Correspondence
Indications for Duplex Sonography Should Be More Liberal
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As readers might have the impression that the described algorithm corresponds to the procedure of choice, we would like to make the following comments:
Due to the persistently frequent femoral complications following transcatheter aortic valve implantation (TAVI) (1), an indication for duplex sonography should be made liberally. In the case of a pseudoaneurysm, using manual compression should be considered as a possibility. The chances of success depend on the correct puncture site and the presence of a narrow-necked aneurysm. These are smaller in obese patients or when vascular closure devices have been used. Thrombin should then be injected percutaneously (2). If this fails, an interventional procedure can be used, whereby the common femoral artery is blocked with a balloon at the level of the aneurysm through a contralateral approach. Thrombin is then injected percutaneously. If there is another complication besides the aneurysm, such as an arteriovenous (AV) shunt, the implantation of a self-expanding stent prosthesis should be discussed (3). Surgery should be used only in the very rare case that the treatment options outlined here are unsuitable (1).
DOI: 10.3238/arztebl.m2021.0189
PD Dr. med. habil. Daniel Kretzschmar
Prof. Dr. med. Marcus Franz
PD Dr. med. Sven Möbius-Winkler
Klinik für Innere Medizin I
Kardiologie, Angiologie, Internistische Intensivmedizin
Universitätsklinikum JenaJena, Germany
daniel.kretzschmar@med.uni-jena.de
| 1. | Perrin N, Ellenberger C, Licker M, et al.: Management of vascular complications following transcatheter aortic valve implantation. Arch Cardiovasc Dis 2015; 108: 491–501 CrossRef MEDLINE |
| 2. | Ehieli WL, Bozdogan E, Janas G, et al.: Imaging-guided percutaneous thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms. Abdom Radiol (NY) 2019; 44: 1120–6 CrossRef MEDLINE |
| 3. | Sedaghat A, Hansen KL, Schahab N, et al.: Long-term follow-up after stent graft placement for access-site and access-related vascular injury during TAVI—The Bonn-Copenhagen experience. Int J Cardiol 2019; 15; 281: 42–6 CrossRef MEDLINE |
| 4. | Jud P, Eibisberger M: Pseudoaneurysm following transfemoral percutaneous aortic valve replacement. Dtsch Arztebl Int 2021; 118: 58 VOLLTEXT |
