3308jum_online_Layout 1 7/21/14 3:20 PM Page 1505
TECHNICAL INNOVATION
Radial Artery Pseudoaneurysm A Simplified Treatment Method
Matthew P. Cauchi, DO, Paul M. Robb, MD, Robert P. Zemple, MD, Timothy C. Ball, MD, PhD
A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band (Terumo Medical Corporation, Somerset, NJ) have been variable and anecdotal, without objective measurements of adequate compression, making this technique prone to failure. In this report, we present an efficient, safe, and noninvasive management protocol using a pulse oximeter and the TR Band for treatment of radial artery pseudoaneurysms that is cost-effective and efficient and ensures correction without occlusion of the radial artery. Key Words—cardiac catheterization; Doppler sonography; pseudoaneurysm; radial artery; TR Band; vascular ultrasound
C Received September 23, 2013, from the Departments of Internal Medicine (M.P.C., P.M.R.), Emergency Medicine (R.P.Z.), and Cardiology (T.C.B.), Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia USA. Revision requested October 30, 2013. Revised manuscript accepted for publication December 4, 2013. Address correspondence to Paul M. Robb, MD, Department of Internal Medicine, Virginia Tech, Carilion Clinic School of Medicine, 1906 Belleview Ave, Roanoke, VA 24014 USA. E-mail: [email protected] doi:10.7863/ultra.33.8.1505
ardiac catheterization and intervention are frequently performed for coronary revascularization, with the overall risk of complications being small, but they can prove to be catastrophic. Over the past decade, the preferred vascular access site has been a highly debated topic, with a transition from the historically popular femoral artery to the radial artery, owing to a dramatic decrease in the incidence and severity of access site complications.1–3 Although rare, these situations can be disastrous, ultimately threatening life and limb.3 Treatment options are limited and can expose the patient to additional risks, such as the need for open surgical repair. In this report, we propose the use of readily available technology, including an external compression device and digital pulse oximetry for the treatment of radial artery pseudoaneurysms.
Case Description A 45-year-old man was admitted for an anterior ST-elevation myocardial infarction. A drug-eluting stent was subsequently placed in the left anterior descending coronary artery by a right radial approach via a 6F introducer sheath with placement of a TR Band (Terumo Medical Corporation, Somerset, NJ) for postprocedural hemostasis. Before the procedure, the patient was given 325 mg of aspirin and 60 mg of prasugrel with the intent to continue dual antiplatelet therapy for a minimum of 1 year. The patient’s TR
©2014 by the American Institute of Ultrasound in Medicine | J Ultrasound Med 2014; 33:1505–1509 | 0278-4297 | www.aium.org
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Cauchi et al—Radial Artery Pseudoaneurysm: A Simplified Treatment Method
Band was removed in the Coronary Care Unit according to the protocol described in the TR Band instructions for use. On awakening, the patient reported a sharp pain in the right wrist, accompanied by swelling and tenderness to palpation over the right radial artery access site. A color flow Doppler arterial sonographic study was performed and revealed a radial artery pseudoaneurysm, characterized by a pathognomonic aliasing to-and-fro waveform, measuring 1.1 cm at the largest diameter, with a 2.9-mm tract and a neck width of 0.5 mm (Figures 1 and 2). Given the size of the pseudoaneurysm and the width of the neck, the decision was made to pursue repeated compression with the TR Band instead of sonographically guided compression. A pulse oximeter was attached to the patient’s right thumb while the ipsilateral ulnar artery was manually compressed proximal to the TR Band. The band was inflated until radial occlusion was obtained, as evidenced by the progressive diminution and ultimate disappearance of the pulse wave on oximetry (Figure 3). The amount of air required to completely occlude the radial artery was noted to be 17.0 mL. While maintaining simultaneous manual ulnar occlusion, 0.5-mL increments of air were released from the TR Band until the blunted oximeter pulse wave returned (2.0 mL removed to a total of 15.0 mL), signifying patency of the radial artery. This procedure was repeated to determine the point of maximum pressure that could be applied without occluding the radial artery. The device was left in place with pressure unchanged for 45 minutes, followed by manual removal of 1 mL of air by nursing staff every 15 minutes until completely deflated (total time, 4.5 hours). During the procedure, the patient had minimal pain, and analgesic medications were not required to complete the procedure. Another color flow duplex examination with Doppler imaging and spectral analysis was performed, showing resolution and thrombosis of the pseudoaneurysm with radial artery patency (Figure 4). The patient remained in the hospital overnight for observation and was discharged home the following day.
Treatment of radial artery pseudoaneurysms has not been standardized. Direct injection of thrombin into the pseudoaneurysm, with the intent to produce immediate thrombosis, has proven to be very successful. However, this procedure is not without risks, and multiple case reports have demonstrated the risk of arterial embolization and Figure 1. Pretreatment 2-dimensional sonogram of the radial artery (RA) and pseudoaneurysm (P).
Figure 2. A, Depiction of the pseudoaneurysm (P), radial artery (RA), and tract (T). B, Color Doppler image showing an aliasing to-and-fro waveform, as noted above, with bidirectional flow.
Discussion The reported incidence of all transradial arterial complications is reported to be 0.6%, compared to 1.5% via a transfemoral approach.2,4 Known risk factors of access site complications include the use of glycoprotein IIB/IIIa inhibitors and an elevated body mass index.2 Pseudoaneurysm formation after arterial access is an uncommon complication met with a myriad of treatment options ranging from thrombin injection, vascular surgery, sonographically guided compression, and external compression devices.
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Cauchi et al—Radial Artery Pseudoaneurysm: A Simplified Treatment Method
peripheral thrombosis of the affected limb, resulting in pain, necrosis, and limb loss despite appropriate use.5–7 In addition, there is no standard dosing regimen of thrombin, with literature reporting between 50 and 2000 U delivered.8 To complicate matters further, much of this literature deals with the incidence of femoral artery pseudoaneurysms after cardiac catheterization, and few address the discrepancy of vessel size and dose adjustment.9–19 A second treatment option that has shown a high degree of success is the use of sonographically guided compression.5,20–22 However, this procedure requires a substantial amount of time from health care professionals, which may not be feasible in busy or understaffed hospital settings, with the most expeditious protocol calling for compression at the site of a radial artery pseudoaneurysm for 10-minute intervals until obliteration of the pseudoaneurysm tract is objectively visualized.21,23 Hybrid techniques of sonographically guided thrombin injection and compression have been reported, with marginal improvement in safety and efficacy, but they still do not address the issue of timeliness. Figure 3. Pulse oximeter waveform demonstration. A, Normal, unoccluded waveform. B, Complete dampening after full TR Band inflation. C, Partial waveform dampening with simultaneous ulnar artery compression to ensure radial artery patency.
J Ultrasound Med 2014; 33:1505–1509
Over the past few years, very few case reports have demonstrated successful radial artery pseudoaneurysm treatment with external compression, most notably the Terumo TR Band.2,20 Postprocedure hemostatic compression devices are used almost exclusively after radial artery access and are specifically designed to prevent pseudoaneurysm formation.20 The TR Band is specifically designed to provide pressure by using dual compression balloons in a controlled manner over the radial artery, allowing for adequate venous return and preventing local nerve compression (Figure 5).24–26 However, these case reports used merely subjective measurements of adequate compression, either by patient-reported discomfort,27 operator palpation of distal pulsation,20 or arbitrary and variable inflation volumes.20 Additionally, these reports had no definitive time frame regarding maintenance of compression, ranging from 6 to 8 hours,20 to more than 72 hours.1 Although these procedures were reported to be effective, without objective determination of adequate Figure 4. A and B, Posttreatment sonograms after removal of the TR Band showing the thrombosed pseudoaneurysm (P) and tract (T), while patency of the radial artery (RA) is maintained.
1507
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Cauchi et al—Radial Artery Pseudoaneurysm: A Simplified Treatment Method
3. 4.
5. 6.
7.
A
8.
9. 10.
B Figure 5. A, Terumo TR Band. B, Cross section of the inflated band showing its intended design to deliver pressure directly onto the radial artery (RA) access site while maintaining venous patency.26
11.
12.
compression of the radial artery pseudoaneurysm neck, initial attempts that are unsuccessful may be seen as “treatment failures,” subjecting these patients to unnecessary surgical intervention. Here we have presented an efficient, safe, and, noninvasive management protocol for the treatment of radial artery pseudoaneurysms, with the key element of timely and cost-effective objectivity to ensure adequate compression without vascular compromise. To our knowledge, this protocol is the first to successfully use an objective measurement of radial arterial occlusion without direct visualization via sonographic compression imaging.
References 1.
2.
1508
Blasco A, Oteo JF, Fontanilla T, Salamanca J, Ocaranza R, Goicolea J. Unusual complications of cardiac catheterization via the radial artery [in Spanish]. Rev Esp Cardiol 2005; 58:1233–1235. Hamid T, Harper L, McDonald J. Radial artery pseudoaneurysm following coronary angiography in two octogenarians. Exp Clin Cardiol 2012; 17:260–262.
13.
14.
15.
16.
17.
18.
19.
Nasiri B, Alizadehasl A, Billejani I, Abdolrahman R, Toluey M. A complicated radial artery pseudoaneurysm. J Cardiovasc Thorac Res2010; 2:47–50. Eichhofer J, Horlick, E, Ivanov, J, et al. Decreased complication rates using the transradial compared to the transfemoral approach in the percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience. Am Heart J 2008; 156:864–870. Pero T, Herrick J. Pseudoaneurysm of the radial artery diagnosed by bedside ultrasound. West J Emerg Med 2009; 10:89–91. Pozniak MA, Mitchell C, Ledwidge M. Radial artery pseudoaneurysm: a maneuver to decrease the risk of thrombin therapy. J Ultrasound Med 2005; 24:119–122. D’Achille A, Sebben RA, Davies RP. Percutaneous ultrasound-guided thrombin injection for coagulation of post-traumatic pseudoaneurysms. Australas Radiol 2001; 45:218–221. Reeder SB, Widlus DM, Lazinger M. Low-dose thrombin injection to treat iatrogenic femoral artery pseudoaneurysms. AJR Am J Roentgenol 2001; 177:595–598. Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. AJR Am J Roentgenol 1986; 147:383–387. Kang SS. Percutaneous thrombin injection of pseudoaneurysms. J Vasc Interv Radiol 1999; 10(suppl):S192–S194. Kang SS, Labropoulos N, Mansour MA, et al. Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms. J Vasc Surg 2000; 31:289–298. Pezzullo JA, Dupuy DE, Cronan JJ. Percutaneous injection of thrombin for the treatment of pseudoaneurysms after catheterization: an alternative to sonographically guided compression. AJR Am J Roentgenol 2000; 175:1035–1040. Liau CS, Ho FM, Chen MF, Lee YT. Treatment of iatrogenic femoral artery pseudoaneurysm with percutaneous thrombin injection. J Vasc Surg 1997; 26:18–23. Kang SS, Labropoulos N, Mansour MA, Baker WH. Percutaneous ultrasound guided thrombin injection: a new method for treating postcatheterization femoral pseudoaneurysms. J Vasc Surg 1998; 27: 1032–1038. Wixon CL, Philpott JM, Bogey WM, Powell CS. Duplex-directed thrombin injection as a method to treat femoral artery pseudoaneurysms. J Am Coll Surg 1998; 187:464–466. Taylor BS, Rhee RY, Muluk S, et al. Thrombin injection versus compression of femoral artery pseudoaneurysms. J Vasc Surg 1999; 30:1052– 1059. Brophy DP, Sheiman RG. Pseudoaneurysm treatment with ultrasoundguided percutaneous thrombin injection. J Vasc Interv Radiol 1999; 10(suppl):S257. Partap VA, Cassoff J. Ultrasound-guided percutaneous thrombin injection for treatment of femoral pseudoaneurysm: technical note. Can Assoc Radiol J 1999; 50:182–184. Brophy DP, Sheiman RG, Amatulle P, Akbari CM. Iatrogenic femoral pseudoaneurysms: thrombin injection after failed US-guided compression. Radiology 2000; 214:278–282. J Ultrasound Med 2014; 33:1505–1509
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Cauchi et al—Radial Artery Pseudoaneurysm: A Simplified Treatment Method
20. Liou M, Tung F, Kanei Y, Kwan T. Treatment of radial artery pseudoaneurysm using a novel compression device. J Invasive Cardiol 2010; 22:293–295. 21. Schaub F, Theiss W, Busch R, Heinz M, Paschalidis M, Schömig A. Management of 219 cases of postcatheterization pseudoaneurysm. J Am Coll Cardiol 1997; 30:670–675. 22. Fellmeth BD, Roberts AC, Bookstein JJ, et al. Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology 1991; 178:671–675. 23. Sheikhzadeh A, Hakim H, Ghabusi P, Ataii M, Tarbiat S. Right pulmonary artery-to-left atrial communication: recognition and surgical correction. Am Heart J 1984; 107:396–398. 24. Terumo Medical Corporation. TR Band radial compression device [product handout]. Terumo Interventional Systems website. http:// www.terumois .com/administration/pdfs/collateral%20library/TR% 20Band%20Sell%20Sheet.pdf. Accessed November 14, 2013. 25. Terumo Medical Corporation. TR Band radial compression device. Terumo Interventional Systems website. http://www.terumois.com/ products/sheaths/trband.aspx?page=closer. Accessed November 14, 2013. 26. Terumo Medical Corporation. Image adapted from: TR band (video): radial artery compression device for post-transradial procedures. Angiosoft.Net website. http://www.angiosoft. net/news_release5.php. Accessed November 14, 2013. 27. Cozzi DA, Morini F, Casati A, Pacilli M, Salvini V, Cozzi F. Radial artery pseudoaneurysm successfully treated by compression bandage. Arch Dis Child 2003; 88:165–166.
J Ultrasound Med 2014; 33:1505–1509
1509
TECHNICAL INNOVATION
Radial Artery Pseudoaneurysm A Simplified Treatment Method
Matthew P. Cauchi, DO, Paul M. Robb, MD, Robert P. Zemple, MD, Timothy C. Ball, MD, PhD
A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band (Terumo Medical Corporation, Somerset, NJ) have been variable and anecdotal, without objective measurements of adequate compression, making this technique prone to failure. In this report, we present an efficient, safe, and noninvasive management protocol using a pulse oximeter and the TR Band for treatment of radial artery pseudoaneurysms that is cost-effective and efficient and ensures correction without occlusion of the radial artery. Key Words—cardiac catheterization; Doppler sonography; pseudoaneurysm; radial artery; TR Band; vascular ultrasound
C Received September 23, 2013, from the Departments of Internal Medicine (M.P.C., P.M.R.), Emergency Medicine (R.P.Z.), and Cardiology (T.C.B.), Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia USA. Revision requested October 30, 2013. Revised manuscript accepted for publication December 4, 2013. Address correspondence to Paul M. Robb, MD, Department of Internal Medicine, Virginia Tech, Carilion Clinic School of Medicine, 1906 Belleview Ave, Roanoke, VA 24014 USA. E-mail: [email protected] doi:10.7863/ultra.33.8.1505
ardiac catheterization and intervention are frequently performed for coronary revascularization, with the overall risk of complications being small, but they can prove to be catastrophic. Over the past decade, the preferred vascular access site has been a highly debated topic, with a transition from the historically popular femoral artery to the radial artery, owing to a dramatic decrease in the incidence and severity of access site complications.1–3 Although rare, these situations can be disastrous, ultimately threatening life and limb.3 Treatment options are limited and can expose the patient to additional risks, such as the need for open surgical repair. In this report, we propose the use of readily available technology, including an external compression device and digital pulse oximetry for the treatment of radial artery pseudoaneurysms.
Case Description A 45-year-old man was admitted for an anterior ST-elevation myocardial infarction. A drug-eluting stent was subsequently placed in the left anterior descending coronary artery by a right radial approach via a 6F introducer sheath with placement of a TR Band (Terumo Medical Corporation, Somerset, NJ) for postprocedural hemostasis. Before the procedure, the patient was given 325 mg of aspirin and 60 mg of prasugrel with the intent to continue dual antiplatelet therapy for a minimum of 1 year. The patient’s TR
©2014 by the American Institute of Ultrasound in Medicine | J Ultrasound Med 2014; 33:1505–1509 | 0278-4297 | www.aium.org
3308jum_online_Layout 1 7/21/14 3:20 PM Page 1506
Cauchi et al—Radial Artery Pseudoaneurysm: A Simplified Treatment Method
Band was removed in the Coronary Care Unit according to the protocol described in the TR Band instructions for use. On awakening, the patient reported a sharp pain in the right wrist, accompanied by swelling and tenderness to palpation over the right radial artery access site. A color flow Doppler arterial sonographic study was performed and revealed a radial artery pseudoaneurysm, characterized by a pathognomonic aliasing to-and-fro waveform, measuring 1.1 cm at the largest diameter, with a 2.9-mm tract and a neck width of 0.5 mm (Figures 1 and 2). Given the size of the pseudoaneurysm and the width of the neck, the decision was made to pursue repeated compression with the TR Band instead of sonographically guided compression. A pulse oximeter was attached to the patient’s right thumb while the ipsilateral ulnar artery was manually compressed proximal to the TR Band. The band was inflated until radial occlusion was obtained, as evidenced by the progressive diminution and ultimate disappearance of the pulse wave on oximetry (Figure 3). The amount of air required to completely occlude the radial artery was noted to be 17.0 mL. While maintaining simultaneous manual ulnar occlusion, 0.5-mL increments of air were released from the TR Band until the blunted oximeter pulse wave returned (2.0 mL removed to a total of 15.0 mL), signifying patency of the radial artery. This procedure was repeated to determine the point of maximum pressure that could be applied without occluding the radial artery. The device was left in place with pressure unchanged for 45 minutes, followed by manual removal of 1 mL of air by nursing staff every 15 minutes until completely deflated (total time, 4.5 hours). During the procedure, the patient had minimal pain, and analgesic medications were not required to complete the procedure. Another color flow duplex examination with Doppler imaging and spectral analysis was performed, showing resolution and thrombosis of the pseudoaneurysm with radial artery patency (Figure 4). The patient remained in the hospital overnight for observation and was discharged home the following day.
Treatment of radial artery pseudoaneurysms has not been standardized. Direct injection of thrombin into the pseudoaneurysm, with the intent to produce immediate thrombosis, has proven to be very successful. However, this procedure is not without risks, and multiple case reports have demonstrated the risk of arterial embolization and Figure 1. Pretreatment 2-dimensional sonogram of the radial artery (RA) and pseudoaneurysm (P).
Figure 2. A, Depiction of the pseudoaneurysm (P), radial artery (RA), and tract (T). B, Color Doppler image showing an aliasing to-and-fro waveform, as noted above, with bidirectional flow.
Discussion The reported incidence of all transradial arterial complications is reported to be 0.6%, compared to 1.5% via a transfemoral approach.2,4 Known risk factors of access site complications include the use of glycoprotein IIB/IIIa inhibitors and an elevated body mass index.2 Pseudoaneurysm formation after arterial access is an uncommon complication met with a myriad of treatment options ranging from thrombin injection, vascular surgery, sonographically guided compression, and external compression devices.
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Cauchi et al—Radial Artery Pseudoaneurysm: A Simplified Treatment Method
peripheral thrombosis of the affected limb, resulting in pain, necrosis, and limb loss despite appropriate use.5–7 In addition, there is no standard dosing regimen of thrombin, with literature reporting between 50 and 2000 U delivered.8 To complicate matters further, much of this literature deals with the incidence of femoral artery pseudoaneurysms after cardiac catheterization, and few address the discrepancy of vessel size and dose adjustment.9–19 A second treatment option that has shown a high degree of success is the use of sonographically guided compression.5,20–22 However, this procedure requires a substantial amount of time from health care professionals, which may not be feasible in busy or understaffed hospital settings, with the most expeditious protocol calling for compression at the site of a radial artery pseudoaneurysm for 10-minute intervals until obliteration of the pseudoaneurysm tract is objectively visualized.21,23 Hybrid techniques of sonographically guided thrombin injection and compression have been reported, with marginal improvement in safety and efficacy, but they still do not address the issue of timeliness. Figure 3. Pulse oximeter waveform demonstration. A, Normal, unoccluded waveform. B, Complete dampening after full TR Band inflation. C, Partial waveform dampening with simultaneous ulnar artery compression to ensure radial artery patency.
J Ultrasound Med 2014; 33:1505–1509
Over the past few years, very few case reports have demonstrated successful radial artery pseudoaneurysm treatment with external compression, most notably the Terumo TR Band.2,20 Postprocedure hemostatic compression devices are used almost exclusively after radial artery access and are specifically designed to prevent pseudoaneurysm formation.20 The TR Band is specifically designed to provide pressure by using dual compression balloons in a controlled manner over the radial artery, allowing for adequate venous return and preventing local nerve compression (Figure 5).24–26 However, these case reports used merely subjective measurements of adequate compression, either by patient-reported discomfort,27 operator palpation of distal pulsation,20 or arbitrary and variable inflation volumes.20 Additionally, these reports had no definitive time frame regarding maintenance of compression, ranging from 6 to 8 hours,20 to more than 72 hours.1 Although these procedures were reported to be effective, without objective determination of adequate Figure 4. A and B, Posttreatment sonograms after removal of the TR Band showing the thrombosed pseudoaneurysm (P) and tract (T), while patency of the radial artery (RA) is maintained.
1507
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Cauchi et al—Radial Artery Pseudoaneurysm: A Simplified Treatment Method
3. 4.
5. 6.
7.
A
8.
9. 10.
B Figure 5. A, Terumo TR Band. B, Cross section of the inflated band showing its intended design to deliver pressure directly onto the radial artery (RA) access site while maintaining venous patency.26
11.
12.
compression of the radial artery pseudoaneurysm neck, initial attempts that are unsuccessful may be seen as “treatment failures,” subjecting these patients to unnecessary surgical intervention. Here we have presented an efficient, safe, and, noninvasive management protocol for the treatment of radial artery pseudoaneurysms, with the key element of timely and cost-effective objectivity to ensure adequate compression without vascular compromise. To our knowledge, this protocol is the first to successfully use an objective measurement of radial arterial occlusion without direct visualization via sonographic compression imaging.
References 1.
2.
1508
Blasco A, Oteo JF, Fontanilla T, Salamanca J, Ocaranza R, Goicolea J. Unusual complications of cardiac catheterization via the radial artery [in Spanish]. Rev Esp Cardiol 2005; 58:1233–1235. Hamid T, Harper L, McDonald J. Radial artery pseudoaneurysm following coronary angiography in two octogenarians. Exp Clin Cardiol 2012; 17:260–262.
13.
14.
15.
16.
17.
18.
19.
Nasiri B, Alizadehasl A, Billejani I, Abdolrahman R, Toluey M. A complicated radial artery pseudoaneurysm. J Cardiovasc Thorac Res2010; 2:47–50. Eichhofer J, Horlick, E, Ivanov, J, et al. Decreased complication rates using the transradial compared to the transfemoral approach in the percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience. Am Heart J 2008; 156:864–870. Pero T, Herrick J. Pseudoaneurysm of the radial artery diagnosed by bedside ultrasound. West J Emerg Med 2009; 10:89–91. Pozniak MA, Mitchell C, Ledwidge M. Radial artery pseudoaneurysm: a maneuver to decrease the risk of thrombin therapy. J Ultrasound Med 2005; 24:119–122. D’Achille A, Sebben RA, Davies RP. Percutaneous ultrasound-guided thrombin injection for coagulation of post-traumatic pseudoaneurysms. Australas Radiol 2001; 45:218–221. Reeder SB, Widlus DM, Lazinger M. Low-dose thrombin injection to treat iatrogenic femoral artery pseudoaneurysms. AJR Am J Roentgenol 2001; 177:595–598. Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection. AJR Am J Roentgenol 1986; 147:383–387. Kang SS. Percutaneous thrombin injection of pseudoaneurysms. J Vasc Interv Radiol 1999; 10(suppl):S192–S194. Kang SS, Labropoulos N, Mansour MA, et al. Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms. J Vasc Surg 2000; 31:289–298. Pezzullo JA, Dupuy DE, Cronan JJ. Percutaneous injection of thrombin for the treatment of pseudoaneurysms after catheterization: an alternative to sonographically guided compression. AJR Am J Roentgenol 2000; 175:1035–1040. Liau CS, Ho FM, Chen MF, Lee YT. Treatment of iatrogenic femoral artery pseudoaneurysm with percutaneous thrombin injection. J Vasc Surg 1997; 26:18–23. Kang SS, Labropoulos N, Mansour MA, Baker WH. Percutaneous ultrasound guided thrombin injection: a new method for treating postcatheterization femoral pseudoaneurysms. J Vasc Surg 1998; 27: 1032–1038. Wixon CL, Philpott JM, Bogey WM, Powell CS. Duplex-directed thrombin injection as a method to treat femoral artery pseudoaneurysms. J Am Coll Surg 1998; 187:464–466. Taylor BS, Rhee RY, Muluk S, et al. Thrombin injection versus compression of femoral artery pseudoaneurysms. J Vasc Surg 1999; 30:1052– 1059. Brophy DP, Sheiman RG. Pseudoaneurysm treatment with ultrasoundguided percutaneous thrombin injection. J Vasc Interv Radiol 1999; 10(suppl):S257. Partap VA, Cassoff J. Ultrasound-guided percutaneous thrombin injection for treatment of femoral pseudoaneurysm: technical note. Can Assoc Radiol J 1999; 50:182–184. Brophy DP, Sheiman RG, Amatulle P, Akbari CM. Iatrogenic femoral pseudoaneurysms: thrombin injection after failed US-guided compression. Radiology 2000; 214:278–282. J Ultrasound Med 2014; 33:1505–1509
3308jum_online_Layout 1 7/21/14 3:20 PM Page 1509
Cauchi et al—Radial Artery Pseudoaneurysm: A Simplified Treatment Method
20. Liou M, Tung F, Kanei Y, Kwan T. Treatment of radial artery pseudoaneurysm using a novel compression device. J Invasive Cardiol 2010; 22:293–295. 21. Schaub F, Theiss W, Busch R, Heinz M, Paschalidis M, Schömig A. Management of 219 cases of postcatheterization pseudoaneurysm. J Am Coll Cardiol 1997; 30:670–675. 22. Fellmeth BD, Roberts AC, Bookstein JJ, et al. Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology 1991; 178:671–675. 23. Sheikhzadeh A, Hakim H, Ghabusi P, Ataii M, Tarbiat S. Right pulmonary artery-to-left atrial communication: recognition and surgical correction. Am Heart J 1984; 107:396–398. 24. Terumo Medical Corporation. TR Band radial compression device [product handout]. Terumo Interventional Systems website. http:// www.terumois .com/administration/pdfs/collateral%20library/TR% 20Band%20Sell%20Sheet.pdf. Accessed November 14, 2013. 25. Terumo Medical Corporation. TR Band radial compression device. Terumo Interventional Systems website. http://www.terumois.com/ products/sheaths/trband.aspx?page=closer. Accessed November 14, 2013. 26. Terumo Medical Corporation. Image adapted from: TR band (video): radial artery compression device for post-transradial procedures. Angiosoft.Net website. http://www.angiosoft. net/news_release5.php. Accessed November 14, 2013. 27. Cozzi DA, Morini F, Casati A, Pacilli M, Salvini V, Cozzi F. Radial artery pseudoaneurysm successfully treated by compression bandage. Arch Dis Child 2003; 88:165–166.
J Ultrasound Med 2014; 33:1505–1509
1509
