Ultrasound-Guided Thrombin Injection Is the Treatment of Choice for Femoral Pseudoaneurysms

Abstract

Hypothesis: Ultrasound-guided injection of thrombin is the treatment of choice for femoral pseudoaneurysms. Design: A prospective study of patients undergoing a single form of treatment for femoral pseudoaneurysms. Setting: Patients were treated at 2 tertiary care, university-affiliated hospitals. Patients: Forty consecutive patients with femoral pseudoaneurysms resulting from diagnostic and therapeutic catheterizations for peripheral arterial, coronary arterial, and cerebrovascular diseases were evaluated. Intervention: Thrombin was injected directly into the pseudoaneurysms under ultrasonographic guidance. Main Outcome Measure: Thrombosis of the pseudoaneurysm following thrombin injection was the goal of treatment. Results: All 40 patients had initial complete thrombosis of their femoral pseudoaneurysms. In each case, except for one, the aneurysm was noted to have thrombosed on followup duplex ultrasongram. There was one complication. Conclusion: Ultrasound-guided thrombin injection is the treatment of choice for femoral pseudoaneurysms.

Contemporary Management of Postcatheterization Pseudoaneurysms

“…36,41 Although some clinicians take the patient immediately to surgery should this complication occur, other patients have been observed while anticoagulated and reported spontaneous resolution with no significant clinical sequelae. 46,53,54 Although it has been suggested that short wide tracts may increase the risk of thrombin injection, we have not altered our indications on the basis of the tract anatomy and have not experienced an increased complication rate in our large series.…”

Intra-pericardial thrombin injection for post-infarction left ventricular free wall rupture

“…[4][5][6][7] From the experience in treating femoral pseudoaneurysms by percutaneous thrombin injection, the risk of a distal embolic event to a lower limb is approximately 2%, although sometimes that condition can be severe. 15,16,19 Nevertheless, most of the thromboembolic events that actually occurred are believed to be asymptomatic, as the thrombin leaked into the systemic circulation becomes instantaneously diluted, while the formed fibrin and clots are lysed by fibrinolytic factors that are abundant in the systemic circulation. It is uncertain whether the high pressure gradient seen between the left ventricle and the pericardial space could affect the chance of thrombin leakage and embolic events.…”

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

“…In literature, there are many studies concerning percutaneous US procedures for treating pseudoaneurysms (injection of thrombin, fibrin adhesive, glue or a detachable balloon) [9,10]. To our knowledge, complications have been reported in two cases treated with thrombin injection.…”