Postcatheterization Pseudoaneurysm: Results of US-guided Percutaneous Thrombin Injection in 240 Patients

Krueger, Karsten; Zaehringer, Markus; Strohe, David; Stuetzer, Hartmut; Boecker, Julia; Lackner, K.

doi:10.1148/radiol.2363040736

Cited by 156 publications

(143 citation statements)

References 39 publications

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“…The mean size of pseudoaneurysms in the current study was similar to previous reports of a pseudoaneurysm size of 3-3.5 cm (2). However, the volume was much larger than in one previous report (1). Compression can be attempted if small pseudoaneurysms do not thrombose spontaneously (2).…”

Section: Discussionmentioning

confidence: 92%

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Gürel¹,

Gür²,

Özkan³

et al. 2011

Diagn Interv Radiol

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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,...

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Section: Discussionmentioning

confidence: 92%

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Gürel¹,

Gür²,

Özkan³

et al. 2011

Diagn Interv Radiol

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“…Treatment success rates are lower with multilobulated PAs and there it is necessary to puncture the PA repeatedly 9 . The anatomical complexity and size of the PAs in the T+F group may have contributed to the poor results.…”

Section: Discussionmentioning

confidence: 99%

“…The anatomical complexity and size of the PAs in the T+F group may have contributed to the poor results. Additionally, injecting larger volumes of thrombin leads to increased complications, such as leakage into the systemic circulation and distal embolization 9,15 .…”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

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

Pinto

Bastianetto

2013

J. vasc. bras.

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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.

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Comparison of ultrasound guidance with the traditional palpation and fluoroscopy method for the common femoral artery puncture

Gedikoglu

Oğuzkurt

Gür

et al. 2013

Cathet Cardio Intervent

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Postcatheterization Pseudoaneurysm: Results of US-guided Percutaneous Thrombin Injection in 240 Patients

Abstract: US-guided percutaneous thrombin injection enables successful, safe management of postcatheterization pseudoaneurysms.

Cited by 156 publications

References 39 publications

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

Ultrasonography guided percutaneous thrombin injection of postcatheterization pseudoaneurysms

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

Comparison of ultrasound guidance with the traditional palpation and fluoroscopy method for the common femoral artery puncture

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