Manual aspiration thrombectomy with adjunctive use of catheter-directed thrombolysis and stent placement is an effective endovascular treatment method with high clinical success and survival rates for phlegmasia cerulean dolens.

Ultrasound guidance improves secondary outcomes of the common femoral artery puncture when compared to palpation-guided puncture. Technical success and complication rates seem lower in the presence of ultrasound guidance but larger study populations are needed to verify the result.

ORIGINAL ARTICLE PURPOSE We aimed to investigate the coronary venous system and its variations by using dual source computed tomography (CT). MATERIALS AND METHODSRetrospective assessment was carried out on 339 patients who underwent coronary CT angiography using 128-slice dual source CT for suspected coronary artery disease. The examinations were performed according to routine imaging protocols used to evaluate coronary arteries. The coronary venous system was evaluated in each case using maximum intensity projection and volume rendering technique multiplanar reformation reconstructions. In each patient, the presence and calibration of normal anatomy, as well as the variations of the coronary sinus, middle cardiac vein, small cardiac vein, posterior cardiac vein, great cardiac vein, anterior interventricular vein, posterolateral vein, left marginal vein, and anterolateral vein were recorded. RESULTSThe coronary sinus, middle cardiac vein, great cardiac vein, and anterior interventricular vein were visualized in all of the patients. In all cases, one of the lateral or posterolateral veins of appropriate localization and diameter for cardiac resynchronization therapy was detected. The posterior cardiac vein was visualized in 87% of the cases, the left marginal vein in 87.9%, and the small cardiac vein in 20%. There was no significant difference in the diameters or visibilities of the coronary veins in terms of age. CONCLUSIONThe coronary venous system and its tributaries may be examined in detail using CT angiography examination performed according to the routine coronary CT angiography protocol used for dual source CT. Dual source CT may be a valuable tool for evaluation of the coronary veins prior to invasive procedures that are directed at the coronary venous system.

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Femoral artery pseudoaneurysms are among the most frequent complications of angiography. Factors that predispose a patient to pseudoaneurysm formation are inadequate compression, simultaneous artery and vein catheterization, hypertension, obesity, hemodialysis, heavily calcified arteries, and low femoral puncture. The risk of pseudoaneurysm formation also increases when large-bore sheaths, postprocedural anticoagulation therapy, and/or antiplatelet therapy are used as interventions (1, 2). The incidence of femoral pseudoaneurysms ranges from 0.05% to 4% (2). Color Doppler scanning reveals a prevalence of 7.7% in all postcatheterization patients regardless of symptoms, but the prevalence may increase up to 16% with more complex procedures that necessitate larger sheaths (2, 3).Open surgical repair was the gold standard for iatrogenic pseudoaneurysms till the development of percutaneous therapeutic options. One prominent disadvantage of the surgical repair of pseudoaneurysms is the remarkably high complication rate. Ultrasonography-guided (US-guided) compression repair is relatively safe and effective, but it has considerable limitations. Specifically, the duration of compression is lengthy, the procedure is painful and may require conscious sedation, and the success rate is approximately 75%. The US-guided injection of thrombin has emerged as an alternative to US-guided compression repair with success rates of 91% to 100%. The complication rate is approximately 2% (2, 4). The USguided injection of thrombin has become the first-line treatment for pseudoaneurysms, and it is increasingly popular for the treatment of iatrogenic pseudoaneurysms in many institutions. This study reports our experience with the use of US-guided percutaneous thrombin injection for the treatment of iatrogenic femoral artery and brachial artery pseudoaneurysms. Materials and methodsAll of the procedures on humans were performed in accordance with the ethical standards of the World Medical Association. Written consent was obtained from all patients following instructions on the nature and risks of the intervention. In this retrospective study, 55 consecutive patients with a mean age of 60.1±12.7 years (26 men, aged 35 to 79 years [mean, 58.2 years]; 29 women, aged 32 to 85 years [mean, 61.9 years]) who were treated from December 2006 to June 2010 and who received a diagnosis of pseudoaneurysm of the femoral or brachial artery with the guidance of color Doppler US (CDUS) were included in this analysis. Patients with any of the following criteria were excluded from this study: a rapid expansion of the pseudoaneurysm, especially in unstable patients, distal ischemia due to femoral artery compression, infection of the pseudoaneurysm, neuropathy, overlying soft tissue or skin ischemia, or impending compartment syndrome. No patients were excluded for these reasons during the study period. The morphology INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE US-guided percutaneous thrombin injection of postcatheterization pseudoaneurysmsKamil Gürel, Serkan Gür,...