Treatment of Iatrogenic Pseudoaneurysms Using Ultrasound-Guided Thrombin Injection over a 5-Year Period

Abstract

In this study we demonstrate that ultrasound (US)-guided injection of thrombin is a safe and effective way to treat iatrogenic pseudoaneurysms as a new treatment modality at a 650-bed urban community hospital. We included retrospective chart review of patients who were treated for iatrogenic pseudoaneurysms from January 2004 to June 2010 at a single institution. All patients' pseudoaneurysms were treated using US-guided thrombin injection. This study demonstrated an overall success rate of 97.1% in treating iatrogenic pseudoaneurysms in 33 of 34 patients. One patient underwent open surgical repair. No mortality or complications were noted. The study was successful in demonstrating that the US-guided injection of thrombin is an efficacious way to treat iatrogenic pseudoaneurysms and can be safely implemented as a new treatment modality by appropriately trained vascular surgeons. A review of different techniques is included. An algorithm for the treatment of iatrogenic pseudoaneurysms is proposed from this study.

Recurrence of Thrombin‐Injected Pseudoaneurysms Under Ultrasound Guidance: A 10‐Year Retrospective Analysis

“…The complication rate, considered separately, was 3.0%. These results are concordant with those in prior studies, which suggest that ultrasound‐guided thrombin injection is a relatively effective and safe treatment . It is noteworthy that no immediate complications were identified in the 32 patients who were excluded from this study for loss to follow‐up.…”

“…These results are concordant with those in prior studies, which suggest that ultrasound-guided thrombin injection is a relatively effective and safe treatment. [7][8][9][10][11][12][13][14][15][16][17][18][19] It is noteworthy that no immediate complications were identified in the 32 patients who were excluded from this study for loss to follow-up. This finding suggests that the complication rate reported in this study is a conservative estimate.…”

“…Although a number of additional studies have demonstrated ultrasound-guided thrombin injection to be both safe and efficacious, [7][8][9][10][11][12][13][14][15][16][17][18][19] most have been conducted with relatively small sample sizes, and few have focused on the need for follow-up imaging or described the factors associated with pseudoaneurysm recurrence. The purpose of this study was to review cases of ultrasoundguided thrombin injection of pseudoaneurysms performed over a 10-year period to determine the procedural success rate, the procedural complication rate, the rate of pseudoaneurysm recurrence, and the factors associated with failure of complete and sustained pseudoaneurysm thrombosis to be able to recommend appropriate follow-up imaging.…”

Pseudoaneurysms of the Peripheral Arteries

“…Other sources of arterial pseudoaneurysms include complications arising as a result of percutaneous hemodialysis access, percutaneous intra-aortic balloon pump placement, traumas, intravenous drug injections, breakdown of surgical arterial anastomosis, and complications of central line placement. 3 The incidence of iatrogenic pseudoaneurysms is 0.44 to 1.8% following diagnostic arterial catheterization and from 3.2 to 7.7% after intervention. 1,2 In several studies evaluating all patients after femoral access for catheterization, the incidence ranges from 2.9 to 3.8%.…”

“…4,5 Patient factors that increase the risk of pseudoaneurysm include female sex, older age (> 75 years old) calcified arteries, increased body mass index, and thrombocytopenia. 1,3,6,7 The common femoral artery is the most common site of iatrogenic pseudoaneurysms which is due to it being the most common access site but also the thicker soft tissues allow for long, narrow necks, and provide space for the sac to develop. 4 Access of the femoral artery below the bifurcation increases the risk for pseudoaneurysms.…”