Duplex scanning–guided thrombin injection for the treatment of iatrogenic pseudoaneurysms (original) (raw)
Related papers
2014
The aim of this study was to assess the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of postcatheterization arterial pseudoaneurysms. We evaluated retrospectively 82 consecutive subjects treated with percutaneous ultrasound-guided thrombin injection of postcatheterization femoral (n 5 79), brachial (n 5 2), and radial (n 5 1) pseudoaneurysms from January 2006 to April 2012. Pseudoaneurysm size, thrombin dose, and therapy outcome were documented. All pseudoaneurysm sacs were thrombosed with a single injection. The overall primary success rate (complete sac thrombosis) was 92.7%. A 30-day Doppler ultrasound follow-up showed a 100% procedural success. There were no complications.
Ultrasound-Guided Thrombin Injection for the Treatment of Iatrogenic Femoral Artery Pseudoaneurysms
Turkiye Klinikleri Cardiovascular Sciences, 2014
Background-This prospective study was designed to assess the safety and efficacy of using bovine thrombin injection to treat pseudoaneurysms. Methods and Results-From April 1998 through December 1999, 70 pseudoaneurysm were injected with bovine thrombin under the guidance of color duplex ultrasound. The most superficial pseudoaneurysm chamber was entered with a 1.5-inch, 19-to 22-gauge or spinal needle. Bovine thrombin, in a 1000 U/cc solution, was injected into the chamber. A total of 36 women and 34 men underwent ultrasound-guided thrombin injection (UGTI). Their mean age was 69.5 years. Most pseudoaneurysms were associated with diagnostic cardiac catheterization or percutaneous coronary intervention (80%). Two pseudoaneurysms arose from the brachial artery; the remainder were in the groin. Twenty-one patients were being treated with either heparin or warfarin, and the majority of the others were on antiplatelet therapy with aspirin or clopidogrel. UGTI was successful in 66 of the 70 patients (94%). The first patient in the series had 2 attempts at thrombin injection and refused further attempts. Two patients had undergone stent graft placement and had short, wide tracts. Both of these patients required surgical repair of their pseudoaneurysms. The fourth patient had a nearly complete pseudoaneurysm thrombosis and was lost to follow-up on discharge. No arterial thrombotic events occurred. One patient had a soleal vein thrombosis in the ipsilateral leg. Conclusions-UGTI was safe and effective in 94% of patients with postcatheterization pseudoaneurysms. Anticoagulant use did not hinder successful thrombosis. UGTI should be the initial treatment of choice for patients with postcatheterization pseudoaneurysms.
Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms
Journal of Vascular Surgery, 2000
Nonanastomotic pseudoaneurysms most commonly occur after iatrogenic trauma. Most of these aneurysms are located in the femoral arteries after catheterization. The standard mode of treatment for these aneurysms had been immediate surgical repair. Since its initial description by Fellmeth el al 1 in 1991, ultrasound-guided compression repair (UGCR) has allowed nonoperative treatment for most patients. In this procedure, pressure is applied with the ultrasound transducer over the center of the neck of the pseudoaneurysm until the flow through the neck is arrested. Pressure is maintained for 10 to 20 minutes and then slowly released. If flow is still present, compression is immediately resumed. This cycle is repeated until the flow in the pseudoaneurysm is eliminated. Dozens of reports have been published that verify the efficacy and overall safety of this procedure. The typical success rate is between 60% and 90%. 2-7 UGCR is a good alternative to surgical repair and has become the primary method of treatment in many institutions. However, the procedure is time-consuming and painful, has poor results with patients who are undergoing anticoagulation therapy, and cannot treat noncompressible pseudoaneurysms. Maywood, Ill Purpose: We previously reported preliminary data on a new procedure that we developed for the treatment of femoral pseudoaneurysms after catheterization. This study presents our current results of percutaneous ultrasound-guided thrombin injection for treating pseudoaneurysms that arise from various locations and causes. Methods: Between February 1996 and May 1999, we performed thrombin injection of 83 pseudoaneurysms in 82 patients. There were 74 femoral pseudoaneurysms: 60 from cardiac catheterization (36 interventional), seven from peripheral arteriography (four interventional), five from intra-aortic balloon pumps, and two from dialysis catheters. There were nine other pseudoaneurysms: five brachial (two cardiac catheterization, two gunshot wounds, one after removal of an infected arteriovenous graft), one subclavian (central venous catheter insertion), one radial (arterial line), and one distal superficial femoral and one posterior tibial (both after blunt trauma). Twenty-nine pseudoaneurysms were injected while on therapeutic anticoagulation. Patients underwent repeat ultrasound examination within 5 days and after 4 weeks. Results: Eighty-two of 83 pseudoaneurysms had initial successful treatment by this technique, including 28 of 29 in patients who were undergoing anticoagulation therapy. The only complication was thrombosis of a distal brachial artery, which resolved spontaneously. There were early recurrences in seven patients: four patients underwent successful reinjection; reinjection failed in two patients, who underwent surgical repair; and one patient had spontaneous thrombosis on follow-up. After 4 weeks, ultrasound examinations were completely normal or showed some residual hematoma, and there were no recurrent pseudoaneurysms. Conclusion: Ultrasound-guided thrombin injection of pseudoaneurysms has excellent results, which support its widespread use as the primary treatment for this common problem. (J Vasc Surg 2000;31:289-98.)
Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms
Diagnostic and Interventional Radiology, 2011
F emoral 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).
Journal for Vascular Ultrasound, 2017
Introduction.-Emergency department point-of-care ultrasound (POCUS) can identify lower extremity venous thrombosis (LEVT) with a published accuracy is 85-90%. The aim of this study was to compare the patterns of LEVT with protocol results and determine the clinical impact of the study results. Methods.-Patterns of superfi cial venous thrombosis(SVT) and deep venous thrombosis (DVT) were collated from positive venous duplex ultrasound (VDU) studies. Each pattern was mapped to the potential fi ndings by the described POCUS protocols. Analysis of the literature was used to identify the potential clinical impact of the fi ndings and the functional effi cacy of each strategy and a numerical result was developed. Results.-One hundred six studies were positive for DVT (42), SVT (44), or both (20) on VDU. Patterns for DVT (single or multiple levels and unilateral or bilateral) and SVT (great saphenous vein above and/or below knee or small saphenous vein in single, multiple or bilateral and juxtajunctional) were noted. The patterns covered by the "two-area" protocol showed DVT = 80% and SVT = 38%, and by "three-point compression" DVT = 74% and SVT = 0%. Particular areas not covered included proximal disease (iliac and vena cava) and calf DVT and SVT in all areas except juxta-junctional. The potential impact for DVT is high, whereas for SVT it is moderate to low. The functional effi cacy of the "two-area" protocol (5.9) exceeds the "three-point compression" strategy (3.7) but falls short of the "gold standard" VDU (10). Conclusion.-Pattern analysis of venous thrombosis identifi es weakness in POCUS strategies; the clinical implications allow for an assignment of the functional effi cacy of each study. Knowledge of these fi ndings should inform emergency room POCUS strategies.
Journal of Ultrasonography, 2018
The purpose of this paper was to evaluate the efficacy of ultrasound-guided percutaneous thrombin injection as a treatment method for arterial access site pseudoaneurysm. Materials and methods: A total of 148 patients with iatrogenic arterial access site pseudoaneurysms were treated in the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin. Of those, 142 pseudoaneurysms were located in the common femoral artery, 3 in the brachial artery and the remaining 3 in the radial artery. The study included 77 woman and 71 men (mean age 64.5 ± 14 years). Patients were qualified for percutaneous thrombin injection after Doppler examination during which pseudoaneurysm size and morphology were assessed as well as the presence of arteriovenous fistula was excluded. Results: In the reported study, 94.8% (128/135) of patients were successfully treated during the initial thrombin injection. Additional 400 IU dose of thrombin after 24 hours was effective in 5 out of 7 patients with recanalization during the follow-up. A total of 98.5% (133/135) of patients were successfully treated with a percutaneous ultrasound-guided thrombin injection. Conclusions: The 10-year experience presented in this study as well as literature reports prove that percutaneous ultrasound-guided thrombin injection is an effective and safe treatment method for iatrogenic arterial access site pseudoaneurysm.
British Journal of Surgery, 2000
Background: The aim was to evaluate the ef®cacy and safety of percutaneous thrombin injection as an alternative non-operative method for treating postcatheterization femoral artery pseudoaneurysm in both anticoagulated and non-anticoagulated patients. Methods: Thirty consecutive patients with a femoral artery pseudoaneurysm secondary to radiological catheterization con®rmed by duplex imaging were included. Thrombin 200±2000 units (1000 units/ml) in a titrating dose was injected into the centre of the cavity under duplex ultrasonographic guidance. Thrombosis was assessed in real time using B mode and colour¯ow. No sedation or anaesthesia was required during the procedure. The distal pulses and ankle pressures were evaluated before and immediately after the injection, to exclude propagation of thrombus into the femoral artery. Results: Successful rapid thrombosis of the false cavity was induced in all 30 patients. There were no immediate or mid-term procedure-related complications, or recurrences at 6 weeks. Eighteen patients were anticoagulated therapeutically at the time and following the procedure with either heparin or warfarin. Conclusion: Percutaneous thrombin injection is a simple, quick, painless, safe and effective technique, particularly in patients taking anticoagulants.
Journal of Ultrasound in Medicine
Objectives-Ultrasound-guided thrombin injection has become standard treatment for extremity pseudoaneurysms. Our specific aims were to determine the procedural success rate, the procedural complication rate, and the factors associated with pseudoaneurysm recurrence. Methods-A total of 262 consecutive cases of ultrasound-guided thrombin repair of pseudoaneurysms were identified between January 1, 2006, and March 20, 2016. The procedural and follow-up ultrasound studies were reviewed. Outcomes of interest included procedural success (defined as complete thrombosis at the time of injection and on a follow-up examination), incomplete pseudoaneurysm thrombosis, and postprocedural recurrence. Postprocedural pseudoaneurysm recurrences were compared to procedural successes with regard to patient demographics, pseudoaneurysm characteristics, amount of thrombin injected, and periprocedural laboratory values. Results-Procedural success occurred in 85.7% of cases. Complications occurred in 3.0% of cases. The mean patient age 6 SD was 72.3 6 11.3 years. The median amount of thrombin injected was 500 U (interquartile range, 400 U). The median follow-up time was 1 day (interquartile range, 0 days). A pseudoaneurysm size of 2 cm or larger and thrombocytopenia were significant independent predictors of pseudoaneurysm recurrence (P 5 .003 and .03, respectively). The odds ratios for pseudoaneurysm recurrence were 2.29 for pseudoaneurysm size of 2 cm or larger (P 5 .03) and 1.04 for thrombocytopenia (P 5 .04). Conclusions-Thrombin injection of pseudoaneurysms is an off-label procedure with few complications and a high success rate. Follow-up imaging is recommended in all pseudoaneurysms that are 2 cm or larger and in patients with thrombocytopenia.
Treatment of femoral artery pseudoaneurysms using ultrasound-guided thrombin injection
Techniques in Vascular and Interventional Radiology, 2003
Femoral artery pseudoaneurysms, a complication of femoral arterial puncture, is increasing in frequency with the proliferation of endovacular interventions. Pseudoaneurysms have historically been treated by open surgical repair, and more recently by ultrasound-guided compression. Ultrasound-guided compression is painful, and has a relatively low success rate of 51% to 73%. Since 1991, ultrasound-guided thrombin injection has become a treatment option. During injection of thrombin into a pseudoaneurysm, immediate thrombosis can be demonstrated within seconds. The entire procedure can be accomplished within 5 minutes, is simple to learn, and can be performed safely on an outpatient basis.