Algin Oktay, Mustafayev Assanaly, Ozmen Evrim
Department of Radiology, Ataturk Hospital, Bilkent, Ankara, Turkey ; National MR Research Center (UMRAM), Bilkent University, Ankara, Turkey.
Department of Radiology, Ahmet Yesevi University, Turkestan, Kazakhstan.
Iran J Radiol. 2014 May;11(2):e7228. doi: 10.5812/iranjradiol.7228. Epub 2014 May 15.
Pseudoaneurysms rarely occur as a serious complication following incomplete hemostasis of an arterial puncture site. As a result of the increase in diagnostic and therapeutic angiography, the frequency of iatrogenic pseudoaneurysm has increased as well. Iatrogenic pseudoaneurysms associated with angiographic catheterization occur most commonly in the common femoral artery. Here we report a case of iatrogenic superficial external pudendal artery (SEPA) pseudoaneurysm following cardiac catheterization, which was diagnosed with Doppler ultrasound (US) and multidetector computed tomographic angiography (MDCTA) before Doppler US-guided compression therapy. To the best of our knowledge, iatrogenic SEPA pseudoaneurysm, which is an unusual vessel location for pseudoaneurysm occurrence, has not been reported in the literature. In patients in whom anticoagulant-thrombolytic therapy or therapeutic catheterization with larger sized sheath is planned, determination of the precise localization of arterial puncture site is important for the prevention of iatrogenic pseudoaneurysm development. Arterial puncture guided with Doppler US might reduce complications. When suspected, MDCTA is useful in the diagnosis and demonstration of iatrogenic pseudoaneurysms. Treatment of US-guided compression should be the first choice for iatrogenic pseudoaneurysms. Interventional radiologists and cardiologists should have enough experience about the catheterization complications and their treatment in order to decrease the morbidity and mortality related to the intervention.
假性动脉瘤很少作为动脉穿刺部位止血不完全后的严重并发症出现。由于诊断性和治疗性血管造影术的增加，医源性假性动脉瘤的发生率也有所上升。与血管造影导管插入术相关的医源性假性动脉瘤最常发生在股总动脉。在此，我们报告一例心脏导管插入术后医源性浅表阴部外动脉（SEPA）假性动脉瘤病例，在多普勒超声（US）引导下压迫治疗前，通过多普勒超声和多排螺旋计算机断层血管造影（MDCTA）进行了诊断。据我们所知，医源性SEPA假性动脉瘤是假性动脉瘤发生的不寻常血管位置，文献中尚未有报道。对于计划进行抗凝溶栓治疗或使用较大尺寸鞘管进行治疗性导管插入术的患者，确定动脉穿刺部位的精确位置对于预防医源性假性动脉瘤的发生很重要。在多普勒超声引导下进行动脉穿刺可能会减少并发症。当怀疑有医源性假性动脉瘤时，MDCTA有助于其诊断和显示。超声引导下压迫治疗应作为医源性假性动脉瘤的首选治疗方法。介入放射科医生和心脏病专家应具备足够的导管插入术并发症及其治疗经验，以降低与干预相关的发病率和死亡率。
