Delayed presentation of femoral pseudoaneurysm after hemodialysis catheter insertion procedure
Presentación diferida de un seudoaneurisma femoral tras cateterización venosa para hemodiálisis
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Such damage may give rise to thrombosis, bleeding, pseudoaneurysms or arteriovenous fistulas.2-4 We describe a case of delayed presentation of a right femoral arterial pseudoaneurysm following failed venous catheterization for hemodialysis. To our knowledge, only one similar case has been reported to date.2 <br></br><br></br>A 41-year-old male was admitted with advanced chronic renal failure of indeterminate origin. The personal history <br></br>included poorly controlled arterial hypertension and dyslipidemia. The start of renal replacement therapy was <br></br>required. Ultrasound was used to identify the anatomical relationship between the femoral artery and vein. In both <br></br>extremities the vein was located posterior to the artery, except over a short trajectory in the region of the inguinal <br></br>fold, where it was found to be positioned slightly medial. Arterial puncture was observed on one attempt, as a result <br></br>of which compression was applied and the left femoral vein was finally catheterized. Dialysis without anticoagulation <br></br>was started in the first two sessions. After 48 hours, and following normal inguinal exploration findings, low molecular weight heparin was resumed as antithrombotic prophylaxis, with doses adjusted to renal function. A few days later during a week-end, the patient participated in a race despite indications to avoid such activities. Twenty days after catheterization he developed sudden right inguinal pain. Inguinal exploration revealed a hard and pulsatile mass with a slight murmur and intense pain in response to palpation. The peripheral pulses were  preserved. Right femoral artery Doppler ultrasound confirmed the presence of a 17-mm right pseudoaneurysm. Initial treatment included strict bed rest with an inguinal compressive bandage. However, one week later the pseudoaneurysm was seen to have increased to 21 mm in size, with persistence of the pain. Aneurysm intracavitary thrombin injection under ultrasound guidance was thus performed (100 IU). This resulted in thrombosis of the pseudoaneurysm, without evidence of recurrences on occasion of the posterior ultrasound controls. <br></br><br></br>An arterial pseudoaneurysm is a pulsatile hematoma resulting from traumatic dissection of the arterial wall, creating <br></br>a communication between the vascular lumen and the surrounding tissue, with the extravasation of arterial blood. The use of anticoagulants, poorly controlled arterial hypertension, vasculopathy (arteriosclerotic or of an infiltrative nature), and even the technique and arterial trajectory used for puncture can give rise to such pseudoaneurysms. <br></br>5-7 The clinical suspicion is established 6-48 hours after arterial puncture, with the identification of a painful, pulsatile mass in the inguinal zone.7 In our patient, the administered low molecular weight heparin facilitated the delayed presentation of the complication, which was triggered by walking. Doppler ultrasound is the diagnostic technique of choice, and is moreover able to evaluate the evolution of the size of the lesion. Although surgical repair may prove necessary in cases where there is a risk of severe bleeding or limb ischemia, conservative <br></br>management is initially recommended. Strict bed rest, the suspension of anticoagulation, and compression applied manually in the form of an inguinal bandage or guided by ultrasound over the aneurysmal neck can resolve over 75% of all cases.5,7 The intra-aneurysmal injection of procoagulating substances such as thrombin represents a treatment option allowing immediate resolution without the need to suspend anticoagulation ¿ though it is not without side effects (generally of an anaphylactic nature).6 <br></br><br></br>It is difficult to prevent complications of this kind, considering the technique employed and the antithrombotic <br></br>indications of our patients. However, compression and prolonged repose after iatrogenic arterial puncture, and the identification and early management of the complications are critical considerations for avoiding traumatic lesions with significant clinical repercussions. " "pdfFichero" => "P-E-S-A339-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440553" "palabras" => array:1 [ 0 => "CATETERIZACIÓN PARA HEMODIÁLISIS" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440555" "palabras" => array:1 [ 0 => "SEUDOANEURISMA" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440557" "palabras" => array:1 [ 0 => "PUNCIÓN ARTERIAL" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440559" "palabras" => array:1 [ 0 => "COMPLICACIONES IATROGÉNICAS" ] ] ] "en" => array:4 [ 0 => array:3 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440554" ] 1 => array:3 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440556" ] 2 => array:3 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440558" ] 3 => array:3 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440560" ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Sr Director: Ocasionalmente, el uso de catéteres venosos centrales como acceso vascular temporal para hemodiálisis puede producir punción arterial 1. Sin embargo, la frecuencia de traumatismo arterial clínicamente significativo tras cateterización femoral para hemodiálisis es un evento raro que puede incluir trombosis, hemorragias, seudoaneurismas o fístulas arteriovenosas 2,3,4. Describimos la presentación diferida de un seudoaneurisma arterial femoral derecho tras un intento fallido de cateterización venosa para hemodiálisis. Hasta donde conocemos sólo hay un caso similar descrito 2." ] "en" => array:1 [ "resumen" => "To the editor: The use of central venous catheters for temporary vascular access in hemodialysis may occasionally result in arterial puncture.1 Nevertheless, the frequency of clinically significant arterial damage after femoral catheterization in hemodialysis is low. Such damage may give rise to thrombosis, bleeding, pseudoaneurysms or arteriovenous fistulas.2-4 We describe a case of delayed presentation of a right femoral arterial pseudoaneurysm following failed venous catheterization for hemodialysis. To our knowledge, only one similar case has been reported to date.2" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "BIBLIOGRAFÍA" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "1- McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 348 : 1123-33, 2003. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12646670" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "2- Rodríguez Jornet A y Mate G. Seudoaneurisma de arteria femoral como complicación tras el cateterismo para hemodiálisis según técnica de Shaldon. Nefrología 8: 406-407, 1988." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "3- Kuramochi G, Ohara N, Hasegawa S, Moro H. Femoral arteriovenous fistula: a complication of temporary hemodiálisis catéter placement. J Artif Organs 9: 114-7, 2006." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "4- Hsieh HS, Liao HT, Wei CJ, Tarng DC. Indwelled femoral vein non-cuffed, double-lumen hemodialysis catheter complicated by pulmonary thromboembolism. Clin Nephrol 62; 162-4, 2004." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "5- Filis K, Arthontovasilis F, Theodorou D, Albanopoulos K, Lagoudianakis E, Manouras A, Vavuranakis M, Vlachopoulos C, Toutouzas K, Tsiamis E, Androulakis A, Kallikazaros I, Giannopoulos A, Bramis I, Stefanadis C. Management of early and late detected vascular complications following femoral arterial puncture for cardiac catheterization. Hellenic J Cardiol 48: 134-142, 2007." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "6- Lenartova M, Tak T. Iatrogenic pseudoaneurysm of femoral artery: case report and literature review. Clin Med Res 1: 243-247, 2003." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "7- Gabriel M, Pawlaczyk K, Waliszewski K, Krasinski Z, Majewski W. Location of femoral artery puncture site and the risk of postcatheterization pseudoaneurysm formation. Int J Cardiol 120: 167-171, 2007." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002800000006/v0_201502091634/X2013251408004417/v0_201502091634/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002800000006/v0_201502091634/X2013251408004417/v0_201502091634/en/P-E-S-A339-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408004417?idApp=UINPBA000064" ]
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| 2016 April | 71 | 0 | 71 |
| 2016 March | 66 | 0 | 66 |
| 2016 February | 78 | 0 | 78 |
| 2016 January | 91 | 0 | 91 |
| 2015 December | 122 | 0 | 122 |
| 2015 November | 89 | 0 | 89 |
| 2015 October | 81 | 0 | 81 |
| 2015 September | 51 | 0 | 51 |
| 2015 August | 77 | 0 | 77 |
| 2015 July | 42 | 0 | 42 |
| 2015 June | 31 | 0 | 31 |
| 2015 May | 57 | 0 | 57 |
| 2015 April | 5 | 0 | 5 |
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