Treatment of iatrogenic femoral artery false aneurysms with ultrasound‐guided thrombin injection

Abstract

The aim of this paper is to review our results of treating iatrogenic pseudoaneurysms of the femoral artery with ultrasound-guided thrombin injection. A retrospective review was carried out of all patients referred for this procedure over a 1-year period from December 1999 to December 2000. Forty-five patients were referred and, of these, 44 were eligible for this treatment, with 300-2500 units of thrombin being injected directly into the false aneurysms under ultrasound guidance. The procedure was well tolerated with no patients requiring sedation or analgesia. There was a primary success rate of 95%, although in four of the patients, there was recurrence on repeat ultrasound performed 2-5 days post-procedure and a second injection of thrombin was required for permanent thrombosis to be achieved. No complications relating to the procedure occurred. Our results confirm increasing evidence in the published research that thrombin injection of femoral artery false aneurysms is a safe and effective treatment.

Prospective Randomized Study Comparing Ultrasound-Guided Thrombin Injection to Compression in the Treatment of Femoral Pseudoaneurysms

“…This method is now widely used, 1,4,17-33 with a primary success rate ranging from 94% to 100%. 1,4,21,24,27,30,33 In complex cases with multilobated pseudoaneurysms, Ramsay and Marshall 27 observed a lower success rate of 61%. Unresponsiveness to thrombin may be due to vascular injury, so those pseudoaneurysms should probably be repaired surgically.…”

“…Kang et al 11 modified the technique, which proved successful in 20 of 21 patients in his initial 1998 study. This method is now widely used, 1,4,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] with a primary success rate ranging from 94% to 100%. 1,4,21,24,27,30,33 In complex cases with multilobated pseudoaneurysms, Ramsay and Marshall 27 observed a lower success rate of 61%.…”

Fatal Complication after Thrombin Injection for Post-Catheterization Femoral Pseudoaneurysm

“…The injection of thrombin is generally well tolerated by patients. Complete obliteration of the pseudoaneurysm is usually achieved within 15-20 seconds [12][13][14][15]. Ramsay et al observed a lower success rate in multilobated FAP [14].…”

“…Complete obliteration of the pseudoaneurysm is usually achieved within 15-20 seconds [12][13][14][15]. Ramsay et al observed a lower success rate in multilobated FAP [14]. Sheiman et al proposed surgical repair in patients who did not respond to treatment with thrombin [16].…”

Iatrogenic Femoral Aneurysms

“…If unsuccessful, there is a variety of endovascular techniques, safer and simpler than open repair, such as ultrasound‐guided thrombin injection, 2 endovascular coil insertion 3 and/or stent insertions, 4 which might remove the need for majority of open reconstructions.…”