Femoral Pseudoaneurysms: Management with Percutaneous Thrombin Injections—Success Rates and Effects on Systemic Coagulation

Krüger, Karsten; Zähringer, M.; Söhngen, Franz-Dietmar; Goßmann, Axel; Schulte, Oliver; Feldmann, Christoph; Strohe, David; Lackner, K.

doi:10.1148/radiol.2262012107

Cited by 101 publications

(81 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, if small residual perfusion existed in the neck after the use of one kit of thrombin (1000 IU), the injection was stopped, and perfusion was examined after two hours of bed rest (i.e., the "wait-andsee" approach). Most patients with residual blood flow in the neck experience spontaneous thrombosis (1,8). However, perfusion persisted after two hours of bed rest in all seven patients whose pseudoaneurysm necks failed to thrombose after the first injection.…”

Section: Discussionmentioning

confidence: 96%

“…The addition of sufficient amounts of thrombin to anticoagulated blood will reliably induce thrombosis because the final pathway of blood coagulation is the generation of thrombin (7). Unlike compression repair, anticoagulation does not affect the success of thrombin injection (2,8). The thrombin injection procedures are extremely quick compared with compression repair (6).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Gürel¹,

Gür²,

Özkan³

et al. 2011

Diagn Interv Radiol

View full text Add to dashboard Cite

Femoral 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).Open surgical repair was the gold standard for iatrogenic pseudoaneurysms till the development of percutaneous therapeutic options. One prominent disadvantage of the surgical repair of pseudoaneurysms is the remarkably high complication rate. Ultrasonography-guided (US-guided) compression repair is relatively safe and effective, but it has considerable limitations. Specifically, the duration of compression is lengthy, the procedure is painful and may require conscious sedation, and the success rate is approximately 75%. The US-guided injection of thrombin has emerged as an alternative to US-guided compression repair with success rates of 91% to 100%. The complication rate is approximately 2% (2, 4). The USguided injection of thrombin has become the first-line treatment for pseudoaneurysms, and it is increasingly popular for the treatment of iatrogenic pseudoaneurysms in many institutions. This study reports our experience with the use of US-guided percutaneous thrombin injection for the treatment of iatrogenic femoral artery and brachial artery pseudoaneurysms. Materials and methodsAll of the procedures on humans were performed in accordance with the ethical standards of the World Medical Association. Written consent was obtained from all patients following instructions on the nature and risks of the intervention. In this retrospective study, 55 consecutive patients with a mean age of 60.1±12.7 years (26 men, aged 35 to 79 years [mean, 58.2 years]; 29 women, aged 32 to 85 years [mean, 61.9 years]) who were treated from December 2006 to June 2010 and who received a diagnosis of pseudoaneurysm of the femoral or brachial artery with the guidance of color Doppler US (CDUS) were included in this analysis. Patients with any of the following criteria were excluded from this study: a rapid expansion of the pseudoaneurysm, especially in unstable patients, distal ischemia due to femoral artery compression, infection of the pseudoaneurysm, neuropathy, overlying soft tissue or skin ischemia, or impending compartment syndrome. No patients were excluded for these reasons during the study period. The morphology INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE US-guided percutaneous thrombin injection of postcatheterization pseudoaneurysmsKamil Gürel, Serkan Gür,...

show abstract

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Gürel¹,

Gür²,

Özkan³

et al. 2011

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…Success ranges from 91% to 100% in large series. 32,[37][38][39][40][41][42][43][44][45][46][47][48][49] More than 45 individual series have been published on the safety and efficacy of this therapy. The cumulative overall success rate in 1329 PSA injections was 97%.…”

Section: Ultrasound-guided Compressionmentioning

confidence: 99%

Contemporary Management of Postcatheterization Pseudoaneurysms

et al. 2007

View full text Add to dashboard Cite

“…The first choice treatment for pseudoaneurysms is now percutaneous thrombin injection and surgery is reserved for cases in which this fails or for more complicated pseudoaneurysms [9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

“…The formula to estimate volume calculated as length × width × height × 0.523 is used for organs such as the thyroid and prostate and for collections with an irregular elliptical shape. We chose this formula on the basis that other authors have used it previously to estimate the volume of femoral pseudoaneurysms 9,10 .…”

mentioning

confidence: 99%

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

Pinto

Bastianetto

2013

J. vasc. bras.

View full text Add to dashboard Cite

Introduction: Femoral pseudoaneurysms are a complication that occurs in connection with up to 8% of percutaneous procedures. Of the available treatments, ultrasound guided thrombin injection has a high success rate and is welltolerated by patients. The combination of thrombin and fibrinogen known as fibrin sealant forms a stable clot and can be used to treat pseudoaneurysms, particularly those with complex anatomy and larger size. Objective: To compare the results of treating femoral pseudoaneurysm in two ways: Group T was treated with thrombin alone and Group T+F was treated with fibrin sealant (thrombin+fibrinogen). Methods: A retrospective analysis was conducted of femoral pseudoaneurysm cases treated between January 2005 and December 2012. Results: Twenty-eight patients were treated, 21 with thrombin alone and seven with fibrin sealant. All patients in group T were treated successfully, but only four patients in group T+F were treated successfully (57.1% success rate in Group T+F, p<0.01). The three cases of failure in group T+F needed surgery and in one of these cases the complication was embolization to the femoral bifurcation. The pseudoaneurysms that were treated with fibrin sealant were larger (25 cm 3 in Group T and 57.7 cm 3 in Group T+F, p=0.02) and required larger volumes of thrombin (0.5 mL in Group T and 1.0 mL in Group T+F, p<0.01). There was one complication in Group T and two complications in Group T+F (p<0.01). Conclusions: Irrespective of the small number of cases reviewed, treatment with thrombin alone was superior to treating with fibrin sealant, since it caused few complications and was more effective at correcting pseudoaneurysms.

show abstract

Femoral Pseudoaneurysms: Management with Percutaneous Thrombin Injections—Success Rates and Effects on Systemic Coagulation

Abstract: US-guided percutaneous injection of thrombin is successful and safe in the management of femoral pseudoaneurysms. The increase of thrombin-antithrombin III complex indicates the possibility of thrombin passage into the arterial circulation.

Cited by 101 publications

References 36 publications

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Contemporary Management of Postcatheterization Pseudoaneurysms

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

Contact Info

Product

Resources

About