Sonographically Guided Thrombin Injection of latrogenic Femoral Pseudoaneurysms

Paulson, Erik K.; Nelson, Rendon C.; Mayes, Charles E.; Sheafor, Douglas H.; Sketch, Michael H.; Kliewer, Mark A.

doi:10.2214/ajr.177.2.1770309

Cited by 126 publications

(108 citation statements)

References 26 publications

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“…In the current study, the thrombosis rate was 69% (38 of 55 pseudoaneurysms) following a single injection and the primary therapeutic success rate (success rate of two injections) was 89% (49 of 55 pseudoaneurysms). Although the primary success rate (89%) was lower than in previous reports (1-3), the secondary success rate (96%) was similar to previous reports (1,2,4,6). No significant differences in success were observed with respect to pseudoaneurysm size (P = 0.30) and lobe number (P = 0.17).…”

Section: Discussionsupporting

confidence: 77%

“…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: 77%

Section: Discussionmentioning

confidence: 99%

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Gürel¹,

Gür²,

Özkan³

et al. 2011

Diagn Interv Radiol

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“…It is rare that embolectomy becomes necessary, but there are descriptions of subclinical embolization with percutaneous thrombin 14 . Distal embolization requiring surgery is described in around 2% of femoral pseudoaneurysm treatments 24 . Lewandowski et al found signs of distal embolization diagnosed clinically and on the basis of abnormal pulse oximetry in 30 to 38% of a sample 7 .…”

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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“…Unresponsiveness to thrombin injection is an indication for open surgical repair. Side effects reportedly associated with thrombin injection include seizures, anaphylaxis (human thrombin may be less immunogenic than the bovine form), systemic activation of the coagulation system, risk of limb ischemia with intra-arterial injection, blue toe syndrome, groin abscess and crampy buttock pain (4).…”

Section: Discussionmentioning

confidence: 99%

Delayed pseudoaneurysm repair: A case report

Franz

Hughart

2007

Int J Angiol

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Iatrogenic pseudoaneurysms are a complication of arterial catheterization performed for both diagnosis and intervention. Their incidence is approximately 1% following diagnostic catheterizations and 3.2% after interventional procedures. The symptoms of iatrogenic pseudoaneurysm are pain and swelling. The preferred method of treatment consists of thrombin injection under ultrasound guidance, although compression can be used. Most published research describes pseudoaneurysms that occurred close to the time of catheterization; the present case report describes a patient who presented two years postcatheterization with a symptomatic pseudoaneurysm.

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Sonographically Guided Thrombin Injection of latrogenic Femoral Pseudoaneurysms

Abstract: For the treatment of iatrogenic femoral pseudoaneurysms, thrombin injection under sonographic guidance is a quick and effective method of therapy. Failures and complications are infrequent. At our institution, sonographically guided thrombin injection has replaced compression repair.

Cited by 126 publications

References 26 publications

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

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

Delayed pseudoaneurysm repair: A case report

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