Choosing a treatment method for post-catheterization pseudoaneurysms guided by the late to early velocity index

Abstract

Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are also first reports of the use of biologically derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. Previously, we have established that a late to early velocity index (LEVI) < 0.2 could be a predictor of an increased risk of psA recurrence after standard UGTI. In this paper, we report our first experiences when the choice of the first-line treatment method was based on LEVI assessment. From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI < 0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) with biological TG and 26 had LEVI > 0.2 and they underwent UGTI. The injection set containing human thrombin and fibrinogen was used for UGTGI. Bovine thrombin was used for UGTI. The success rate was 100% and no psA recurrence was detected during a 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 14 years of experience (0% vs. 13%, p = 0.01). All complications (10% in the UGTGI group and 15% in the UGTI group) were mild and transient and included clinical symptoms of paresthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. It may increase the success rate and avoid unnecessary repetition of the procedure, without increasing complication rate while keeping costs of the procedure reasonable.

Non-Surgical treatment Versus Surgery for Iatrogenic Femoral Artery Pseudoaneurysms: Systematic Review and Meta-Analysis

“…Currently, UGTI is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms. But there are also treatments that use various glues instead of thrombin, such as N-butyl cyanoacrylate (NBCA) ( 38 ), N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) ( 39 ), fibrin glue ( 40 ), and tissue glue (TG) ( 41 ). The use of these glues has been proven to be safe and effective, and they have the potential to become an alternative to thrombin ( 14 ).…”

Thrombin and Thrombin‐Incorporated Biomaterials for Disease Treatments

“…The authors investigated 36 patients with pseudoaneurysms, among which 26 had LEVI > 0.2 and received UGTI with bovine thrombin, and another 10 had LEVI < 0.2 and received ultrasound‐guided tissue glue injection (UGTGI) with biologically derived tissue glues. [ 127 ] The success rate was 100% and in the following 2 weeks, there was no pseudoaneurysm recurrence. As a result, this study represents a promising strategy to choose the first‐line treatment for iatrogenic pseudoaneurysms according to the LEVI measurement.…”

“…Enhanced incisional wound healing, with high skin tensile strength values [106] Wound management Thrombin Fibrin biomatrices Matrices with a low concentration of thrombin bringing less wound severity and more rapid wound closure [111] Wound healing Thrombin Preconditioning regimen of MSC-derived extracellular vesicles Boosted wound healing efficacy, enhanced extracellular vesicle production [112] Pseudoaneurysm therapy Thrombin Percutaneous injection Minimal system damage risk [120] Visceral pseudoaneurysms therapy Thrombin Ultrasound-guided injection Cost-effective, painless, and radiation-free [116] Pseudoaneurysms therapy Thrombin Tissue glue Efficient when ultrasound-guided thrombin injection is unsuccessful [127] Pseudoaneurysm therapy in COVID-19 patient Thrombin Ultrasound-guided, balloon-assisted percutaneous injection…”

“…When dealing with iatrogenic post-catheterization pseudoaneurysms, ultrasound-guided thrombin injection (UGTI) is usually the first-line treatment. [127][128][129][130] Ultrasound-guided percutaneous thrombin injection is a cost-effective, painless, and radiation-free approach for treating pseudoaneurysms. [116,131,132] In addition, it has been reported that when pseudoaneurysms recur or UGTI is unsuccessful, the application of a biologically derived tissue glue (TG), a mixture of fibrinogen and human thrombin, is quite efficient.…”

“…[116,131,132] In addition, it has been reported that when pseudoaneurysms recur or UGTI is unsuccessful, the application of a biologically derived tissue glue (TG), a mixture of fibrinogen and human thrombin, is quite efficient. [127] Then how do we decide between UGTI and tissue glue? Recently, Kurzawski et al developed an approach to choose treatment strategy for post-catheterization pseudoaneurysms.…”