Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin

Insights into Imaging, Apr 2018

Massimo Tonolini, Anna Maria Ierardi, Gianpaolo Carrafiello, Domenico Laganà

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Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin

Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin Massimo Tonolini 0 1 2 Anna Maria Ierardi 0 1 2 Gianpaolo Carrafiello 0 1 2 Domenico Laganà 0 1 2 0 Department of Radiology, BMagna Grecia 1 Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo , Via A di Rudinì 8, 20142 Milan , Italy 2 Department of Radiology, BLuigi Sacco 3 University , Viale Europa, 88100 Catanzaro , Italy The number and complexity of endovascular procedures performed via either arterial or venous access are steadily increasing. Albeit associated with higher morbidity compared to the radial approach, the traditional common femoral artery remains the preferred access site in a variety of cardiac, aortic, oncologic and peripheral vascular procedures. Both transarterial and venous cannulation (for electrophysiology, intravenous laser ablation and central catheterisation) at the groin may result in potentially severe vascular access site complications (VASC). Furthermore, vascular and soft-tissue groin infections may develop after untreated VASC or secondarily to non-sterile injections for recreational drug use. VASC and groin infections require rapid diagnosis and appropriate treatment to avoid further, potentially devastating harm. Whereas in the past colour Doppler ultrasound was generally used, in recent years cardiologists, vascular surgeons and interventional radiologists increasingly rely on pelvic and femoral CT angiography. Despite drawbacks of ionising radiation and the need for intravenous contrast, multidetector CT rapidly and consistently provides a panoramic, comprehensive visualisation, which is crucial for correct choice between conservative, endovascular and surgical management. This paper aims to provide radiologists with an increased familiarity with iatrogenic and self-inflicted VASC and infections at the groin by presenting examples of haematomas, active bleeding, pseudoaneurysms, arterial occlusion, arterio-venous fistula, endovenous heat-induced thrombosis, septic thrombophlebitis, soft-tissue infections at the groin, and late sequelae of venous injuries. Teaching Points Complications may develop after femoral arterial or venous access for interventional procedures. Arterial injuries include bleeding, pseudoaneurysm, occlusion, arteriovenous fistula, dissection. Endovenous heat-induced thrombosis is a specific form of iatrogenic venous complication. Iatrogenic infections include groin cellulitis, abscesses and septic thrombophlebitis. CT angiography reliably triages vascular access site complications and groin infections. Vascular access; Femoral artery; Complications; Pseudoaneurysm; Computed Tomography (CT) Introduction The number of endovascular procedures performed via either arterial or venous access by cardiologists, vascular surgeons and interventional radiologists has been steadily increasing over the past decades. Percutaneous transarterial access represents the initial step in a variety of cardiac, peripheral vascular, aortic and oncologic procedures. The radial approach is associated with lower morbidity and is therefore recommended by the European Society of Cardiology [ 1 ]. However, the traditional common femoral artery (CFA) access remains the preferred technique by many operators due to its easiness and familiarity, particularly when the radial access is unfeasible or large-bore access is needed. Unfortunately, piercing into the arterial system carries the potential risk of vascular access site complications (VASC) that result in prolonged hospitalisation, higher costs, increased morbidity and, occasionally, mortality [ 2–6 ]. Alternatively, VASC at the groin may occur following endovascular procedures performed via venous access such as electrophysiology, intravenous laser ablation, or short- or midterm central venous catheter (CVC) placement. Unfortunately, compared to subclavian veins the femoral venous access suffers from a higher rate of thrombosis and bacterial colonisation [ 7–10 ]. Furthermore, vascular and soft-tissue inguinal infections may develop following unrecognised VASC, particularly with use of vascular closure devices (VCD) [ 11–13 ] and secondarily to non-sterile injections performed for recreational drug use [ 14, 15 ]. Potentially severe vascular and soft-tissue injuries require rapid diagnosis and proper treatment to limit the associated morbidity and avoid further complications. Traditionally, colour Doppler ultrasound (CDUS) was used to investigate suspected VASC, and CT was reserved for those patients with inconclusive sonographic findings. However, in our experience cardiologists and interventional radiologists increasingly rely on pelvic and femoral CT angiography to rapidly and consistently provide a panoramic, comprehensive visualisation of both vascular and infectious complications, which proves crucial for a correct choice between conservative, endovascular and surgical management. This (...truncated)


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Massimo Tonolini, Anna Maria Ierardi, Gianpaolo Carrafiello, Domenico Laganà. Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin, Insights into Imaging, 2018, pp. 1-12, DOI: 10.1007/s13244-018-0613-6