Tse GH et al, 2011: Shockwave lithotripsy: arterial aneurysms and vascular complications
Tse GH, Qazi HA, Halsall AK, Nalagatla SR.
Department of Urology, Monklands Hospital, Airdrie, United Kingdom.
BACKGROUND AND PURPOSE: The application of shockwave lithotripsy (SWL) in patients with arterial aneurysm remains controversial, and several case reports exist in the world literature that describe both safe use and rupture. In addition, other vascular complications have been reported. The potential for hemorrhage is affected by coagulation status and antiplatelet therapy, yet little evidence exists on their interaction with SWL. We aim to review the vascular complications after SWL.
METHODS: A review of the world literature was performed in accordance with methodology that is defined by the Cochrane Collaboration. An Internet bibliographic search on MEDLINE was performed during May and June 2010, with additional hand-searching of references. The search terms lithotripsy, aneurysm, abdominal aortic aneurysm, pseudoaneurysm, hemorrhage, hematoma, coagulation, aspirin, clopidogrel, and warfarin were used.
RESULTS: In reported cases, there have been 18 patients with abdominal aortic aneurysm (AAA) who have undergone SWL. Both safe and uncomplicated treatment have been reported as well as rupture of AAA. Other vascular complications after SWL have included pseudoaneurysm, venous thrombosis, arterial stenosis, and arteriovenous fistulation. Patients with hemorrhagic risk factors can undergo SWL after correction of coagulopathy. Experimental work on animal models and human tissue has evaluated the effects of SWL on the vasculature.
CONCLUSION: There is currently no high-level evidence to suggest that SWL in the presence of arterial aneurysm is unsafe. Experimental work on ex vivo human tissue does not suggest that SWL is causative to aneurysm rupture. With the availability of CT imaging in modern clinical practice, aneurysms of the arterial tree should be identified as part of the investigation of urinary tract calculi. SWL can be safely performed in patients with AAA, but monitoring postprocedure is mandatory, along with access to emergency vascular surgery support; importantly, any onset of new pain or symptoms should be aggressively investigated by radiologic imaging in the first instance.
J Endourol. 2011 Mar;25(3):403-11. doi: 10.1089/end.2010.0355. Epub 2011 Jan 15
PMID: 21235424 [PubMed - in process]
This publication reviews the literature on vascular complications after ESWL in cases of vascular pathology, coagulation and connective tissue disorders and anticoagulant therapy. Connective tissue disorder carry an increased the risk of vascular rupture. The authors suggest that in these patients ESWL injury to any intra-abdominal organ or to the vasculature should be considered, and a period of observation in the hospital after SWL should be mandatory.