Effective treatment of iatrogenic femoral pseudoaneurysms by combined endovascular balloon inflation and percutaneous thrombin injection

Hayakawa, Naoki; Kodera, Satoshi; Miyauchi, Ayako; Hirano, Seishiro; Sahashi, Shuichi; Ishibashi, Noriyuki; Kasai, Yuhei; Arakawa, Masataka; Shakya, Sandeep; Kanda, Junji

doi:10.1007/s12928-021-00764-9

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…Because the EVT method occludes blood flow into the aneurysm using a balloon until hemostasis is achieved, thrombosis is unlikely to occur, and treatment can be performed regardless of the morphology of the neck and aneurysm 14. Our study demonstrated the feasibility of EVT for treating FPAs through our high procedural success rate, lack of complications, and short hospital stays.…”

mentioning

confidence: 68%

Incidence, clinical course, and risk factors in the development of femoral pseudoaneurysm after atrial fibrillation ablation

Koyama,

Tobita,

Kawaguchi

et al. 2023

Journal of Arrhythmia

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BackgroundPrevious studies have revealed the risk factors for femoral pseudoaneurysms (FPA). Most data on FPA are based on coronary and peripheral interventions, with limited studies focusing on atrial fibrillation (AF) ablation. However, patient backgrounds, anticoagulation regimens, and vascular access methods differ. In addition, a standard for managing FPA after AF ablation remains elusive due to the difficult nature of achieving thrombosis in pseudoaneurysms.MethodsThis single‐center, retrospective, observational study included 2805 consecutive patients who underwent AF ablation between January 2016 and December 2021. All patients underwent femoral artery and vein punctures. Puncture sites were checked 1 day post‐procedure.ResultsA total of 23 FPA patients were identified during the study period. Multivariate logistic regression analysis showed that hypertension (odds ratio 4.66, 95% confidence interval: 1.38–15.71; p = .0032) and warfarin use (odds ratio 3.83, 95% confidence interval: 1.40–10.45; p = .021) were significantly associated with the occurrence of FPA. The compression success rate was low (22%). There were nine and six patients in the endovascular treatment (EVT) and ultrasound‐guided thrombin injection (UGTI) groups, respectively. The success rates were 100% and 84% in the EVT and UGTI groups, respectively. The length of hospital stay after FPA treatment was 2.1 days in the EVT group and 1.3 days in the thrombin group.ConclusionWe must be careful about post‐procedural FPA, especially for hypertension and warfarin‐using patients. Treatment of pseudoaneurysms with anticoagulants is unlikely to achieve hemostasis, and an early switch to invasive treatments, such as EVT, should be considered.

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mentioning

confidence: 68%

Incidence, clinical course, and risk factors in the development of femoral pseudoaneurysm after atrial fibrillation ablation

Koyama,

Tobita,

Kawaguchi

et al. 2023

Journal of Arrhythmia

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“…None of the patients developed any complications. 9 Embolization of upper extremity PSA using this technique has also been reported. 10,11 In addition, Holder et al reported a case of carotid artery PSA treated successfully with percutaneous thrombin injection combined with transient balloon occlusion of the common carotid artery for 10 sec.…”

Section: Discussionmentioning

confidence: 94%

“…Combined use of parent artery balloon occlusion and embolic agent administration of PSAs has been reported previously. [5][6][7][8][9][10][11][12][13] Samal et al successfully treated 4 cases of IFAP with percutaneous thrombin injection with balloon protection without any complications or recurrence. Reasons not suitable for USG-guided compression therapy (UGCT) included severe vascular disease, ongoing anticoagulation, and large size and tenderness of IFAP.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Thrombin Injection with Balloon Protection for a Large Iatrogenic Femoral Artery Pseudoaneurysm: A Case Report with Review of Literature

Patel

Tripathy

Debbarma

et al. 2023

AML

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Iatrogenic femoral artery pseudoaneurysms (IFAPs) are not uncommon due to the increase in various minimally-invasive endovascular procedures. Percutaneous thrombin injection is an established technique for large pseudoaneurysms. When ultrasound-guided compression of an aneurysmal neck is not feasible, percutaneous thrombin injection can be combined with endovascular balloon occlusion to prevent leakage of thrombin into the parent artery. We describe a large IFAP following the removal of the femoral dialysis catheter after an inadvertent arterial puncture, which was managed with percutaneous ultrasound-guided (USG) thrombin injection with simultaneous balloon occlusion at the level of the aneurysmal neck without any complications. Follow-up imaging showed thrombosed IFAP without any recurrence.

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“…[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. [127] Then how do we decide between UGTI and tissue glue?…”

Section: Pseudoaneurysm Therapymentioning

confidence: 99%

Thrombin and Thrombin‐Incorporated Biomaterials for Disease Treatments

Zhang,

Duan,

et al. 2023

Adv Healthcare Materials

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Thrombin, a coagulation‐inducing protease, has long been used in the hemostatic field. During the past decades, many other therapeutic uses of thrombin have been developed. For instance, burn treatment, pseudoaneurysm therapy, wound management, and tumor vascular infarction (or tumor vasculature blockade therapy) have all utilized the unique and powerful function of thrombin. Based on their therapeutic effects, many thrombin‐associated products have been certificated by the Food and Drug Administration, including bovine thrombin, human thrombin, recombinant thrombin, fibrin glue, etc. Besides, several thrombin‐based drugs are currently undergoing clinical trials. In this article, we summarize the therapeutic uses of thrombin (from the initial hemostasis to the latest cancer therapy), the commercially available drugs associated with thrombin, and the pros and cons of thrombin‐based therapeutics (e.g., adverse immune responses related to bovine thrombin, thromboinflammation, and vasculogenic “rebounds”). Further, we discuss the current challenges and possible future research directions of thrombin‐incorporated biomaterials and therapies. It is hoped that this review may provide a valuable reference for researchers in this field and help them to design safer and more effective thrombin‐based drugs for fighting against various intractable diseases.This article is protected by copyright. All rights reserved

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Effective treatment of iatrogenic femoral pseudoaneurysms by combined endovascular balloon inflation and percutaneous thrombin injection

Cited by 5 publications

References 21 publications

Incidence, clinical course, and risk factors in the development of femoral pseudoaneurysm after atrial fibrillation ablation

Incidence, clinical course, and risk factors in the development of femoral pseudoaneurysm after atrial fibrillation ablation

Percutaneous Thrombin Injection with Balloon Protection for a Large Iatrogenic Femoral Artery Pseudoaneurysm: A Case Report with Review of Literature

Thrombin and Thrombin‐Incorporated Biomaterials for Disease Treatments

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