Percutaneous Duplex-guided Thrombin Injection for Treatment of Iatrogenic Femoral Artery Pseudoaneurysms

Abstract

this initial experience suggests that duplex-guided thrombin injection in the treatment of post-catheterisation pseudo-aneurysms is feasible and safe.

Thrombin injection for repair of pseudoaneurysms: A case for caution

“…The amount injected in the earlier studies for iatrogenic femoral artery pseudoaneurysms ranged from 250 to 2500 units, and no systemic complications were observed 1,2 . More recent reports have shown similar efficacy using smaller dosages ranging from 100 to 600 units 6,17 …”

“…The presence of an arteriovenous fistula might also increase the risk of systemic complications 16 . To minimize this risk, most authors recommend treating only pseudoaneurysms of larger sized vessels and using a small volume of concentrated thrombin injected as far away from the aneurysm neck as possible under continuous ultrasound guidance 15,17 …”

“…16 To minimize this risk, most authors recommend treating only pseudoaneurysms of larger sized vessels and using a small volume of concentrated thrombin injected as far away from the aneurysm neck as possible under continuous ultrasound guidance. 15,17 There has been one previous report of a successful repair of a superficial temporal artery pseudoaneurysm by thrombin injection where 1000 units of thrombin was injected into a 3-cm pseudoaneurysm. In our case, a similar amount of thrombin was injected into a pseudoaneurysm measuring less than 1 cm in its greatest diameter.…”

“…We believe that the complications that followed were related to thromboembo- reports have shown similar efficacy using smaller dosages ranging from 100 to 600 units. 6,17 Pseudoaneurysms of small calibre arteries that have been successfully treated include distal brachial, distal radial and mid-posterior tibial arteries. 7 However, there have been at least two cases of native vessel thrombosis following thrombin injection in the literature, both involving brachial artery pseudoaneurysms.…”

Compression assisted by removable coils as a new treatment for iatrogenic femoral pseudoaneurysms

“…4 The overall complication rate of the compression is of 3.6% with possibility of rupture, skin necrosis, distal embolization, or venous thrombosis. 1,4,5 The overall thrombosis rate of thrombin infusion is 95% to 98%, 6,7 with a recurrence rate of 6%. 3 The complication rate of thrombin is 0% to 4% in the largest series, with possibility of arterial or venous thrombosis.…”