Ultrasound-Guided Thrombin Injection for the Treatment of Iatrogenic Femoral Artery Pseudoaneurysms (original) (raw)
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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).
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.
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.
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.)
Treatment of iatrogenic femoral artery pseudoaneurysm with percutaneous thrombin injection
Journal of Vascular Surgery, 1997
Purpose: Local compression has been advocated for the treatment of femoral artery pseudoaneurysms. Although it is effective and has a high success rate, this method bears some limitations; among them are prolonged procedure time, discomfort for patients, and recurrence. As a potent thrombosis-inducing agent, thrombin has been used topi-caUy, and occasionally intravascularly, for hemostasis. Pseudoaneurysms with a narrow connecting tract to the native artery may be suitable for treatment with thrombin injection to induce intracavitary coagulation.
Femoral pseudoaneurysm thrombinjection
The American Journal of Surgery, 2001
The risk of pseudoaneurysm (PSA) increases with the number of catheterizations performed for cardiovascular diagnosis and therapy. Thrombin injection, or "thrombinjection," is an alternative to ultrasound-guided compression or surgical repair. Thrombinjection is effective and economical, but the specter of systemic arterial thrombosis hinders its wide application. We report cautionary steps taken prior to injection and lessons learned during our first 20 cases. Methods and Results: Thrombinjection was performed under ultrasound (US) guidance in 12 women and 8 men with PSA after femoral catheterization. PSA varied in size from 17 to 39 mm with neck openings from 1.5 to 3.9 mm. Under local anesthesia and US longitudinal view, a 20-gauge US needle tip was placed in the PSA away from the neck. With 12 cases under 600 units, 100 to 2,300 units of thrombin (1,000 U/mL) were injected slowly. Slow injection, positioning of the ball of thrombus formed at the needle tip, probe compression, and combined or interchangeable use of US color flow and B-mode were the essential techniques utilized. All PSA thrombosed successfully on the first treatment. One patient had fever and another returned for compression treatment of a second, not recurrent, PSA. Conclusions: Successful thrombinjection was accomplished by focusing on common femoral artery PSA with small neck openings, avoiding arteriovenous fistulas, and using standard thrombin concentration, US needle, state of the art ultrasonography, slow injection, thrombus ball positioning, and adjunctive probe compression.
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.