Percutaneous ultrasound guided thrombin injection: A new method for treating postcatheterization femoral pseudoaneurysms

Kang, Seung-Min; Labropoulos, Nicos; Mansour, M. Ashraf; Baker, William H.

doi:10.1016/s0741-5214(98)70006-0

Cited by 269 publications

(193 citation statements)

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“…No significant differences in success were observed with respect to pseudoaneurysm size (P = 0.30) and lobe number (P = 0.17). These results are parallel to the results of Kang et al (7). However, higher failure rates with complex multicompartmental pseudoaneurysms have been reported (9).…”

Section: Discussionsupporting

confidence: 87%

“…The addition of sufficient amounts of thrombin to anticoagulated blood will reliably induce thrombosis because the final pathway of blood coagulation is the generation of thrombin (7). Unlike compression repair, anticoagulation does not affect the success of thrombin injection (2,8).…”

Section: Discussionmentioning

confidence: 99%

“…This hole is rarely more than a few millimeters wide, which is likely too small for the passage of a large clot. If the thrombin itself leaked into the artery, it could be effectively neutralized by dilution and anticoagulant factors on the endothelium and in the circulating blood, such as thrombomodulin and antithrombin III (2,4,7). Thromboembolic complication occurs when an inadvertent injection of thrombin into the artery or injection is performed too close to the pseudoaneurysm neck.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Gürel¹,

Gür²,

Özkan³

et al. 2011

Diagn Interv Radiol

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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,...

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Gürel¹,

Gür²,

Özkan³

et al. 2011

Diagn Interv Radiol

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“…Previous investigators demonstrated the efficacy and safety of an alternative approach to the repair of postcatheterization pseudoaneurysms using US guided thrombin injection [11][12][13]. Naidu et al [14] reported a case of percutaneous embolization of a lumbar pseudoaneurysm in a patient with type IV Ehlers-Danlos syndrome using nbutyl cyanoacrylate and coils via a US guided lumbar approach.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided trans-hepatic embolization of a renal artery pseudoaneurysm in a patient with acquired solitary kidney and with chronic renal failure secondary to phenacetin abuse

et al. 2014

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A patient with a pseudoaneurysm of the right renal artery underwent treatment with percutaneous approach. No complications were observed. Based on the experience described in this report, a percutaneous ultrasound guided approach can be proposed in selected patients. Renal insufficiency and allergic reactions are potential contraindications to angiography with conventional ionic iodinated contrast dye in patients who need endovascular stent-graft placement. Real-time contrastenhanced ultrasound (CEUS) guided endovascular procedures may provide an alternative to overcome these limitations. We report an endovascular renal artery repair in a solitary kidney patient with an asymptomatic infrarenal aortic aneurysm and renal insufficiency due to phenacetin abuse. The precise placement of the stent-graft was performed with CEUS and intraprocedural angiographic fluoroscopy without the use of any nephrotoxic contrast dye. During follow-up, CEUS was used to exclude endoleaks, stent-graft failure or malposition.Keywords Renal artery pseudoaneurysm Á Chronic renal failure Á Ultrasound Á Coil embolization Á Phenacetine Riassunto Presentiamo il caso di una paziente portatrice di uno pseudoaneurisma dell'arteria renale destra trattato con un approccio percutaneo senza alcuna complicanza. Sulla base dell'esperienza descritta nel presente caso clinico l'approccio percutaneo eco guidato potrebbe essere indicato in pazienti selezionati. La presenza di insufficienza renale e la diatesi allergica rappresentano controindicazioni alla convenzionale manovra angiografica con mezzo di contrasto iodato nei pazienti candidati a manovre di posizionamento endovascolari. Le procedure endovascolari sotto guida ecografica con mezzo di contrasto (CEUS) possono rappresentare una valida alternativa in presenza dei suddetti limiti. Riportiamo il caso di un trattamento endovascolare di uno pseudoaneurisma dell'arteria renale in una paziente con rene unico acquisito destro, affetta inoltre da insufficienza renale cronica da abuso di fenacetina. La manovra di embolizzazione dello pseudoaneurisma, mediante il posizionamento di spirali, è stata eseguita mediante CEUS e angiografia intraprocedurale senza mezzo di contrasto nefrotossico. Durante il follow-up è stata utilizzata la CEUS per escludere endoleaks o malposizionamento delle spirali.Electronic supplementary material The online version of this article

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“…Since it was described by Kang et al 13 , countless subsequent publications have shown that treatment with thrombin is effective, rapid and comfortable for the patient and has an efficacy rate of 96% to 100% 14,15 . Small pseudoaneurysms, especially those with diameters smaller than 2.0 cm, can be treated conservatively and spontaneous thrombosis can be expected 16,17 .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of femoral pseudoaneurysms: comparison of fibrin sealant against thrombin

Pinto

Bastianetto

2013

J. vasc. bras.

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Introduction: Femoral pseudoaneurysms are a complication that occurs in connection with up to 8% of percutaneous procedures. Of the available treatments, ultrasound guided thrombin injection has a high success rate and is welltolerated by patients. The combination of thrombin and fibrinogen known as fibrin sealant forms a stable clot and can be used to treat pseudoaneurysms, particularly those with complex anatomy and larger size. Objective: To compare the results of treating femoral pseudoaneurysm in two ways: Group T was treated with thrombin alone and Group T+F was treated with fibrin sealant (thrombin+fibrinogen). Methods: A retrospective analysis was conducted of femoral pseudoaneurysm cases treated between January 2005 and December 2012. Results: Twenty-eight patients were treated, 21 with thrombin alone and seven with fibrin sealant. All patients in group T were treated successfully, but only four patients in group T+F were treated successfully (57.1% success rate in Group T+F, p<0.01). The three cases of failure in group T+F needed surgery and in one of these cases the complication was embolization to the femoral bifurcation. The pseudoaneurysms that were treated with fibrin sealant were larger (25 cm 3 in Group T and 57.7 cm 3 in Group T+F, p=0.02) and required larger volumes of thrombin (0.5 mL in Group T and 1.0 mL in Group T+F, p<0.01). There was one complication in Group T and two complications in Group T+F (p<0.01). Conclusions: Irrespective of the small number of cases reviewed, treatment with thrombin alone was superior to treating with fibrin sealant, since it caused few complications and was more effective at correcting pseudoaneurysms.

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Percutaneous ultrasound guided thrombin injection: A new method for treating postcatheterization femoral pseudoaneurysms

Abstract: Percutaneous ultrasound guided thrombin injection appears to be a safe and expeditious method for treating postcatheterization femoral pseudoaneurysms. It has significant advantages with respect to ultrasound guided compression repair or surgical repair.

Cited by 269 publications

References 21 publications

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Ultrasound-guided trans-hepatic embolization of a renal artery pseudoaneurysm in a patient with acquired solitary kidney and with chronic renal failure secondary to phenacetin abuse

Percutaneous treatment of femoral pseudoaneurysms: comparison of fibrin sealant against thrombin

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