Risk and prognostic factors of post-catheterization pseudoaneurysm

Kenkichi Michimoto; Shinsuke Takenaga; Yo Matsui; Keitaro Enoki; Yosuke Nozawa; Takahiro Higuchi; Hiroshi Sakamoto; Yasuto Noda; Satoru Morooka

doi:10.5114/pjr.2021.109077

Risk and prognostic factors of post-catheterization pseudoaneurysm

Pol J Radiol. 2021 Sep 2:86:e511-e517. doi: 10.5114/pjr.2021.109077. eCollection 2021.

Authors

Kenkichi Michimoto¹, Shinsuke Takenaga¹, Yo Matsui¹, Keitaro Enoki¹, Yosuke Nozawa¹, Takahiro Higuchi¹, Hiroshi Sakamoto², Yasuto Noda³, Satoru Morooka³

Affiliations

¹ Department of Radiology, Fuji City General Hospital, Japan.
² Department of Cardiology, Fuji City General Hospital, Japan.
³ Department of Neurosurgery, Fuji City General Hospital, Japan.

Abstract

Purpose: To evaluate the risk and prognostic factors of post-catheterization pseudoaneurysm (PPA).

Material and methods: To identify the risk factors for PPA occurrence, clinical findings were compared between 22 consecutive patients with radiologically confirmed PPAs (PPA group) and 300 randomly extracted patients without PPA, who underwent transarterial angiography or intervention (sample group) between 1 January 2015 and 31 March 2020. The PPA group was further divided into those treated successfully with mechanical compression (group A) and those requiring ultrasound-guided thrombin injection after compression failed (group B). Univariate and multivariate analyses were used to compare patient demographics, preoperative laboratory findings, procedure details, PPA diameter, and time interval between the procedure and compression between groups A and B to evaluate the prognostic factors of PPA.

Results: The PPA group demonstrated significantly elevated prothrombin time international normalized ratios (PT/INR) (odds ratio [OR]: 6.27, 95% confidence interval [CI]: 2.020-19.5; p = 0.00151) and more frequent popliteal access (OR: 14.2, 95% CI: 1.040-195.0; p = 0.0467) compared to the sample group, and radial access decreased the risk of PPA (OR: 0.382, 95% CI: 0.0148-0.987; p = 0.0468). One of the 22 PPAs resolved spontaneously, and 11 others (52.4%) were successfully treated by mechanical compression. An interval exceeding 24 hours between the procedure and compression was the only significant prognostic factor (p = 0.0281) between groups A and B.

Conclusions: Elevated PT/INR and popliteal access may predispose patients to PPA; close consideration of the site of access may lower the risk of refractory PPA.

Keywords: catheterization; prognostic factor; pseudoaneurysm; risk factor.