carried out after 1 year. Results. Number of CD34+CXCR4+ cells in acute MI was significantly higher in comparison with SAP and CTRL, but lower in patients with decreased LVEF ≤40%. In patients who had significant LVEF increase ≥5% in 1 year FU the number of cells in acute MI was significantly higher versus patients with no LVEF improvement. Number of cells was positively correlated (r = 0,41, P = 0,031) with absolute LVEF change and inversely with absolute change of ESD and EDD in 1-year FU. Mobilization of CD34+CXCR4+ cells in acute MI was negatively correlated with maximum TnI and NT-proBNP levels. Conclusion. Mobilization of CD34+CXCR4+ cells in acute MI shows significant positive correlation with improvement of LVEF after 1 year

A 64-year-old man suffering from ST-elevation myocardial infarction and severe thrombocytopenia: Procedures in the case of a patient not fitting the guidelines

The objective of this case report is to present how the chronic condition significantly complicates life-saving procedures and influences further treatment decisions. A 64-year-old man suffering from arterial hypertension and immune thrombocytopenic purpura presented to the Emergency Department with anterior ST-elevation myocardial infarction. An immediate coronary angiography was performed where critical stenosis of the proximal left anterior descending was found. It was followed by primary percutaneous intervention with bare metal stent. In first laboratory results, extremely low platelet count was found (13 × 10 9 /L). Consulting haematologist advised the use of single antiplatelet therapy and from the second day of hospitalisation only clopidogrel was prescribed. On the sixth day of hospital stay, patient presented acute chest pain with ST elevation in anterior leads. Emergency coronary angiography confirmed acute stent thrombosis and aspiration thrombectomy was performed. It was therefore agreed to continue dual antiplatelet therapy for 4 weeks. As there are no clinical trials where patients with low platelet count are included, all therapeutic decisions must be made based on clinician’s experience and experts’ consensus. Both the risk of haemorrhagic complications and increased risk of thrombosis must be taken into consideration when deciding on patient’s treatment

Case reportMassive pulmonary embolism mimicking ST-elevation acute coronary syndrome successfully treated with hybrid therapy in a trauma patient receiving nadroparin: diagnostic and therapeutic dilemmas

A case of a 48-year-old woman with a comminuted fracture of the left tibia and receiving prophylactic doses of nadroparin, with massive pulmonary embolism mimicking ST-elevation acute coronary syndrome and complicated by cardiogenic shock and cardiac arrest, is presented. Pulmonary angiography showed total right pulmonary artery occlusion. Intraarterial thrombolysis with reduced dose of alteplase (50 mg), platelet GP IIb/IIIa blockade with eptifibatide, endovascular embolus fragmentation with a pigtail rotation catheter, and rescue pulmonary balloon angioplasty were performed, after which complete recovery was achieved. On day 4 of hospitalisation the patient was transferred to the orthopaedic ward where she underwent uneventful tibial surgery