Tratamento percutâneo de pseudoaneurismas por injeção de trombina guiada por Ultrassom

Abstract

RESUMOIntrodução: Pseudoaneurisma iatrogênico ocorre em 0,5% a 2% dos procedimentos percutâneos diagnósticos e em até 7% a 8% dos procedimentos percutâneos terapêuticos. A oclusão do pseudoaneurisma pela injeção de trombina guiada por ultrassom diretamente no interior do saco aneurismático é técnica pouco invasiva, de execução rápida e segura, e com alto índice de sucesso. A proposta deste trabalho é relatar nossa experiência no tratamento do pseudoaneurisma iatrogênico por injeção de trombina guiada por ultrassom. Método: Entre setembro de 2006 e fevereiro de 2010 realizamos 1.811 procedimentos cardíacos percutâneos com ocorrência de 15 pseudoaneurismas (0,8%), dos quais 13 foram tratados com injeção de trombina guiada por ultrassom de forma consecutiva. Características clínicas, tipo de procedimento, medicações coadjuvantes, tamanho e morfologia dos pseudoaneurismas, dose de trombina utilizada, resultado da terapia e ocorrência de complicações foram documentados e armazenados prospectivamente em banco de dados e, então, analisados retrospectivamente. Resultados: A taxa de sucesso primário foi de 100%, com apenas uma recidiva sete dias após a abordagem inicial, tratada com sucesso pela mesma técnica. Não foi observada ocorrência de complicações relacionadas à injeção de trombina guiada por ultrassom e todos os pacientes apresentavam-se assintomáticos aos 30 dias de acompanhamento. Conclusão: A injeção de trombina guiada por ultrassom realizada por profissionais com experiência em ultrassom vascular e em punções transparietais de cistos e coleções é uma opção terapêutica viável, prática e segura no tratamento do pseudoaneurisma iatrogênico. DESCRITORES:Trombina. Cateterismo cardíaco. Ultrassonografia de intervenção. ABSTRACT Percutaneous Treatment of Pseudoaneurysms by Ultrasound-guided Thrombin InjectionBackground: Iatrogenic pseudoaneurysm is observed in 0.5% to 2% of diagnostic percutaneous procedures and in up to 7% to 8% of therapeutic percutaneous procedures. Pseudoaneurysm occlusion by ultrasound-guided thrombin injection directly in the aneurysm sac is a minimally invasive, quick and safe procedure with a high success rate. The aim of our study is to report our initial experience in treatment of iatrogenic pseudoaneurysms by ultrasound-guided thrombin injection. Method: Between September 2006 and February 2010, 1,811 percutaneous coronary interventions were carried out with an occurrence of 15 pseudoaneurysms (0.8%), of which 13 were consecutively treated by ultrasound-guided thrombin injection. Clinical characteristics, type of percutaneous procedure, adjuvant therapy, size and morphology of pseudoaneurysms, thrombin dose, success and complication rate were prospectively documented and later retrospectively analyzed. Results: Primary success rate was 100% with just one recurrence seven days after the initial approach, which was successfully treated using the same technique. There were no complications related to the ultrasound-guided thrombin injection and all of the patients were asymptomatic 30 days a...

Bilateral post-arterial puncture pseudoaneurysm in a patient with amyloidosis

“…Nowadays, variants of the same technique and less-invasive alternatives are options in certain cases. 5,6 The case described here exhibited a large volume pseudoaneurysm, with onset 3 months previously, causing discomfort to the patient. The decision to conduct treatment with conventional surgery was founded on the need not only to correct the arterial injury, but also to remove the large clot.…”

“…Expectant conservative management can be considered in cases of small lesions, measuring less than 2 cm. [4][5][6] Larger injuries than this are unlikely to exhibit spontaneous closure of the puncture orifice, and so some type of intervention will be necessary. Another aspect that should be taken into account is the factor that caused the pseudoaneurysm.…”

Injeção de trombina guiada por ultrassom no tratamento de pseudoaneurisma da artéria femoral após procedimento percutâneo em pacientes com síndrome coronária aguda

“…Subsequently, several studies in the literature reported success rates between 93% and 100%. [11][12][13][14][15] When compared to ultrasound-guided compression, TI had a higher success rate (100% vs. 87%; P < 0.05) with lower hospital cost. 22 Krüger et al 11 also observed that the success rates were higher with simple pseudoaneurysms, when compared to the rates of multiloculated pseudoaneurysms (97% vs. 61%).…”

“…10 Several studies, both Brazilian and international, have shown high success rates when using thrombin for femoral artery pseudoaneurysm correction. [11][12][13][14][15] However, few data are currently available on the safety and efficacy of local thrombin use in patients with acute coronary syndrome. In this population, it is speculated that the frequent use of anticoagulants and antiplatelet agents could reduce the technique effectiveness.…”

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

“…They have an incidence of 0.05% to 2% in diagnostic procedures and 8% in therapeutic procedures [1][2][3] . The incidence of this complication is increasing because endovascular procedures are becoming more common 4 .…”