Endoscopic ultrasound-guided thrombin injection for management of visceral artery pseudoaneurysm: A novel approach

Jhajharia, Ashok; Wanjari, Shashank; Ashdhir, Prachis; Sharma, Deepak; Pokharna, Rupesh; Nijhawan, Sandeep

doi:10.1007/s12664-018-0865-6

Cited by 12 publications

(11 citation statements)

References 10 publications

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“…A case series on three patients with visceral artery pseudoaneurysms due to pancreatitis revealed complete thrombosis of the pseudoaneurysm and on short follow-up of 1 month, none of the patients had recurrence of symptoms [3]. Another small case series with short follow-up showed similar results [6]. EUS-guided thrombin injection has also been used successfully along with coil in a bleeding gastroduodenal artery pseudoaneurysm [13].…”

Section: Outcomementioning

confidence: 85%

“…A few initial case reports showed the successful use of EUS-guided thrombin injection in the management of visceral artery pseudoaneurysms [7][8][9][10][11][12]. Another small case series described the successful use of EUS-guided human thrombin with no recurrence on short follow-up [6].…”

Section: Discussionmentioning

confidence: 99%

“…After puncture, the reconstituted thrombin was injected in aliquots of 1 mL until the pseudoaneurysm became echogenic. Further details of the procedure are given later in Materials and methods [3,6].…”

Section: Methodsmentioning

confidence: 99%

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Endoscopic ultrasound-guided thrombin injection, a management approach for visceral artery pseudoaneurysms

Maharshi

Sharma

et al. 2020

Endosc Int Open

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Background and study aims Pseudoaneurysms are usually associated with high rates of morbidity and mortality. There are limited data in the literature on endoscopic ultrasound (EUS)-guided thrombin injection for pseudoaneurysms. The aim of this study is to assess the efficacy and safety of EUS-guided thrombin injection for pseudoaneurysms. Patients and methods This prospective study was conducted in our department between January and December 2018. All patients with symptomatic visceral artery pseudoaneurysms, who were unable to undergo angioembolization, were enrolled consecutively. Data related to demography, laboratory parameters, radiological imaging, pseudoaneurysms, and endotherapy were analyzed. Results Eight patients with median age 34 years (27–58 years), all men, were studied. The vessel involved was the splenic artery in 5 patients (62.5 %), the left hepatic artery in 2 (25 %), and the gastroduodenal artery in 1 patient (12.5%). The median size of the pseudoaneurysms was 2.9 cm × 2.6 cm (range, 1.8 × 1.9–4 × 5 cm). The median thrombin requirement was 400 IU (range, 200–500 IU) for loss of Doppler flow signals. EUS after 3 months showed obliterated pseudoaneurysms in 7 patients (87.5 %), while recurrence was observed in 1 patient (12.5 %) after 6 weeks. Conclusions EUS-guided thrombin injection may be a new option for the management of pseudoaneurysms.

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Section: Outcomementioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasound-guided thrombin injection, a management approach for visceral artery pseudoaneurysms

Maharshi

Sharma

et al. 2020

Endosc Int Open

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“…Since 1997, there have been many case reports regarding LTP-mediated embolization for the treatment of false aneurysms through local injection by ultrasound guidance, 11–14 which turned out to be effective. However, there are no reports related to LTP treatment against hemostasis during embolization of a cerebral aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

Jiang

Wang

et al. 2019

Interv Neuroradiol

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Background Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient’s condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply. If the conditions are permissible, a balloon guiding catheter may even be used to restrict the proximal blood flow. At times, due to limitations of these methods, neurosurgeons are requested to perform craniotomy to treat the hemostasis. However, the delayed transition often leads to rapid deterioration of the patient’s condition and even death due to cerebral hernia. Case description We herein presented two cases of ruptured cerebral aneurysms to provide an alternative method for hemostasis and to save the lives of patients as much as possible. In an extremely urgent situation (conventional treatment is ineffective), we successfully saved the patient’s life by injecting lyophilizing thrombin powder (LTP) solution into the aneurysmal sac and the parent artery through a microcatheter. Conclusions To our knowledge, this is the first report of successful hemostasis during coil embolization of ruptured cerebral aneurysm with LTP. Further prospective studies are needed to confirm the safety and efficacy of LTP in cerebrovascular interventional therapy.

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“…As another method, direct thrombin injection into the pseudoaneurysm by entering from the femoral artery reaches a success rate of 97%. There are few case reports or series where EUS-guided glue injection and coil embolization were applied alone or in combination in the treatment of CP-associated pseudoaneurysm bleeding (176, [449][450][451]. Although data are limited, it is a promising technique.…”

Section: Question F9-c: When Is the Patient Directed To Surgery In The Treatment Of Biliary Stenosis?mentioning

confidence: 99%

Turkish Gastroenterology Association, Pancreas Study Group, Chronic Pancreatitis Committee Consensus Report

Soytürk

Bengi

Oğuz

et al. 2020

Turk J Gastroenterol

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Endoscopic ultrasound-guided thrombin injection for management of visceral artery pseudoaneurysm: A novel approach

Cited by 12 publications

References 10 publications

Endoscopic ultrasound-guided thrombin injection, a management approach for visceral artery pseudoaneurysms

Endoscopic ultrasound-guided thrombin injection, a management approach for visceral artery pseudoaneurysms

Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

Turkish Gastroenterology Association, Pancreas Study Group, Chronic Pancreatitis Committee Consensus Report

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